Role of hair follicles in the repigmentation of vitiligo.

Vitiligo is a common pigment disease that is difficult to treat. The mechanism of repigmentation is not known. We combined Dopa-Toluidine Blue complex stain, hair follicle split-Dopa stain, and hair follicle split-scanning electron microscope (SEM) to observe the changes of melanocytes in 23 normal, 24 vitiliginous, and 36 repigmented skin specimens. We found that only active (Dopa-positive) melanocytes existed in the epidermis of normal skin. There were some inactive (Dopa-negative) melanocytes in the outer root sheaths of normal hair follicles, which form the melanocyte reservoir in human skin. In the patients with vitiligo the active melanocytes in the epidermis were totally missing, whereas the inactive melanocytes in the outer root sheaths of hair follicles were not affected. Treatment stimulated the inactive melanocytes in the middle and/or lower parts of the outer root sheaths of hair follicles to divide, proliferate, and migrate upward along the surface of the outer root sheath to the nearby epidermis, where the melanocytes continued to migrate radially to form the pigmented island visible clinically in repigmented vitiligo lesions. During the migration to the epidermis, the melanocytes matured gradually from an inactive phase to an active condition. In conclusion, the existence of these inactive melanocytes provided the melanocyte sources for repigmentation of vitiligo.