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KMID : 0363220160540080679
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Korean Journal of Dermatology
2016 Volume.54 No. 8 p.679 ~ p.681
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A Case of Pentachrome Vitiligo
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Yun Chul-Hyun
Kim Jeong-Soo
Ryu Ha-Ryeong
Kim Ji-Hoon
Baek Jin-Ok
Roh Joo-Young
Lee Jong-Rok
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Abstract
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Vitiligo is a chronic idiopathic disorder characterized by the appearance of patchy, depigmented macules and patches 1,2. The pathogenesis of vitiligo is not well understood. It has been attributed to autoimmune causes, oxidative stress, and sympathetic neurogenic disturbances3. The common clinical feature of vitiligo is homogenous and amelanotic macules surrounded by a well-defined border. Pentachrome vitiligo is a rare variant of vitiligo, and as its name suggests, it exhibits five shades of color: white, tan, medium brown, dark brown, and black4. A 35-year-old woman presented with multiple depigmented and hyperpigmented macules on her left hand, and both upper and lower extremities, of 5 years’ duration (Fig. 1). The lesions started as a single depigmented patch, which was followed by spontaneous development of new hyperand hypopigmented lesions around the original area of depigmentation. Skin examination revealed the presence of five colors: white, tan, medium brown, dark brown, and black. The hypopigmented spots were well-demarcated macules that were accentuated by examination under Wood’s light. The patient had no concomitant dermatological or autoimmune disease. The number of melanocytes in biopsy specimens of depigmented macules was markedly diminished; however, the number in hyperpigmented macules was normal. Depigmented and hyperpigmented macules exhibited decreased and increased basal pigmentation, respectively (Fig. 2). Based on the above, a diagnosis of pentachrome vitiligo was made. The patient remains under follow-up observation without treatment. The pathogenesis of pentachrome vitiligo has not been established. Zhang and Zhu5 suggested that the condition may arise due to repigmentation. In our case and two previously reported cases4,5, patients with a dark skin phenotype were affected, and hyperpigmentation followed an initial depigmented lesion, which supports the suggestion that pentachrome vitiligo may result from a repigmentation process. However, further study is needed to establish its pathogenesis. In our case, the biopsy of depigmented macules revealed a prominent decrease in melanocyte count. Although, melanocytes are usually absent from vitiligo lesions, however they were present in our case. We differentially diagnosed pentachrome vitiligo based on the following: (1) the lesions typically developed in areas of friction, like the dorsum of the hand, elbow, knees, and thighs reflecting Koebnerization; (2) depigmented lesions preceded the other lesions, (3) well-demarcated depigmented macules were accentuated by examination under Wood’s light, (4) lack of any preceding inflammation in the skin lesions, (5) the possibility that the skin biopsy was performed on less-than-fully depigmented lesion, and (6) the possibility that repigmentation occurred during the process of vitiligo recovery. Vitiligo is not a rare disease and can be distressing, especially in darker skinned individuals. Pentachrome vitiligo may develop at a higher rate in people who have a dark skin phenotype, because it may occur due to a process of repigmentation, and as it is easily distinguished in darker skinned types. It is also possible that the condition has been underdiagnosed because of dermatologists’ lack of familiarity with this variant. Here, we report a rare and interesting case of pentachrome vitiligo exhibiting five shades of color in a 35-year-old woman.
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KEYWORD
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Pentachrome vitiligo, Vitiligo
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