КЛІНІКО-ГІСТОЛОГІЧНІ Й ІМУНОГІСТОХІМІЧНІ ЗІСТАВЛЕННЯ ОСОБЛИВОСТЕЙ УРАЖЕННЯ ШКІРИ У ХВОРИХ НА ВІТИЛІГО

Abstract

Abstract. Vitiligo is an idiopathic disease characterized by the presence of well-defined depigmented spots as a result of progressive melanocyte loss. The urgency of the problem is associated with a pronounced negative impact on the patients’ psychological state, a significant number of young patients and the lack of reliable therapeutic algorithms. Traditional therapy of vitiligo includes the use of vitamin therapy, hepatoprotectors, in severe cases - systemic steroids, topical steroids and calcineurin inhibitors. Phototherapy is widely used: psoralen and UVA, narrowband UVB 311nm. Prolonged and consistent use of UVB phototherapy in only half of patients can achieve 75% repigmentation. Given the vitiligo resistance to traditional therapy, in the last decade widely used regenerative tissue grafting techniques (blister grafting, punch grafting, thin dermoepidermal split-grafts, follicular grafting, cell suspensions of melanocytes and keratinocytes). Conducted clinical-instrumental, immunological and biochemical studies served as a basis for the development of a comprehensive method of treatment of vitiligo patients using, along with traditional therapy and UVB 311nm phototherapy, cell technology techniques - melanocyte-keratinocyte suspension (MKS) and automesoconcentrate (AMC). The aim of the work is to study histological and immune-histochemical changes of the affected skin in patients with vitiligo and to identify their gender characteristics. We observed 107 vitiligo patients aged 19 - 65 years, including 45 (42.06%) men and 62 (57.94%) women. Morphological, immunohistochemical and morphometric studies of the affected skin in 107 patients with vitiligo were performed. General pathological changes of the skin, the presence of inflammatory infiltrate in the dermis were determined by microscopy of micropreparations stained with hematoxylin-eosin. Immunohistochemical study included determination of CD3 (DAKO, polyclonal), CD4 (DAKO, clone 4B12), CD8 (DAKO, clone C8 / 144B), S100 (DAKO, polyclonal) and Melan A (DAKO, clone A103). Research results. Comparison of complex clinical-histological and immuno-histochemical studies revealed the absence or insufficient number of melanocytes in the affected skin, dystrophic changes of keratinocytes needed to regulate the growth and differentiation of melanocytes. The identified changes justify the use in the treatment of patients with vitiligo cell technology techniques aimed at filling the insufficient number of melanocytes in the affected skin, and restoring the normal keratinocytes functioning. Conclusions. Studies have shown that patients with vitiligo have changes in epidermis: hyperkeratosis, acanthosis, focal granulosis; in dermis - moderate vascular reactions, focal lymphohistiocytic infiltrates, which were characterized by a significant number of CD3 cells and the predominance of CD4 cells over CD8. Gender features of these changes are shown. The use of specific staining showed the absence of melanocytes in all studied epidermis, which is a characteristic of vitiligo, and the detection of single Langerhans cells in the dermal infiltrate. Summarizing the conducted comparative analysis of histological and pathomorphological changes in patients with vitiligo, it can be assumed that the use of MKS and AMA will significantly expand the possibilities and increase the effectiveness of therapeutic strategies in vitiligo.