Dicembre Vol.3 N° 3 - 2007 - Salute per tutti

G. Menchini, C. ComacchiM ethodsO b s e rvations data on the clinical andmorphological status of VVB patches, gathere din ten years of activity in the field, led us to discoverthe pathognomonical signs of the disea s e ’s improvement, worsening and stationarys t a t u s .Morphological features of a worsening VVBpatches are mainly two: pinpoint depigmentationand edge delamination.Pinpoint depigmentations develop in closep roximity of the mother patch or on healthyskin, in the shape of small ipochro m i c /a c h rom ic dots measuring approximately 1-2m i l l i m e t res; in absence of therapy this dotsdevelop in time centrifugally and they merg eoriginating a new patch or expanding the existentmother patch. This sign is found mostc o m m o n l y, but not exclusively, on limbs andtorso (Figures 1, 2).a) b)Figure 3. Edge delamination of a patch in male patient, 43 years old, with worsening VVB.It is clearly noticeable how the patch edge, particularly on the left border, gradually fadesfrom initial white to natural skin colour; here it is shown in normal lightning (a) and underWood’s lamp (b).Figure 1. Pinpoint depigmentation of patch edgeson medial wrist surface in a young female patientwith worsening VVB.Figure 2. Pinpoint depigmentation in male subject,33 years old, with worsening VVB.Pinpoint depigmentation a few millimetres away fromthe main patch edge appeared in a few days anddeveloped centrifugally into the patch, as shown alsoby pronounced delaminated edge areas, in the upperleft side.Another sign of the pro g ress of the disease isedge delamination that is the whitening of pigmentationaround the edge of a VVB patch thatin time will expand and include the whiteneda rea.This phenomenon confers to the patch a distinctiveappearance; in common patches onlytwo kinds of pigmentation appear: thewhitened ipochromic/achromic area and thedarker surrounding skin, while in delaminatedpatches a few strips of intermediate pigmentationare noticeable between the two previouslymentioned tones.Edge delamination is supposedly due to thegradual disappearing of healthy pigmentationaround the patch edges, indicating an increasedVVB activity (Figure 3).Edge lamination is the phenomenon that someresearchers in the past identified as “trichromic”or “quadrichromic” vitiligo, we assign to it acompletely different value (8-10).The main sign of repigmentation is commonlyknown as “follicle repigmentation”, that is thedevelopment of small healthy coloured dotsmainly localized in follicles; in time the dotsexpand and restore the whole patch to the naturalskin tone (Figures 4, 5).Stationary patches have defined edges and noneof the previous phenomena are noticeablearound them (Figure 6).Evaluating this signs as indicators of the disease36Journal of Plastic Dermatology 2007; 3, 3