Cutaneous Vitiligo Research Articles

Vogt-Koyanagi-Harada-like Syndrome and Electronegative Electroretinogram after Nivolumab Therapy for Metastatic Cutaneous Melanoma: A Case Report

Background: Vogt-Koyanagi-Harada-like (VKH) syndrome or electronegative electroretinograms (ERG) have both been described before or after immunotherapy for metastatic cutaneous melanoma, but they have not been described occurring together. Objective: The objective of this study is to describe a case of VKH-like syndrome occurring simultaneously with an electronegative ERG after nivolumab therapy for metastatic cutaneous melanoma. Methods: Case report of a patient with ocular findings after nivolumab therapy for metastatic melanoma was reported. Multimodal imaging, including color fundus photography, optical coherence tomography (OCT), and both full-field and multifocal ERGs were used to describe the findings. Literature review was conducted with PubMed. Results: We reported a case of a patient with nivolumab-treated melanoma presenting with presumed VKH-like syndrome with panuveitis, choroidal depigmentation, and cutaneous vitiligo, as well as melanoma-associated retinopathy (MAR)-like electronegative ERG findings. Nivolumab was stopped and corticosteroid therapy was initiated. Although the patient’s visual acuity remained severely limited, her inflammation resolved, and the areas of choroidal depigmentation slowly decreased over years of subsequent follow-up. Conclusion: Vision loss accompanied by simultaneous VKH-like findings with choroidal vitiligo and a MAR-like electronegative ERG may develop after nivolumab therapy. The uveitic and vitiligo may improve with immunosuppressive therapy, but the vision loss and ERG findings may persist.

Choroidal flame.

A 31-year-old lady came for routine refractive check-up. Her best corrected visual acuity was 6/6 in both eyes (OU). Intraocular pressure and anterior segment examination were normal in OU. Fundus examination showed clear vitreous, normal disk, retinal vasculature, and fovea. Large ill-defined areas of orange-colored choroidal lesions were noted over superonasal, nasal, and inferonasal quadrants in Right eye (OD) [Fig. 1a]. The rest of the choroidal background appeared normal. Left eye had similar areas of ill-defined orangish choroidal lesions in nasal and inferotemporal periphery [Fig. 1b].Figure 1: (a) Right eye color fundus montage showing orange-colored choroidal lesion occupying nasal half of the fundus. (b) Left eye shows similar lesion in the peripheral quadrantsWhat is Your Next Step? Look for similar pigmentary lesions over ocular adnexa or rest of the body B scan ultrasonography Fundus autofluorescence All of the above. Findings There was no significant previous systemic or ocular history. There was also no history of any topical or systemic medication use in this patient. Thorough examination ruled out cutaneous hypopigmented lesions, poliosis, or white forelock. Ocular examination revealed no evidence of past or present intraocular inflammation. Optical coherence tomography scan through the lesions was normal with no evidence of overlying retinal pigment epithelium (RPE) abnormalities. B scan ultrasonography ruled out mass lesions and revealed normal choroidal thickness throughout. The lesions remained stable in follow-up over a period of 2 years. Diagnosis Primary choroidal vitiligo. Correct Answer D. All of the above. Discussion Primary choroidal vitiligo is an uncommon benign asymptomatic lesion that presents as flat depigmentation of the choroid. It is usually associated with cutaneous vitiligo, often of the lids and periorbital region. Secondary choroidal vitiligo occurs following intraocular inflammation, particularly Vogt–Koyanagi–Harada (VKH) syndrome.[1] Choroidal hypopigmentation with uveitis, poliosis, and hyperacusis also constitutes a rare syndrome called Alezzandrini syndrome.[2] Presence of white forelock and iris hypopigmentation with typical facial features points toward Waardenburg syndrome.[3] Investigations including angiography, autofluorescence, and ultrasonography helps us rule out conditions mimicking choroidal vitiligo, including amelanotic choroidal nevus, choroidal osteoma, diffuse choroidal hemangioma, amelanotic melanomas, and chorioretinal atrophy. Usually, primary choroidal vitiligo is a nonprogressive condition and no treatment is required. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Ungueal melanoma and a generalized vitiligo: Is this a rare association?

We report an observation of a good prognosis ungual melanoma showed up 10 years after the onset of a generalized vitiligo. It’s a 66ans years old male, with a history of a rapidly progressing vulgar vitiligo showed up 10 years earlier. The patient has been referred to us for the management of a nail melanoma, retained on clinical and histological data, with a vitiligo extended to 70% Body Surface Area. The assessment of locoregional and distant extension was without abnormalities. Several authors have reported the association of vitiligo and other autoimmune disorders, non-melanoma skin cancers, or as part of a particular syndrome. The association of ungueal melanoma and generalized vitiligo was rarely reported in literature. Across this observation, we illustrate that The association of cutaneous melanoma and vitiligo is not rare and may be a factor of good prognosis.

