Segmental vitiligo usually has an onset early in life and spreads rapidly within the affected area. Among 1,300 patients with vitiligo, 191 patients with segmental vitiligo involving the face were evaluated. In this study, the distribution of segmental vitiligo on the face could be classified into 5 patterns which have distinctive features. This classification of facial segmental vitiligo can provide some indication of the future distribution of early lesions if they have begun to spread.
Female ; Human ; Male ; Vitiligo/pathology ; Vitiligo/classification*

This is an analysis of 174 patients classified as generalized vitiligo by Ortonnes' classification during the period from May till December in 1985. The retults are summarized as follows. There were 89 females(51.l%) and 85 males(48, 9%). 2. The mean age of onset was 24.2 years(male: 23.4, female: 24. 8). 3. The mean age at the first visit was 33 years(male: 32. 2, female: 34, 8) 4. The mean duration of t.he disease was 10. 8 years (male: 10. 3, female: 11. 3). 5. The mean interval between onset and visiting was 9 years(male: 8. 8, female: 10). 6. Mode of onset was unicentric in 90, 2% and multicentric in 9. 8% 7.The most common site of initial involvement was abdomen(15. 0%). 8. The most common precipitating factor was trauma(11%). 9.The most common previous treatment was sunlight irradiation after application of topical oxoralene(33.3%). 10. The most common degree of depigmented lesion was 5~10%.(39.7%). 1l. Family history was present in 12% and thyroid disease was associated in only one case.
Age of Onset ; Classification ; Female ; Humans ; Precipitating Factors ; Sunlight ; Thyroid Diseases ; Vitiligo*

BACKGROUND: Vitiligo is a distressing skin condition in which acquired destruction of melanocytes causes depigmented patches of various shapes & sizes by as yet unclear mechanisms. Its classification is as varied and unresolved as the theories on its pathogenesis, the most plausible of which are autoimmune, neurohumoral and self-destruction theories. OBJECTIVE: Our purpose was to devise a classification scheme which would correlate well with the disease course and prognosis. METHOD: We classified vitiligo into 3 types(symmetric: type 1, segmental; type 2, localized; type 3) based on different proposed pathogenetic mechanisms and analyzed the differences between these types in the clinical manifestations of 502 Korean cases. RESULTS: 1. There were 203 males(40.4% ) and 299 females(59.6%). 2. The most frequent clinical type was the symmetric type(49.8%), followed by the localized type(34.1%) and the segmental type(16.1%). 3, The male-to-female ratio was highest in type 2, but not significantly so. 4. Poliosis and halo nevus were associated in 22.3% and 3.8%, respectiuely. 5. The mean age at the first visit was 32.7 years(male, 29.2 years, female; 27.5 years), and there was a significant difference between the clinical types(type 1; 41.0 years, type 2; 20.5 years, type 3; 26.2 years). 6. The mean age of onset was 25.6 years(male; 23.0 years, female; 27.5 years), and there was a significant difference between the clinical types(type 1; 31.3 years, type 2; 15.7 years, type 3; 22.1 years). 7. A family history of vitiligo was observed in 11.2% of patients, whose sisters were most frequently affected, and there was no significant difference between the clinical types. 8. Associated diseases were seen in 12.1% of the patients, the frequency of which was significantly higher in type 1 vitiligo. 9. Abnormal laboratory findings were found in 14.7% and were significantly more common in type 1 vitiligo. CONCLUSIONS: The 3 types differ significantly in the mean age at the first visit, the mean age of onset, disease association and abnormal laboratory findings. Type 1 develops by autoimmune mechanisms, as shown by the continuous progression and the close association with other diseases and abnormal laboratory findings, Types 2 and 3 have a different disease course, becoming stationary after initial progression, Thus, the 3 clinical types classified by the authors are thought to be useful in predicting the course and prognosis of vitiligo and in determining the appropriate therapy. For a more optimal classification, further study on the pathogenesis of vitiligo seems to be in order.
Age of Onset ; Classification* ; Female ; Humans ; Melanocytes ; Nevus, Halo ; Prognosis ; Siblings ; Skin ; Vitiligo*

