A very common finding in vitiligo is the involvement of hair follicles over the white patch. It has been observed that the hair follicles also turn white during the course of the disease. Hair is initially spared from depigmentation in vitiligo but after a prolonged course, a lack of hair pigmentation within vitiligo-affected areas may occur as poliosis or leukotrichia. However, the appearance of white hair over white spots has no correlation with disease activity as such since vitiligo does not progress more rapidly in patients with leukotrichia than in patients with normally pigmented hair.
Leukotrichia is known to occur more rapidly in segmental vitiligo (SV), whereas in non-segmental vitiligo (NSV) usually occurs at a slower rate.
It is also interesting to note that during normal aging process, abnormal melanocytes may be observed in the hair follicle however, in vitiligo with regard to histological and ultrastructural findings, depigmented hair in vitiligo do not show any melanocytes.
In vitiligo, normally pigmented hair is the main source of repigmentation since they constitute the most important reservoir of melanocytes in this condition. When leukotrichia is present, the possibilities of re pigmentation are minimal or null because hair melanocyte loss is usually permanent and repigmentation does not occur with medical therapy.
Leucotrichia happening in vitiligo can be corrected using surgical modalities namely melanocyte transplant. The most reasonable explanation of surgical outomes is that melanocytes transplanted in the close vicinity depigmented hair would have reached the follicular ostium and migrated downward through the external root sheath.
Areas such as the eyebrows, scalp, or beard areas responded well to surgical interventions
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