Moellmann G, Klein-Angerer S, Scollay D A, Nordlund J J, Lerner A B
J Invest Dermatol. 1982 Nov;79(5):321-30. doi: 10.1111/1523-1747.ep12500086.
Multiple biopsy specimens from the skin of 28 patients with common vitiligo were examined by light and electron microscopy. The patients were grouped according to the activity of their disease: progressing, stable, repigmenting, and resistant to treatment with psoralen plus sunlight. Three biopsy sites were sampled from each patient: (W) a white spot; (I) the pigmented and white interface; and (P) normally pigmented skin 1-15 cm away from I. Control specimens were obtained from 17 persons without vitiligo. Two microscopic abnormalities were observed in the epidermis of the patients with vitiligo: deposits of extracellular granular material, and foci of vacuolar degeneration of basal and parabasal keratinocytes. The extracellular granular material appeared to be derived from the cytoplasm of vacuolated keratinocytes. The abnormalities were observed in greatest abundance in the normally pigmented skin of patients with rapidly progressing or stable disease. They were absent from repigmenting skin and from the skin of healthy controls. Epidermal infiltrates of mononuclear leukocytes were seen only in the normal pigmented skin of the 2 patients whose vitiligo was resistant to treatment. Our observations indicate that cellular degeneration and the generation of debris in vitiligo are not limited to melanocytes but include keratinocytes and probably whole epidermal melanin units. Our findings also indicate that the fine structure of the epidermis in normal-appearing skin is markedly altered by the disease process in patients with vitiligo.
对28例寻常型白癜风患者皮肤的多个活检标本进行了光镜和电镜检查。根据疾病活动度将患者分组：进展期、稳定期、复色期以及对补骨脂素加日光治疗耐药。从每位患者身上取三个活检部位：(W)白斑处；(I)色素沉着与白色皮肤的交界处；(P)距I点1 - 15厘米的正常色素沉着皮肤。对照标本取自17名无白癜风的人。在白癜风患者的表皮中观察到两种微观异常：细胞外颗粒物质沉积，以及基底和基底旁角质形成细胞的空泡变性灶。细胞外颗粒物质似乎来源于空泡化角质形成细胞的细胞质。在疾病快速进展或稳定的患者的正常色素沉着皮肤中，这些异常最为丰富。在复色皮肤和健康对照者的皮肤中未观察到这些异常。仅在2例白癜风对治疗耐药患者的正常色素沉着皮肤中见到单核白细胞的表皮浸润。我们的观察表明，白癜风中的细胞变性和碎片产生不仅限于黑素细胞，还包括角质形成细胞，可能还包括整个表皮黑素单位。我们的研究结果还表明，白癜风患者外观正常皮肤的表皮精细结构因疾病过程而明显改变。