BACKGROUND: Vitiligo is an acquired disorder with destruction of melanocytes and is clinically characterized by depigmented patches of skin. The pathogenesis of vitiligo is still unclear, but melanocyte self destruction, neurohumoral factors, autoimmunity and inherent cellular defects have all been proposed as possible etiological factors. OBJECTIVE: The purpose of this study was to find out the differences in expression of HLA antigens among subtypes of vitiligo according to classification, onset and family history and then to disclose the pathogenesis of vitiligo in view of genetic and autoimmunological aspects. METHODS: We investigated HLA-A, B, C, DR in subgroups of 87 vitiligo patients according to type, onset, and family history. Results : 1. There were no HLA antigens with significantly increased frequency in vitiligo patients compared to the control group. 2. There was a significant increase in frequency of HLA-DRl2 in patients of non-segmental vitiligo with a family history ; an increase in frequency of HLA Cw2 in patients without a family history ; and a significant increase in frequency of HLA-DRl2 in all patients of non-segmental vitiligo compared to the control group.(p(c)<0.05). 3. The frequency of HLA-B63 was significantly increased in all patients of segmental vitiligo compared to the control group(p(c)<0.05), but there were no HLA antigens with significantly increased frequency in patients of subgroups of segmental vitiligo divided by the presence or absence of a family history of vitiligo. 4. The frequency of HLA-B54 was significantly increased in all vitiligo patients with a family history(p(c)0.05) but there were no HLA antigens with significantly increased frequency in all vitiligo patients without a family history. 5. There were no HLA antigens with significantly increased frequency in vitiligo patients subgrouped by age of onset (less or over 16 years) of disease. Conclusion : From the above results, we can assume that non-segmental vitiligo may have autoimmune mechanisms in the pathogenesis, as there was a significant increase in HLA-DRl2 in patients with non-segmental vitiligo.
Age of Onset ; Autoimmunity ; Classification ; HLA Antigens* ; HLA-A Antigens ; Humans ; Melanocytes ; Skin ; Vitiligo*

Vesicles and bullae are the primary lesions in many diseases. The histologic classification of bullous disorders is based on the level in the skin on which that cleavage developed. We report a 44-year-old man with vitiligo at dorsum of hand who has experienced spontanous bullae at recipient site after epidermal graft for the treatment of vitiligo. Histopathologic examination revealed a subepidermal bullae and moderate lymphocytes and eosinophil infiltration in the dermis. Direct immunofluorescence test was negative. There was a change of CD4/CD8 ratio in immunohistochemical staining for CD4 and CD8 monoclonal antibody. There were no clinical signs of infection and drug eruption, and friction did not seem to have been a contributing factor.
Adult ; Classification ; Dermis ; Drug Eruptions ; Eosinophils ; Fluorescent Antibody Technique, Direct ; Friction ; Hand ; Humans ; Lymphocytes ; Skin ; Transplants* ; Vitiligo*

BACKGROUND: Vitiligo, the pigmentary disorder of the skin and hair, affects patients of various ages from neonates to old adults. According to the onset age, vitiligo is classified as adult or childhood type. Previous clinical studies on childhood vitiligo are rare in Korea. OBJECTIVE: Our purpose was to evaluate the clinical characteristics of childhood vitiligo. METHOD: A clinical investigation was made of 381 outpatients with childhood vitiligo (between 6months and 15years of onset) who had visited the Department of Dermatology, Pusan National University Hospital from January 1988 till December 1997. Results : The results a summarized as follows 1. The subjects consisted of 206(54.1%) females and 175(45.9%) males. 2. The mean age of onset was 7.7 years(males : 8.0, female 7.5). 3. The mean duration of the disease was 2.6 years(male : 2.5, female : 2.7). 4. Familial history was obtained in 30 cases(7.9%) and the most common precipitating factor was trauma(40.0%). 5. Both vulgaris(43.3%) and segmental type(30.4%) were common clinical types in the classification of Ortone et at. Trigeminal distribution(53.4%) was the most common segmental types in Koga's classification. 6. The most common site of initial involvement was the face and neck(52.2%) 7. The most common degree of depigmented lesion was within 5%(84.5%). 8. The progression of vitiligo was present in 68.2% of patients and the incidence of poliosis was 11.5%. 9. Koebner phenomenon was present in 12 cases(3.1%). 10. The most common associated diseases were acne and halo nevus (18.0%). Conclusion : Childhood vitiligo is relatively unique in the clinical findings such as the clinical type(high incidence of segmental type), precipitating factor(trauma is the main factor), depigmented area(small involvement in the extent of the lesion) and the progression of the disease.
Acne Vulgaris ; Adult ; Age of Onset ; Busan ; Classification ; Dermatology ; Female ; Hair ; Humans ; Incidence ; Infant, Newborn ; Korea ; Male ; Nevus, Halo ; Outpatients ; Precipitating Factors ; Skin ; Vitiligo*

