32053 Vitiligo koebnerising to varicose veins of the lower limbs

Abstract

A 29-year-old woman with Fitzpatrick skin type II noticed new white patches on her lower limbs after reporting a sudden onset of pain behind her knees along with the sudden appearance of bilateral varicose veins extending from the thighs down to the calves and shins. Subsequently she developed symmetrically distributed white patches in the submammary and groin areas. Examination of the affected areas revealed depigmented macular patches without scale, atrophy or induration in keeping with vitiligo. Strikingly, the white patches on the legs were confined to the prominent varicosities, consistent with koebnerisation of vitiligo to the skin overlying the varicose veins. Investigation of the pain behind the knees was unremarkable, leading to a likely diagnosis of symptomatic varicose veins. Koebner phenomenon, also called the isomorphic response, describes the development of lesions at sites of traumatised previously uninvolved skin, and is well-known to occur in vitiligo. The pathogenesis of this is thought to be an integration of immunologic mechanisms, deficiency of melanocyte growth factors, defective melanocyte adhesion, and increased oxidative stress. To our knowledge, this is only the second case reported in the literature of vitiligo koebnerising to areas of varicosities.