Vitiligo Workup

Updated: Jul 20, 2022
  • Author: Shekhar Neema, MD; Chief Editor: Dirk M Elston, MD  more...
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Laboratory Studies

Although the diagnosis of vitiligo generally is made on the basis of clinical findings, biopsy is occasionally helpful for differentiating vitiligo from other hypopigmentary disorders.

Because of the association with other autoimmune diseases and endocrinopathies, further testing may be necessary in patients with suggestive signs or symptoms to rule out an underlying condition. Vitiligo may be associated with thyroid disease, diabetes mellitus, pernicious anemia, Addison disease, and alopecia areata. Appropriate tests should be performed only in the presence of signs or symptoms of associated disease. [4, 31]

Laboratory work for vitiligo may include the following:

  • Thyroid panel consisting of thyroid-stimulating hormone (TSH), free triiodothyronine (T3), and free thyroxine (T4) levels
  • Antinuclear antibody
  • Antithyroid peroxidase antibody
  • CBC count with differential

Histologic Findings

Microscopic examination of involved skin shows a complete absence of melanocytes in association with a total loss of epidermal pigmentation. Superficial perivascular and perifollicular lymphocytic infiltrates may be observed at the margin of vitiliginous lesions, consistent with a cell-mediated process destroying melanocytes. Degenerative changes have been documented in keratinocytes and melanocytes in both the border lesions and adjacent skin. Other documented changes include increased numbers of Langerhans cells, epidermal vacuolization, and thickening of the basement membrane. Loss of pigment and melanocytes in the epidermis is highlighted by Fontana-Masson staining and immunohistochemistry testing. [2, 3]