BACKGROUND: PUVA has been used effectively in the treatment of vitiligo, but the mechanism by which PUVA stimulates melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and the incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies ; Candida* ; Classification* ; DNA* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo

BACKGROUND: PUVA has been used effectively in the treatment of vitiligo, but the mechanism by which PUVA stimulates melanocyte proliferation in vitiligo is not known. Several mechanisms have been suggested to be involved in the process of repigmentation of vitiligo. First, UV light, with or without psoralen, directly stimulates the proliferation of melanocytes. Secondly, PUVA may act. on epidermal keratinocytes or dermal components to stimulate t,hem to release certain melanocyte growth st,inulation factors that enhance the proliferation of melanocytes in depigmented lesions. Thirdly, PUVA irnmunologically leads to the impairment of epidermal Langerhans cell function and alteration of circulating T and B cell function, which results in the suppression of the stimuli is for rnelanocyte destruction during the therapy. OBJECTIVE: To test, th hypothesis that PUVA induced repigmentation in vitiligo results from the stimulation of growth factors that induce melanocyte proliferation, and that PUVA may suppress the immune reacticin to melanocytes, especially in autoantibody synt,hesis, we examined the effects of sera on the growth of epidermal melanocytes and control cells, and the incidence of antibodies to melanocyte and melanoma cells(SK-Mel 2~3) in the sera of patients with vitiligo. We also had normal control individuals and studied the changes of the antibody titer in the sera of patients with vitiligo. METHODS: The rate of H thymidine uptake was estimat,ed in cultured melanocytes and fibroblasts t,reated by patients sera before and after PUVA treatment. SDS-PAGE and immunoblotting analysis were used to idcntify anti pigment cell autoantibodies and were compared to the titers of autoantibodies after PUVA. RESULTS: 1. Melanocyte and fibrablast proliferation was increased by PUVA treated sera. Their proliferation was in proportion to the duration of the PUVA treatment. Melanocytes proliferated more than fibroblasts. 2. Significant differences between vitiligo patients and normal controls were found in the inci dence of anti-pigment cell antibodies. The antibodies were predominantly directed to melanocyte antigens of 110 kD, 65 kD, 45 kD and melanoma cell antigens of 110 kD, 103 kD, 88kD, 70 kD, 56 kD, 41 kD. 3. The titer of anti piment cell antibodies showed a tendency to decrease after PUVA treat- ment in most patients regardless of clinical improvement. Conclusion ; PUVA treated sera induced proliferation of melanocytes and fibroblasts and the production of aut,oantibodies was suppressed against pigment cell antigens through irnmunosuppression, which might help in the repigmentation of vitiligo.
Antibodies ; Autoantibodies ; Candida* ; Classification* ; DNA* ; Electrophoresis, Polyacrylamide Gel ; Fibroblasts ; Ficusin ; Humans ; Immunoblotting ; Incidence ; Intercellular Signaling Peptides and Proteins ; Keratinocytes ; Melanocytes ; Melanoma ; Thymidine ; Ultraviolet Rays ; Vitiligo

Chronic mucocutaneous candidiasis (CMCC) is a general term used to denote a complex group of disorders characterized by a recurrent and persistent infection of the skin, mucous membranes and nails with organism of the genus candida, most frequently Candida albicans. It is often associated with an endocrinopathy and cell mediated immunopathy. CMCC is not a single disease entity, but rather a final common pathway for multiple predisposing abnormalities of the immune system that ranges from severe, life-threatening immunodeficiency syndromes to subtle deficiencies, especially of cell mediated immunity. Conditions that have been associated with CMCC include; candida esophagitis or laryngitis, endocrinopathies (usually hypoparathyroidism, hypadrenalism, hypothyroidism), circulating autoimmune antibodies, diabetes mellitus, vitiligo with antibodies to melanocytes, iron deficiency, chronic active hepatitis, pernicious anemia, malabsorption, alopecia totalis, dental enamel dysplasia, keratoconjunctivitis, pulmonary fibrosis, KED syndrome (keratitis, ichthyosis, and deafness), and recurrent pyogenic, viral or other fungal infections. When CMCC first appaears in adulthood, it is often associated with a thymoma. There is virtually no propensity for disseminated, visceral candidiasis. A suitable clinical classification of the major subtypes of CMCC was described by Lehner and Wells et al into six groups. Kirkpatrick et al found the mean age of onset of CMCC to be 3 years and both boys and girls are affected equally. We review CMCC and 5 reported CMCC cases in the dermatologic literatures in Korea.
Age of Onset ; Alopecia ; Anemia, Pernicious ; Antibodies ; Candida ; Candida albicans ; Candidiasis ; Candidiasis, Chronic Mucocutaneous* ; Classification ; Dental Enamel ; Diabetes Mellitus ; Esophagitis ; Female ; Hepatitis, Chronic ; Humans ; Hypoparathyroidism ; Ichthyosis ; Immune System ; Immunity, Cellular ; Iron ; Keratoconjunctivitis ; Korea* ; Laryngitis ; Melanocytes ; Mucous Membrane ; Pulmonary Fibrosis ; Skin ; Thymoma ; Vitiligo

