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| THE CLINICAL PICTURE |
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| Year : 2015 | Volume
: 2
| Issue : 1 | Page : 60-61 |
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Vitiligo and lines of Blaschko
Arunprasath Palanisamy, Bhagirath Singh, Srivenkateswaran Kothandapany
Department of Dermatology and STD, Vinayaka Mission's Medical College and Hospital, Karaikal, Puducherry, India
| Date of Web Publication | 26-Jun-2015 |
Correspondence Address:
Arunprasath Palanisamy
Department of Dermatology and STD, Vinayaka Mission's Medical College and Hospital, Karaikal - 609 609, Puducherry
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2349-5847.159401
How to cite this article:
Palanisamy A, Singh B, Kothandapany S. Vitiligo and lines of Blaschko. Pigment Int 2015;2:60-1 |
A 23-year-old male patient, presented with asymptomatic, depigmented patches, suggestive of vitiligo, involving the front of chest in a symmetrical fashion, extending onto the anterior aspect of both arms [Figure 1]. The depigmented patch on the back was seen in the mid back in a narrow Blaschkoid pattern and on right scapular region [Figure 2]. Few patches were seen on the face and sides of abdomen. | Figure 1: Vitiligo involving the front of chest, extending onto the anterior aspect of both arms in a broad Blaschkoid pattern along with multiple follicular papules
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 | Figure 2: Vitiligo in the mid back in a narrow Blaschkoid pattern along with multiple follicular papules
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The depigmented patches started to develop 10 years ago, gradually progressed to reach the present size and remained stable for the past 1-year. There was no history of contact with aromatic chemicals or phenol. Family history was not contributory. In addition to vitiligo lesions, he was found to have asymptomatic follicular scaly papules on the chest, back and abdomen [Figure 1], [Figure 2] and [Figure 3]. A clinical diagnosis of blaschkoid pattern vitiligo with atypical pityriasis rubra pilaris (PRP) was entertained and was corroborated by histopathological examination. | Figure 3: Multiple follicular papules in the anterior abdomen and vitiligo in the lateral aspect
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The characteristic segmental distribution of vitiligo in this patient followed blaschkoid pattern in a broad band and narrow band type of distribution, on the front and back of chest, respectively [Figure 4]. Lines of Blaschko More Details correspond to migration pattern restricted to cells of ectodermal or neuroectodermal origin and represent an underlying cutaneous mosaicism. | Figure 4: Comparison with actual broad band and narrow band patterns of lines of Blaschko
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Koga and Tango classified vitiligo into Type A and Type B and hypothesised that in Type B, depigmented patches confined to a definite dermatome, results from the dysfunction of sympathetic nerves in the affected area, while Type A vitiligo was caused by autoimmune mechanisms. [1]
Segmental vitiligo tends to occur in a localised area, remains stable in its course and responds poorly to medical treatment. [2] Segmental patterns described include dermatomal, narrow Blaschkoid, broad Blaschkoid, phylloid, checkerboard, and those following acupuncture lines. [2],[3] Vitiligo having both segmental and generalised distribution may represent mosaicism involving germline mutation, as could be presumed in the present patient. [4]
This case is highlighted for the unusual blaschkoid pattern of vitiligo, in addition to the coexistent atypical PRP.
| References | |  |
| 1. | Koga M, Tango T. Clinical features and course of type A and type B vitiligo. Br J Dermatol 1988;118:223-8.  |
| 2. | Khaitan BK, Kathuria S, Ramam M. A descriptive study to characterize segmental vitiligo. Indian J Dermatol Venereol Leprol 2012;78:715-21. [ PUBMED]  |
| 3. | Hann SK. Clinical features of segmental vitiligo. In: Hann SK, Nordlund JJ, editors. Vitiligo. 1 st ed. UK: Blackwell Science; 2000. p. 49-60. |
| 4. | Happle R. Dohi Memorial Lecture. New aspects of cutaneous mosaicism. J Dermatol 2002;29:681-92. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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