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LETTER TO EDITOR
Year : 1996  |  Volume : 62  |  Issue : 2  |  Page : 132-133

Evidence for cytomegalovirus infection as the cause of vitiligo



Correspondence Address:
R C Shukla


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Source of Support: None, Conflict of Interest: None


PMID: 20948012

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How to cite this article:
Shukla R C. Evidence for cytomegalovirus infection as the cause of vitiligo. Indian J Dermatol Venereol Leprol 1996;62:132-3

How to cite this URL:
Shukla R C. Evidence for cytomegalovirus infection as the cause of vitiligo. Indian J Dermatol Venereol Leprol [serial online] 1996 [cited 2019 Jun 16];62:132-3. Available from: http://www.ijdvl.com/text.asp?1996/62/2/132/4350



  To the Editor, Top


The exact cause of vitiligo has not been known. I have found that (1) the melanocyte in vitiligo was a rounded structure which (2) formed the first stage of cytopathic effect (CPE) of cytomegalovirus (CMV) culminating in the loss of melanocyte to produce vitiligo. This possibility was investigated by 3 experiments, namely, (I) cytological, (II) immunofluorescent study, and (III) therapeutic test.

Four patients were selected for the first study, 2 for the second and 10 for the third. Their ages varied between 30 to 40 years and they had been suffering from vitiligo for last 5 years or more. Group I and II consisted of males alone and patients of Group III were 9 females and one male. That the patches of vitiligo were not secondarily due to syphilis, fungus infection, psoriasis, Kala-azar and eczema etc was confirmed by pathological examination and clinical history. Diagnosis in each case was confirmed by reaction to dihydroxyphenylalanine (DOPA).

For the cytological and immunofluorescent (IF) tests, pure epidermis preparations,[2] from (a) less pigmented border of vitiligo spots and from (b) contralateral part of normally coloured skin were digested in normal saline and mounted on albuminised slides. One portion of slides from (a) and (b) was subjected to treatment with DOPA, H&E and methyl green pyronin stain to visualise reaction to DOPA, nucleus and nucleolus under the light microscope. The other portion of slides from (a) and (b) were challenged with rabbit antihuman IgG sera, specific for CH2 domain, both plain and FITC conjugated, by direct and indirect methods and examined under the fluorescent microscope. The digests of normally coloured skin served as control. The results of the cytological and immunofluorescent tests are presented in [Table - 1], as found in I, II, III and IV stages of CPE of CMV in angular melanocyte.[4] Some basal cells showed CPE of CMV upto II stage with + IF test.

For conducting the therapeutic test, 4 patients were put on idoxuridine and 4 on acyclovir iontophoresis each, passing a direct current of 10 V at 3-4 mAmp for 15 to 20 minutes for 60 days, introducing psoralen ultraviolet ray A range therapy (usually designated as PUVA) after 15 to 20 days, when the vitiliginous spots had regained normal colour. Two patients were kept for control. All the 8 patients were completely cured without any relapse for the last 5 years (UK Patent No. 2251380, published on 13.7.1994). The treatment by iontophoresis was restricted to an area of 3"x2" at one time. CMV infection of vitiligo explained occurrence of family history in 30% and Kobner's phenomenon.


  Acknowledgements Top


Thanks are due to Dako Patts for supply of sera free of cost and to Mr BA York, Director, Patents, Sandoz Pharmaceuticals, Switzerland for critical evaluation of the data on treatment and subsidy of Sw.Fr.3,000/- towards filing a patent in UK.

 
  References Top

1.Shukla RC. Isolation and identification of melanocytes in the nonpigmented skin of guinea pig and vitiliginous human skin. Curr Sci 1959;28:444.  Back to cited text no. 1    
2.Medawar PB. Sheets of pure epidermal epithelium of human skin. Nature 1941;148:783.  Back to cited text no. 2    
3.Shukla RC. A method to make the digest of the epidermis of mammals in normal saline solution. Curr Sci 1967;36:97-8.  Back to cited text no. 3    
4.Shukla R C. Morphological classification of the basal melanocytes of the human skin. Experientia 1967;23:259-62.  Back to cited text no. 4    


    Tables

[Table - 1]



 

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