Rare Presentation of Concomitant Alopecia Areata and Vitiligo in a Teenager

Abstract

Introduction: Alopecia areata (AA) and vitiligo are two chronic, autoimmune skin diseases. While these two conditions are common, their co-existence is rare.
 Case Presentation: A 13-year-old Caucasian female presented to the dermatology clinic with a 1-2-month history of hair loss on her occipital scalp. The patient was diagnosed with AA and prescribed topical mometasone 1% lotion twice daily and pulse-dose prednisolone solution 12 mL 1 day per month for 3 months. At her 3-month follow-up, the patient reported new-onset hair depigmentation. On physical examination, the patient’s occipital scalp and right eyelash demonstrated a depigmented patch of hair, concerning for vitiligo. The patient was diagnosed with concomitant disease and topical tofacitinib was added to her treatment regimen.
 Discussion/Conclusion: The colocalization of AA and vitiligo is rare, and the presentation suggests an underlying pathogenic link between the two skin diseases. While the definitive immunologic pathway remains unknown, researchers have narrowed down inflammatory markers involved in the development of both conditions, including CD8+ cytotoxic T-cells, interferon gamma (IFN-ɣ), and IFN-ɣ-induced chemokines. We present a 13-year-old female patient who presented to the clinic with scalp alopecia and later developed overlying scalp and eyelash vitiligo. The rare nature of the patient’s presentation makes concomitant disease a therapeutic challenge and can impose significant psychological distress to a pediatric patient.