Development of cutaneous hyperpigmentation and vitiligo during the recovery period of palmoplantar pustulosis in a patient of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: A case report

Development of cutaneous hyperpigmentation and vitiligo during the recovery period of palmoplantar pustulosis in a patient of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome: A case report

Cutaneous Vitiligo Associated With Chorioidal Vitiligo: Case Report

We report on an unusual case of a 68-year-old patient with previously undiagnosed cutaneous vitiligo and extensive ocular involvement. This case demonstrates that vitiligo can affect choroidal and, due to an atypical pattern of choroidal hypopigmentation, simulate a large choroidal unclear tumor

Isolated choroidal melanocytosis: clinical update on 37 cases

PurposeIsolated choroidal melanocytosis is a congenital melanocytic hyperpigmentation involving the choroid that is not associated with iridic or scleral features of ocular melanocytosis. The purpose of this work was to describe the clinical features and course of a relatively large series of patients with this disorder.MethodsA retrospective clinical study of 37 patients with isolated choroidal melanocytosis encountered in a single practice 1986–2018 was done. All lesions were 5 mm or larger in the largest basal diameter, homogeneously melanotic, and completely flat by conventional ocular ultrasonography.ResultsThe 37 patients ranged in age from 2 weeks to 87 years (mean 31.5 years, median 18 years) at initial diagnosis of the melanotic choroidal lesion. Arc length largest basal diameter of the melanotic choroidal lesion ranged from 5.5 to 37 mm (mean 14.6 mm, median 13 mm). The lesion extended beneath the fovea in 18 eyes and to the optic disc margin in 6 eyes. Ten of the lesions straddled the ocular equator, but the center point of all of the lesions was posterior to the equator. The retina was fully attached and appeared normal over the melanotic choroidal lesion in each of these eyes. None of the melanotic choroidal lesions exhibited clumps of orange pigment or drusen on its surface. The lesion was unilateral and unifocal in 36 of the 37 patients. One patient had bilateral choroidal melanocytosis that was isolated in one eye but associated with partial iris melanocytosis in the fellow eye. Three adult patients had a choroidal melanoma localized to the patch of choroidal melanocytosis at baseline. One other adult patient had a choroidal melanoma in the fellow eye at baseline. One pediatric patient had viable unilateral non-familial retinoblastoma in the fellow eye and two adult patients had a classic choroidal nevus in the fellow eye. None of the flat patches of choroidal melanocytosis that were monitored periodically after initial diagnosis expanded appreciably during follow-up ranging from 4.9 months to 15.2 years (mean 5.0 years, median 2.3 years).ConclusionsIsolated choroidal melanocytosis is a distinct clinical entity that must be distinguished from broad-based choroidal nevus, choroidal melanocytoma, small choroidal malignant melanoma, acquired bilateral patchy-streaky choroidal melanocytic fundopathy associated with disorders such as cutaneous vitiligo and Waardenburg syndrome, acquired bilateral zonal choroidal melanocytic fundopathy, and diffuse uveal melanocytic proliferation associated with systemic cancer. This disorder appears to predispose affected eyes to development of choroidal melanoma arising from the hypermelanotic patch.

Cutaneous vitiligo associated with hypovitaminosis D in Malayan flying foxes (Pteropus vampyrus) and Island flying foxes (Pteropus hypomelanus)

Eight Malayan flying foxes (Pteropus vampyrus) and three Island flying foxes (Pteropus hypomelanus) presented for varying degrees of skin depigmentation of the wing membranes, face and feet. Lesions were observed...

Prevalence of Ocular Findings in Patients with Vitiligo

Background: Vitiligo involves 1% of the population and is equally seen in all races and in both genders. It is a multifactorial polygenic disorder, although various hypotheses have been proposed including autoimmunity, viral infection, biochemical, neural and oxidant/antioxidant theories (oxygen radical species), yet the exact mechanism of the disease has not been yet established. Objectives: To evaluate the prevalence of ocular findings in patients with vitiligo and reveal risk factors or possible associations that might increase the risk of ocular manifestations. Patients and Methods: In this cross-sectional study, 92 patients previously diagnosed as cutaneous vitiligo referred to the dermatology clinic of Rassoul Akram Hospital from April 2007 to September 2008, were examined for ocular abnormalities. The data of the patients including age, gender, duration of vitiligo, positive family history, association with autoimmune diseases, and anatomic distribution of depigmented macules were recorded. Next, an ophthalmologist at the hospital’s ophthalmology clinic examined the patients to detect depigmentation of eyelids, poliosis and signs of uveitis as well as signs of retinal atrophy or hypopigmentation by a direct ophthalmoscope. Corneal sensation and intraocular pressure (IOP) were evaluated to rule out infection and glaucoma in patients with uveitis. All recorded data were analyzed by the Social Sciences Statistical Software (SPSS version 15) using Chi-square tests and t-test. Results: This cross-sectional study included 92 patients (47 male and 45 female) with mean age of 32.1 ± 13.16 years (ranging from nine to 61 years of age). Mean duration of vitiligo was 10.84 ± 10.17 years. The most common distribution of the lesions was on the upper limbs (60.8%) and the least was on the genital region (10.8%). Positive family history was found in 26 (28.3%) patients. Diabetes and Hypothyroidism were found in 10 (10.86%) and 9 (9.87%) patients, respectively. Ocular problems were discovered in 19 (20.7%) patients with mean age of 41.26 ± 10.7 years, including uveitis in 10 (10.9%), optic atrophy in 4 (4.3%) and retinal hypopigmentation in 5 (5.4%) patients. Mean age of cases with positive ocular findings was significantly higher than those without ocular findings (29.6 ± 12.7 years, P < 0.0001). Mean duration of vitiligo was significantly longer in patients with positive ocular findings than in those without ocular problems (8.84 ± 9.08 years, P < 0.0001). No statistical correlation was found between sex and ocular findings (P > 0.05). Ocular findings were statistically more in patients with positive family history of vitiligo (P = 0.001) and with associated autoimmune diseases (P = 0.01). No significant association was found between anatomical distribution of depigmented macules and ocular findings (P > 0.05). Conclusions: Ocular findings are important and assessable in patients with vitiligo. Older age and duration of vitiligo can increase the risk of ocular abnormalities and patients with positive family history and autoimmune disorders should be prioritized for screening.

