BRIEF COMMUNICATION Trichrome vitiligo in segmental type Dong-Youn Lee, Cho-Rok Kim & Joo-Heung Lee Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea Key words: trichrome vitiligo; segmental type; segmental vitiligo; vitiligo Correspondence: Prof. Dong-Youn Lee, Department of Dermatology, Sungkyunkwan University School of Medicine, Samsung Medical Center, 50 Ilwon-dong, Gangnam-gu, Seoul, Republic of Korea. Tel: 822 3410 3543 Fax: 822 3410 3869 e-mail: dylee@skku.edu Accepted for publication: 8 December 2010 Conflicts of interest: None declared. Summary Trichrome vitiligo consists of an intermediate zone of hypopigmentation located between the depigmentation center and the normal unaffected skin. Previously, trichrome vitiligo was described in non-segmental vitiligo. Here, we report two cases of trichrome vitiligo that showed a poor response to phototherapy or systemic steroid. These findings suggest that trichrome vitiligo in segmental type seems to be an active lesion resistant to medical treatment. V itiligo is classified into generalized and segmental type (1). This classification is of value because the course of vitiligo is different depending on its type. The term trichrome vitiligo was first suggested long time ago (2). The lesions consist of an intermediate zone of hypopigmentation located between the depigmentation center and the peripheral normal unaffected skin. A previous study suggested that trichrome vitiligo is a variant of active vitiligo (3). It was shown mostly in generalized vitiligo such as vitiligo vulgaris, but it has not been reported in segemental type yet. Case report A 30-year-old woman presented with white patches of 10-year duration on the abdomen. The lesions were accentuated by the examination under Wood lamp (data not shown). She was diagnosed as segmental vitiligo. Skin examination showed well-defined white patches on the left side of abdomen and back (Fig. 1a–c). We performed suction blister epidermal grafting partially on the anterior abdomen. In addition, she was treated with narrow band UVB twice a week for several months, but there was a little effect. Despite the photototherapy, new hypopigmented lesions around the original depigmented patches developed, suggesting trichrome vitiligo (Fig. 1d). Portable digital microscopy (USB Microscope M2, Scalar Corporation, Japan) (4) showed some white hairs on the hypopigmented lesions. Thus, to prevent spreading oral prednisolone (20 mg/day) was started for 2 months. In addition, we continued to irradiate NB-UVB twice a week for 5 months. However, the hypopigmented lesions were persistent without any improvement (Fig. 1e). A 17-year-old woman presented with white patches of 5-year duration on the face and neck. Skin examination showed depigmented and hypopigmented patches on the right side of chin and neck, indicating trichrome vitiligo in segmental type (Fig. 2a). She told that hypopigmented lesions developed more recently than depigmented lesions. Compared with the hypopigmented lesions, the depigmented lesions were accentuated by the examination under Wood lamp (Fig. 2b). The other side of the face and neck was intact. Portable digital microscopy showed some white hairs on the hypopigmented lesions. To prevent spreading and improve vitiligo lesions, especially hypopigmented lesions oral prednisolone (20 mg/ day) was started for 3 months. In addition, topical tacrolimus was applied. However, there was no improvement. Three months later hypopigmented lesions changed into whiter lesions (Fig. 2c). Then, 4 months later suction blister epidermal grafting was performed for all lesions. To hasten repigmentation by epidermal grafting targeted UVB (Dualight s , TheraLight Inc., Carlsbad, CA, 111 r 2011 John Wiley & Sons A/S  Photodermatology, Photoimmunology & Photomedicine 27, 111–112