Parsad Davinder, Pandhi Roma, Dogra Sunil, Kumar Bhushan
Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Am Acad Dermatol. 2004 Jan;50(1):63-7. doi: 10.1016/s0190-9622(03)00786-2.
Because the etiopathogenesis of depigmentation in vitiligo is still obscure, the source of pigmentation in the repigmentating lesion and its stability is also not fully known. Several authors have shown on histopathology and electron microscopy predominantly a perifollicular spread of pigment. The aim of this study was to clinically assess the types of repigmentation patterns obtained with different treatment modalities and their correlation with speed and stability of repigmentation. A total of 125 patients with vitiligo on treatment with psoralens (topical and systemic psoralen-UVA [PUVA]), steroids (both topical and systemic), and topical calcipotriol, alone or in combination were enrolled. Representative lesions of vitiligo excluding mucosal sites were selected in each patient and photographed at baseline. Repigmentation was assessed and labeled as marginal, perifollicular, diffuse, or combined. The preselected patches were evaluated at 3 months to assess the speed of repigmentation. Retention of pigment (stability) was noted at 6 months, after the stoppage of active treatment. Of the 352 vitiligo patches selected, 194 (55%) showed predominant perifollicular repigmentation, of which a majority (127; 65.5%) were on systemic PUVA and 35 (18%) were on topical PUVA. Diffuse pigmentation was observed in 98 patches (27.8%) of which 66 (67.3%) were on topical steroids. Marginal repigmentation was seen in 15, of which the majority (80%) were on systemic PUVA and topical calcipotriol. Of the 28 total lesions showing marked repigmentation at 3 months, 22 lesions pigmented in a diffuse manner, 2 in a perifollicular pattern, and 4 showed a combined type of repigmentation. On follow-up, marginal repigmentation was the most stable (93.3%), followed by perifollicular (91.7%) and combined type (84.4%). Diffuse repigmentation was the least stable (78.5%). Psoralens predominantly exhibit a perifollicular pattern of repigmentation and steroids (topical/systemic), a diffuse type. The speed of repigmentation is much faster when initial repigmentation is of the diffuse type as compared with follicular repigmentation. The marginal and perifollicular repigmentation is more stable than the diffuse type of repigmentation.
由于白癜风色素脱失的发病机制仍不清楚，复色皮损中色素沉着的来源及其稳定性也尚未完全明确。几位作者通过组织病理学和电子显微镜观察发现，色素主要呈毛囊周围扩散。本研究的目的是临床评估不同治疗方式所获得的复色模式类型及其与复色速度和稳定性的相关性。共有125例接受补骨脂素（局部和全身补骨脂素-紫外线A[PUVA]）、类固醇（局部和全身）以及局部卡泊三醇单独或联合治疗的白癜风患者入组。在每位患者身上选择白癜风的代表性皮损（不包括黏膜部位），并在基线时拍照。评估复色情况并标记为边缘性、毛囊周围性、弥漫性或混合型。在3个月时对预先选定的皮损进行评估，以评估复色速度。在停止积极治疗后的6个月时记录色素沉着的保留情况（稳定性）。在所选的352个白癜风皮损中，194个（55%）主要表现为毛囊周围复色，其中大多数（127个；65.5%）接受全身PUVA治疗，35个（18%）接受局部PUVA治疗。98个皮损（27.8%）观察到弥漫性色素沉着，其中66个（67.3%）接受局部类固醇治疗。15个出现边缘性复色，其中大多数（80%）接受全身PUVA和局部卡泊三醇治疗。在3个月时显示明显复色的28个皮损中，22个以弥漫方式色素沉着，2个呈毛囊周围模式，4个表现为混合型复色。随访时，边缘性复色最稳定（93.3%），其次是毛囊周围性（91.7%）和混合型（84.4%）。弥漫性复色最不稳定（78.5%）。补骨脂素主要表现为毛囊周围复色模式，而类固醇（局部/全身）表现为弥漫型。与毛囊性复色相比，初始复色为弥漫型时复色速度要快得多。边缘性和毛囊周围性复色比弥漫型复色更稳定。
