Ultrastructural studies in stable vitiligo

Vitiligo is a disease of melanocytes characterized by achromic lesions in the skin, affecting the epidermis and the pilosebaceous follicle. We performed an ultrastructural analysis of biopsy specimens from four patients with noninflammatory, stable vitiligo of long duration (three had generalized vitiligo and one had segmental vitiligo). The samples were taken from the oldest achromic lesions, and the biopsy sites were far from normal skin. In all cases we noted alterations in keratinocytes, Langerhans cells, and melanocytes. We also found lymphocytes in the epidermis, and these cells and macrophages were noted in the dermis. The basal membrane disappeared at some points, and sometimes it was possible to see dermal cells with processes that engulfed either granular material or vesicles of epidermal origin in such areas. Our studies suggest that even in stable vitiligo, achromia implies intense cytologic activity, probably involving cell-mediated cytotoxicity, and ultrastructural findings resemble those of a lichenoid reaction.