Resumen

Objectives: We examined whether any nuclearus and cell fusion associated with a positive immunolabelling of varicella-zoster virus (VZV) and VZV mature virions could be found in segmental vitiligo (SV) skin samples as in herpes zoster (HZ) Introduction: Segmental vitiligo (SV) is a unilateral subtype of vitiligo which is clinically characterized by a cutaneous depigmentation and histologically by a melanocyte loss from the epidermis and hair follicle reservoirs. To date, its pathogenesis remains a mystery. In many cases, this skin depigmentation shares several clinical features and dysfunctions with herpes zoster (HZ). Materials / method: A total of 40 SV samples were used for histological and immunochemical studies. Control samples were obtained from three HZ, and 10 generalized vitiligo lesions. For ultrastructural study, three recent SV and one HZ as controls were recruited. Results: We report that nuclear fusion in epidermal cells were statistically associated with recent SV (p<0.001) whereas, syncytia formation was associated with long-lasting SV (p= 0.001). A positive detection of VZV antigen was statistically associated in the epidermis with recent SV and in the dermis with long-lasting SV (p=0.001). Finally, the discovery of mature virions in 3/3 recent SV samples provides additional arguments for our viral hypothesis. Conclusion: We hypothesize that in SV, an occult, brief and non-contagious VZV reactivation could be the first step of a cascade of events leading to a local depigmentation, and possibly to an autoimmune process. In this hypothesis, we could consider SV as a chronic depigmented sequelae developed in a localized area, following unique or successive viral reactivations of brief duration and low-grade intensity occurring in anatomically corresponding autonomic ganglia.