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Acral Vitiligo and Lichen Sclerosus - Association or a Distinct Pattern?: A Clinical and Histopathological Review of 15 Cases.

Attili VR, Attili SK - Indian J Dermatol (2015 Sep-Oct)

Bottom Line: Lichen sclerosus (LS) in a milder expression, results in oral and genital vitiligoid depigmentation without textural changes and thus needs to be differentiated from AFV.One hundred and sixteen cases had associated oral/genital lesions.Among these, 15 patients demonstrated typical clinical as well as histological features of LS.

View Article: PubMed Central - PubMed

Affiliation: Visakha Institute of Skin and Allergy, Visakhapatnam, Andhra Pradesh, India.

ABSTRACT

Background: Acral or acrofacial vitiligo (AFV) with bilateral lesions over the extremities and face is considered as a transitional form that may progress to generalized vitiligo. Oral and genital mucosal lesions are often integral to this pattern. Lichen sclerosus (LS) in a milder expression, results in oral and genital vitiligoid depigmentation without textural changes and thus needs to be differentiated from AFV.

Materials and methods: We reviewed 217 cases of AFV recorded over a period of 12 years.

Results: One hundred and sixteen cases had associated oral/genital lesions. Among these, 15 patients demonstrated typical clinical as well as histological features of LS.

Discussion: Coexistence of typical LS essentially among oral and genital lesions of acral vitiligo suggests that acral vitiligo might be a distinct sub-group of NSV. Since both the diseases have an autoimmune basis, the co-existence may be explained by epitope spreading, as a result of interface dermatitis seen in vitiligo. In addition, the possibility of a common genetic predisposition needs to be explored.

No MeSH data available.


Related in: MedlinePlus

AV (a-c) with a guttate lesion over the hand showing hyperkeratosis, thin epidermis and extensive dermal sclerosis as in resolved LS (d). H and E, (×20)
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Figure 5: AV (a-c) with a guttate lesion over the hand showing hyperkeratosis, thin epidermis and extensive dermal sclerosis as in resolved LS (d). H and E, (×20)

Mentions: The age of patients in this group of 15 varied from 10 to 60 years and duration of disease from 3 months to several decades. Only three were females of which two had LS of lips [Figure 4] and one had guttate LS among acral lesions of vitiligo [Figure 5]. Among 12 males, 9 had phimosis associated with depigmentation [Figure 6] and circumcision was performed. The remaining three had mild textural changes without phimosis [Figure 7]. Nonetheless, all the 12 had histological features of LS. All the LS lesions among males as well as females were asymptomatic, noted on routine examination. In addition to the typically larger macular AV lesions, punctate and guttate lesions were often observed and in two instances, these were palpably thick with histological features of LS on biopsy [Figures 5 and 8]. One male patient who had AV for many years, developed features of LS in all the three areas (acral, oral and genital); and, further on developed squamous cell carcinoma (SCC) over the lower lip [Figure 8].


Acral Vitiligo and Lichen Sclerosus - Association or a Distinct Pattern?: A Clinical and Histopathological Review of 15 Cases.

Attili VR, Attili SK - Indian J Dermatol (2015 Sep-Oct)

AV (a-c) with a guttate lesion over the hand showing hyperkeratosis, thin epidermis and extensive dermal sclerosis as in resolved LS (d). H and E, (×20)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4601436&req=5

Figure 5: AV (a-c) with a guttate lesion over the hand showing hyperkeratosis, thin epidermis and extensive dermal sclerosis as in resolved LS (d). H and E, (×20)
Mentions: The age of patients in this group of 15 varied from 10 to 60 years and duration of disease from 3 months to several decades. Only three were females of which two had LS of lips [Figure 4] and one had guttate LS among acral lesions of vitiligo [Figure 5]. Among 12 males, 9 had phimosis associated with depigmentation [Figure 6] and circumcision was performed. The remaining three had mild textural changes without phimosis [Figure 7]. Nonetheless, all the 12 had histological features of LS. All the LS lesions among males as well as females were asymptomatic, noted on routine examination. In addition to the typically larger macular AV lesions, punctate and guttate lesions were often observed and in two instances, these were palpably thick with histological features of LS on biopsy [Figures 5 and 8]. One male patient who had AV for many years, developed features of LS in all the three areas (acral, oral and genital); and, further on developed squamous cell carcinoma (SCC) over the lower lip [Figure 8].

Bottom Line: Lichen sclerosus (LS) in a milder expression, results in oral and genital vitiligoid depigmentation without textural changes and thus needs to be differentiated from AFV.One hundred and sixteen cases had associated oral/genital lesions.Among these, 15 patients demonstrated typical clinical as well as histological features of LS.

View Article: PubMed Central - PubMed

Affiliation: Visakha Institute of Skin and Allergy, Visakhapatnam, Andhra Pradesh, India.

ABSTRACT

Background: Acral or acrofacial vitiligo (AFV) with bilateral lesions over the extremities and face is considered as a transitional form that may progress to generalized vitiligo. Oral and genital mucosal lesions are often integral to this pattern. Lichen sclerosus (LS) in a milder expression, results in oral and genital vitiligoid depigmentation without textural changes and thus needs to be differentiated from AFV.

Materials and methods: We reviewed 217 cases of AFV recorded over a period of 12 years.

Results: One hundred and sixteen cases had associated oral/genital lesions. Among these, 15 patients demonstrated typical clinical as well as histological features of LS.

Discussion: Coexistence of typical LS essentially among oral and genital lesions of acral vitiligo suggests that acral vitiligo might be a distinct sub-group of NSV. Since both the diseases have an autoimmune basis, the co-existence may be explained by epitope spreading, as a result of interface dermatitis seen in vitiligo. In addition, the possibility of a common genetic predisposition needs to be explored.

No MeSH data available.


Related in: MedlinePlus