Focal gaps in the basement membrane of involved and uninvolved skin of vitiligo: are they normal?

Trends in Regenerative Medicine: Repigmentation in Vitiligo Through Melanocyte Stem Cell Mobilization

Vitiligo is the most frequent human pigmentary disorder, characterized by progressive autoimmune destruction of mature epidermal melanocytes. Of the current treatments offering partial and temporary relief, ultraviolet (UV) light is the most effective, coordinating an intricate network of keratinocyte and melanocyte factors that control numerous cellular and molecular signaling pathways. This UV-activated process is a classic example of regenerative medicine, inducing functional melanocyte stem cell populations in the hair follicle to divide, migrate, and differentiate into mature melanocytes that regenerate the epidermis through a complex process involving melanocytes and other cell lineages in the skin. Using an in-depth correlative analysis of multiple experimental and clinical data sets, we generated a modern molecular research platform that can be used as a working model for further research of vitiligo repigmentation. Our analysis emphasizes the active participation of defined molecular pathways that regulate the balance between stemness and differentiation states of melanocytes and keratinocytes: p53 and its downstream effectors controlling melanogenesis; Wnt/β-catenin with proliferative, migratory, and differentiation roles in different pigmentation systems; integrins, cadherins, tetraspanins, and metalloproteinases, with promigratory effects on melanocytes; TGF-β and its effector PAX3, which control differentiation. Our long-term goal is to design pharmacological compounds that can specifically activate melanocyte precursors in the hair follicle in order to obtain faster, better, and durable repigmentation.

Possible patterns of epidermal melanocyte disappearance in nonsegmental vitiligo: a clinicopathological study

BACKGROUND

The depigmentation of vitiligo results in a progressive and chronic melanocyte loss with rare melanocytes occasionally remaining in the epidermis or the hair follicle reservoirs. Destruction by immune infiltrates in close contact with melanocytes within microvesicles and/or detachment of melanocytes followed by their transepidermal elimination should be regarded as possible mechanisms of chronic loss of pigment cells.

OBJECTIVES

To assess the frequency of these two histological findings and to establish a direct correlation with clinical features.

METHODS

This was a prospective observational study that took place over 1 year. Each patient received a standardized evaluation that included daylight and Wood's lamp examinations, pictures, biopsies performed on the marginal area, and histological and immunohistological studies. A second examination to assess the activity of the lesions was performed 1 year after inclusion in the study. Clinical changes associated with microvesicles were compared with those associated with detached melanocytes from the basal layer.

RESULTS

This study included 50 patients. The histological findings were classified as inflammatory with isolated microvesicles (29 cases), noninflammatory with only detached melanocytes from the basal layer (12 cases) and a combination of coexisting microvesicles and detached melanocytes (six cases). Correlations were obtained between the histological findings and clinical features (aspect and activity of the lesions) and E-cadherin expression.

CONCLUSIONS

Our data suggest the existence of two patterns of melanocyte disappearance in nonsegmental vitiligo.

Vitiligo: a review of some facts lesser known about depigmentation

Vitiligo is a disorder that causes the destruction of melanocytes. It has three important factors underlying this destruction. The depigmented skin has many aberrant functions such as a muted response to contact allergens, a phenomenon also seen in mice that depigment. The white skin of those with vitiligo does not form non-melanoma skin cancers although the white skin of albinos, which has a similar color as vitiligo, is highly susceptible to skin cancer.

Value of histopathology in vitiligo

BACKGROUND

Histopathologic studies of vitiligo have been rather limited in number, thus the microscopic features of this common disorder are not very well known.

SUBJECTS AND METHODS

Skin specimens from 20 human vitiligo patients and skin specimens from five equine vitiligo patients were studied by light and transmission electron microscopy.

RESULTS AND DISCUSSION

Absence of melanocytes, increased number of Langerhans' cells, epidermal vacuolization, thickening of the basement membrane, T-cell inflammatory infiltrate, and neural alterations were noted in the vitiligo lesions. These results may explain the development of depigmentation, but do not yet fully explain why and how this occurs.

Melanocyte detachment after skin friction in non lesional skin of patients with generalized vitiligo

BACKGROUND

In vitiligo, melanocytes are gradually lost in depigmented macules of the skin. The disappearance of melanocytes has, however, not been clearly observed and consequently the aetiology of the disease (autoimmune, neural, cytotoxic) is still elusive. The starting point of vitiligo macules is frequently determined by local conditions such as wounds and excoriations, but may also follow minor traumas such as pressure or repeated friction. This prominent feature is often neglected.

OBJECTIVES

To clarify the biological consequences of repeated friction on the attachment and survival of melanocytes in non lesional vitiligo skin.

METHODS

Light reproducible skin friction was performed for 4 min on the volar forearm of 18 patients with extensive vitiligo and five controls with normal healthy skin. Biopsies from the test area and control skin were taken at 1, 4, 24 and 48 h following friction. Serial sections were examined with standard light microscopy, transmission electron microscopy, histochemistry and immunohistochemistry (dihydroxyphenylalanine, HMB-45, E-cadherin and an early apoptosis marker, M30 cytoDEATH antibody).

RESULTS

The observation of sections at 1 and 48 h after friction on vitiligo skin and at all time points in controls revealed no changes. In contrast, in vitiligo skin at 4 and 24 h after friction, several melanocytes had undergone detachment and were found in various suprabasal positions, including the stratum spinosum, granular layer, and within and outside the stratum corneum.

CONCLUSIONS

Detachment and transepidermal elimination of melanocytes following minor mechanical trauma in non lesional vitiligo skin is probably the cause of depigmentation occurring in the isomorphic response (Koebner phenomenon). We propose that transepidermal elimination of melanocytes in vitiligo should be regarded as a possible mechanism of chronic loss of pigment cells, perhaps previously damaged by another process.

Recent investigations on vitiligo vulgaris

Vitiligo is a depigmenting disorder of the skin caused by destruction of melanocytes. The depigmented skin has several abnormal functions, including some autonomic nervous functions. The inflammatory response in the depigmented skin is muted. Recent genetic and epidemiologic studies indicate that vitiligo affects men and women equally. The prevalence in the population is about one in 200. Vitiligo seems to be transmitted as a polygenic trait. New data suggest that it is not associated with autoimmune endocrine disorders, but more comprehensive studies are required.