Vitiligo
analysis of grafting versus curettage alone, using melanocyte morphology and reverse transcriptase polymerase chain reaction for tyrosinase mRNA
Keywords:
Vitiligo, Transplants, Tyrosinase, Polymerase chain reaction, PathologyAbstract
CONTEXT AND OBJECTIVE: Recent studies have indicated that vitiligo areas contain inactive or dormant melanocytes. Melanin synthesis is related to tyrosinase presence and indicative of active metabolic state. The aim of this study was to compare repigmentation, epidermal melanocyte distribution and tyrosinase mRNA detection through reverse transcriptase polymerase chain reaction, in tissue samples of vitiligo, before and after curettage, with or without subsequent autologous skin graft using a new method. DESIGN AND SETTING: Prospective, in the Department of Dermatology, Faculdade de Medicina do ABC, Santo André. METHODS: Two vitiligo areas were curetted. One subsequently received grafted normal sacral autologous skin, whereas the other had no further treatment. The curetted areas were examined after 30 days, to evaluate the degree of repigmentation. The melanocyte percentages and tyrosinase mRNA presence in normal skin and vitiligo areas, before and after curettage and grafting, were compared. RESULTS: Complete repigmentation was seen in all grafted areas, whereas non-grafted curetted vitiligo presented partial repigmentation. The me- lanocyte percentage in grafted areas was greater than in non-treated vitiligo skin (p = 0.01) and skin with curettage alone (p = 0.015). Tyrosinase mRNA was negative in 93.75% of non treated vitiligo areas. After treatment (curettage alone or curettage and grafting), all lesions became positive for tyrosinase mRNA. CONCLUSION: Metabolically inactive or dormant melanocytes are probably present within vitiligo areas, and may be activated by exogenous or endogenous stimuli.
Downloads
References
Pawelek JM. After dopachrome? Pigment Cell Res. 1991;4(2):53-62.
Breathnach AS, Bor S, Wyllie LM. Electron microscopy of peripheral nerve terminals and marginal melanocytes in vitiligo. J Invest Dermatol. 1966;47(2):125-40.
Xie Z, Chen D, Jiao D, Bystryn JC. Vitiligo antibodies are not directed to tyrosinase. Arch. Dermatol. 1999;135(4):417-22.
Okamoto T, Irie RF, Fujii S, et al. Anti-tyrosinase-related protein-2 immune response in vitiligo patients and melanoma patients receiving active-specific immunotherapy. J Invest Dermatol. 1998;111(6):1034-9
Bartosik J, Wulf HC, Kobayasi T. Melanin and melanosome complexes in long standing stable vitiligo - an ultrastructural study. Eur J Dermat. 1998;8(2):95-7.
Galadari E, Mehregan AH, Hashimoto K. Ultrastructural study of vitiligo. Int J Dermatol. 1993;32(4):269-71.
Le Poole IC, van den Wijngaard RM, Westerhof W, Dutrieux RP, Das PK. Presence or absence of melanocytes in vitiligo lesions: an immunohistochemical investigation. J Invest Dermatol. 1993;100(6):816-22.
Hirobe T. Structure and function of melanocytes: microscopic morphology and cell biology of mouse melanocytes in the epider- mis and hair follicle. Histol Histopathol. 1995;10(1):223-37.
Blaheta HJ, Schittek B, Breuninger H, et al. Detection of melanoma micrometastasis in sentinel nodes by reverse transcrip- tion-polymerase chain reaction correlates with tumor thickness and is predictive of micrometastatic disease in the lymph node basin. Am J Surg Pathol. 1999;23(7):822-8.
Ortonne JP, MacDonald DM, Micoud A, Thivolet J. PUVA- induced repigmentation of vitiligo: a histochemical (split-DOPA) and ltrastructural study. British J Dermatol. 1979;101(1):1-12.
Chakrabarti SG, Grimes PE, Minus HR, Kenney JA Jr, Pradhan TK. Determination of trimethylpsoralen in blood, ophthalmic fluids, and skin. J Invest Dermatol. 1982;79(6):374-7.
Urbanek RW. Tar vitiligo therapy. J Am Acad Dermatol.1983;8(5):755.
Camacho F, Mazuecos J. Treatment of vitiligo with oral and topical phenylalanine: 6 years of experience. Arch Dermatol. 1999;135(2):216-7.
Parsad D, Saini R, Verma N. Combination of PUVAsol and topi- cal calcipotriol in vitiligo. Dermatology. 1998;197(2):167-70.
Schallreuter KU, Moore J, Wood JM, et al. In vivo and in vitro evidence for hydrogen peroxide (H2O2) accumulation in the epidermis of patients with vitiligo and its successful removal by UVB-activated pseudocatalase. J Investig Dermatol Symp Proc. 1999;4(1):91-6.
Koga M. Vitiligo: a new classification and therapy. Br J Derma- tol. 1977;97(3):255-61.
Vasistha LK, Singh G. Vitiligo and intralesional steroids. Indian J Med Res. 1979;69:308-11.
Gokhale BB, Mehta LN. Histopathology of vitiliginous skin. Int J Dermatol. 1983;22(8):477-80.
Tsuji T, Hamada T. Topically administered fluorouracil in vitiligo. Arch Dermatol. 1983;119(9):722-7.
Mosher DB, Parrish JA, Fitzpatrick TB. Monobenzylether of hydroquinone. A retrospective study of treatment of 18 vitiligo patients and a review of the literature. Br J Dermatol. 1977;97(6):669-79.
Orentreich N. Autografts in alopecias and other selected der- matological conditions. Ann N Y Acad Sci. 1959;83:463-79.
Bonafe JL, Lassere J, Chavoin JP, Baro JP, Jeune R. Pigmentation induced in vitiligo by normal skin grafts and PUVA stimulation: a preliminary study. Dermatologica. 1983;166(3):113-6.
Malakar S, Dhar S. Repigmentation of vitiligo patches by trans- plantation of hair follicles. Int J Dermatol. 1999;38(3):237-38.
Andreassi L, Pianigiani E, Andreassi A, Taddeucci P, Biagioli M. A new model of epidermal culture for the surgical treatment of vitiligo. Int J Dermatol. 1998;37(8):595-8.
Njoo MD, Das PK, Bos JD, Westerhof W. Association of the Kobner phenomenon with disease activity and therapeutic responsiveness in vitiligo vulgaris. Arch Dermatol.1999;135(4):407-13.
Brossart P, Keilholz U, Willhauck M, Scheibenbogen C, Mohler T, Hunstein W. Hematogenous spread of malignant melanoma cells in different stages of disease. J Invest Dermatol. 1993;101(6):887-9.
Naeyaert JM, Eller M, Gordon PR, Park HY, Gilchrest BA. Pigment content of cultured human melanocytes does not correlate with tyrosinase message level. Br J Dermatol. 1991;125(4):297-303.
Abdel-Malek Z, Swope VB, Suzuki I, et al. Mitogenic and melanogenic stimulation of normal human melanocytes by melanotropic peptides. Proc Natl Acad Sci U S A. 1995;92(5):1789-93.
Archambault M, Yaar M, Gilchrest BA. Keratinocytes and fibroblasts in a human skin equivalent model enhance melano- cyte survival and melanin synthesis after ultraviolet irradiation. J Invest Dermatol. 1995;104(5):859-67.
Horikawa T, Norris DA, Yohn JJ, Zekman T, Travers JB, Morelli JG. Melanocyte mitogens induce both melanocyte chemokinesis and chemotaxis. J Invest Dermatol. 1995;104(2):256-9.
