Dermatoscopic and histopathological correlation in stable and unstable vitiligo

Objectives: Vitiligo is an autoimmune disorder leading to depigmented macules of varying shapes and sizes. The objectives of this study were to determine dermoscopic and histopathological features in stable and unstable vitiligo in a tertiary care center. Materials and Methods: A hospital-based, cross-sectional study was conducted on 40 non-pregnant vitiligo patients. After ethical approval and consent, clinical, dermoscopic, and histopathological evaluations were performed. Statistical analysis was conducted using STATA MP 16, with categorical variables analyzed through the Chi-square test ( P < 0.05 considered significant). Results: Stable vitiligo (52.5%) showed sharply defined borders (95.24%), absent/reduced pigment network (61.9%), frequent perilesional (80.95%), and perifollicular (80.95%) hyperpigmentation. Unstable vitiligo (47.5%) exhibited ill-defined (57.89%) or trichrome (42.11%) borders, reversed pigment network (31.58%), starburst appearance (73.68%), comet tail sign (63.16%), and tapioca sago lesions (68.42%) ( P < 0.05). Non-segmental vitiligo vulgaris (40%) was most common, with mucosal involvement in 32.5% of cases. Histopathologically, unstable vitiligo showed more basal cell vacuolization (68.42%), dense lymphocytic infiltration (47.37%), and epidermal spongiosis ( P < 0.01). Ill-defined borders, comet tails, and tapioca sago signs strongly correlated with severe histopathological changes ( P = 0.00). Conclusion: This study highlights the correlation between dermoscopic and histopathological features in distinguishing stable and unstable vitiligo. Dermoscopy serves as a valuable, non-invasive tool for assessing vitiligo stability, particularly in resource-limited settings. Larger, long-term studies are needed to refine diagnostic criteria and improve clinical decision-making.