BACKGROUND: Ota's nevus, characterized by the presence of melanocytes in the dermis, has been familiar among dermatologists, but the etiology, the pathophysiology, the clinical and histological classification are not entirely clear. To understand and elucidate them, more clinical studies and researches are necessary. OBJECT: The aim of this study was to document the clinical and histopathological features of Ota's nevus. METHODS: We examined 299 patients with Ota's nevus who visited the dermatology clinic in Korea from February 1993 to August 2003. Among them, 188 patients were biopsied. All the specimens were stained with hematoxylin and eosin. We examined the age & sex distribution, age of onset, seasonal variation, associated skin diseases, aggravating factors and color. We clinically classified Ota's nevus into 4 types according to Tanino's classification and histologically into 5 types based on the pattern of pigmentation. RESULTS: 1. The ratio of male and female was 1: 3. 2. The peak age of onset was at birth (28.4%) and puberty (24.8%). 3. Seasonal variation was observed with distinct aggravation in the summer (60%). 4. The associated diseases were 9 cases of persistent mongolian spot, 6 cases of nevus flameus, 4 cases of blue nevus, 3 cases of vitiligo, 3 cases of nevus of Ito, 2 cases of atopic dermatitis, 2 cases of psoriasis, 2 cases of cafe au late macules and 2 cases of contact dermatitis. 5. The aggravating factors were sunlight (35.8%), emotional stress (21.0%), menstruation (12.6%), cold exposure (9.5%), pregnancy (9.5%), fatigue (9.5%) and chemical agents (2.1%). 6. The color of lesions were blue black (36.8%), brown (34.8%), dark brown (16.1%) and slate (11.0%). 7. All cases were classified according to Tanino's METHODS: type Ia (23.1%), type Ib (20.1%), type II (26.7%), type III (9.4%), type IV (20.7%). 8. The histological subtypes of Ota's nevus were classified as: the superficial type (35.6%); the middermis type (5.9%), the superficial-middermis type (18.6%); the mid-lower dermis type (2.7%); the diffuse type was composed of the superficial dominant type (19.7%), the middermis dominant type (4.8%), the dispersed (true diffuse) type (12.2%) and the deep dominant type (0.5%). 9. In the relation between histological types and the color of the lesion: the superficial type had 31 cases of brown color, 15 cases of blue black color, 11 cases of dark brown color and 9 cases of slate color; the middermis type had 6 cases of blue black color and 2 cases of dark brown color, query number of cases of slate color; the superficial-middermis type had 12 cases of blue black color, 10 cases of dark brown color, 7 cases of brown color and 6 cases of slate color: the mid-lower dermis type had 3 cases of blue black color; for the diffuse type, the superficial dominant type had 13 cases of brown color, query number of cases of blue black color and 7 cases of dark brown color; the mid-dermis dominant type had 4 cases of brown color, query number of cases of dark brown color, the dispersed type had 14 cases of blue black color and 5 cases of brown color; the deep dominant type had 1 case of blue black color. CONCLUSION: The histological reclassification of Ota's nevus may be very useful in making a therapeutic prognosis of the disease.
Adolescent ; Age of Onset ; Classification ; Dermatitis, Atopic ; Dermatitis, Contact ; Dermatology ; Dermis ; Eosine Yellowish-(YS) ; Fatigue ; Female ; Hematoxylin ; Humans ; Korea ; Male ; Melanocytes ; Menstruation ; Mongolian Spot ; Nevus ; Nevus of Ota* ; Nevus, Blue ; Parturition ; Pigmentation ; Pregnancy ; Prognosis ; Psoriasis ; Puberty ; Seasons ; Sex Distribution ; Skin Diseases ; Stress, Psychological ; Sunlight ; Vitiligo