title: Acral Vitiligo and Lichen Sclerosus - Association or a Distinct Pattern?: A Clinical and Histopathological Review of 15 Cases.
abstract: BACKGROUND
  Acral or acrofacial vitiligo (AFV) with bilateral lesions over the extremities and face is considered as a transitional form that may progress to generalized vitiligo. Oral and genital mucosal lesions are often integral to this pattern. Lichen sclerosus (LS) in a milder expression, results in oral and genital vitiligoid depigmentation without textural changes and thus needs to be differentiated from AFV.
  
  
  METHODS
  We reviewed 217 cases of AFV recorded over a period of 12 years.
  
  
  RESULTS
  One hundred and sixteen cases had associated oral/genital lesions. Among these, 15 patients demonstrated typical clinical as well as histological features of LS.
  
  
  CONCLUSIONS
  Coexistence of typical LS essentially among oral and genital lesions of acral vitiligo suggests that acral vitiligo might be a distinct sub-group of NSV. Since both the diseases have an autoimmune basis, the co-existence may be explained by epitope spreading, as a result of interface dermatitis seen in vitiligo. In addition, the possibility of a common genetic predisposition needs to be explored.
authors.affiliation: Visakha Institute of Skin and Allergy, Visakhapatnam, Andhra Pradesh, India.
authors.forename: Venkat Ratnam
authors.initials: VR
authors.lastname: Attili
authors.affiliation: Visakha Institute of Skin and Allergy, Visakhapatnam, Andhra Pradesh, India.
authors.forename: Sasi Kiran
authors.initials: SK
authors.lastname: Attili
keywords: Acral vitiligo; lichen sclerosus; mucosal vitiligo; vitiligo