Cutaneous Vitiligo Following Management of Uveal Melanoma in 6 Patients

The relationship of vitiligo to cutaneous melanoma is believed to be due to an immune response generated to melanoma antigens that cross-react with normal skin. There is little in the literature on the relationship between cutaneous vitiligo and uveal melanoma. To describe the clinical profile, treatment, and outcome in patients with uveal melanoma who subsequently developed cutaneous vitiligo. Retrospective case series of 6 patients with uveal melanoma who had developed cutaneous vitiligo and were examined at a tertiary eye care institution. Development of cutaneous vitiligo. The mean age at presentation was 62 years (range, 39-85 years). No patient had a personal history of cutaneous melanoma, autoimmune disease, or cutaneous vitiligo. The mean tumor basal diameter was 12.9 mm (median, 12.7 mm; range, 7-19 mm), with a mean thickness of 9.5 mm (median, 8.4 mm; range, 3-19 mm). Treatment included plaque radiotherapy in 4 patients and enucleation in 1 patient; 1 patient refused therapy. No patient had local tumor recurrence at the 71-month mean follow-up, but of the 3 patients who developed metastases at the 52-month mean follow-up, 2 were treated with a melanoma vaccine. The mean interval from initial presentation to onset of vitiligo was 77 months (range, 5-168 months). The vitiligo developed bilaterally with multiple well-defined lesions, affecting 5% to 40% of the cutaneous surface, generally in the upper body. During the 71-month mean follow-up (range, 4-205 months), there was 1 death. Patients with uveal melanoma can develop vitiligo spontaneously or following vaccine therapy. Involvement is multiple and bilateral, predominantly affecting the upper body.

Choroidal Vitiligo Masquerading as Large Choroidal Nevus: A Report of Four Cases

To describe 4 patients with choroidal vitiligo masquerading as large choroidal nevus. Retrospective chart review. Observational case series of 4 patients. Retrospective chart review. Clinical features. Four patients referred with the diagnosis of large choroidal nevus were found to have unilateral (n = 1) or bilateral (n = 3) extensive patchy choroidal depigmentation classified as choroidal vitiligo. There was no evidence of choroidal nevus, and the pigmented "lesion" proved to be normal choroidal pigment surrounded by a region of pigment absence (vitiligo). There was no evidence of ocular inflammation or related retinal or retinal pigment epithelial changes. The choroidal vitiligo was clinically flat and measured 12 to 24 mm diameter, involving the post-equatorial fundus in all cases. There were no related anterior segment abnormalities. Cutaneous vitiligo was present in all cases. There was no documented progression of the choroidal or cutaneous vitiligo over a maximum 2-year follow-up. Choroidal vitiligo is an idiopathic benign process that can involve large segments of the posterior choroid, leaving only patches of residual choroidal pigment, simulating, in reverse, a large choroidal nevus. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Hypopigmentary Fundus Changes With Cutaneous Vitiligo

Hypopigmentary Fundus Changes With Cutaneous Vitiligo

Omission of Author's Name and a Missing Middle Initial for an Author in: Hypopigmentary Fundus Changes Seen With Cutaneous Vitiligo

Omission of Author's Name and a Missing Middle Initial for an Author in: Hypopigmentary Fundus Changes Seen With Cutaneous Vitiligo

Hypopigmentary Fundus Changes Seen With Cutaneous Vitiligo

Hypopigmentary Fundus Changes Seen With Cutaneous Vitiligo

Vitiligo and ocular findings: a study on possible associations

In this study, we aimed to evaluate the ocular findings in vitiligo patients and reveal any clinical feature that might suggest an association or a risk factor. Very few reports in the literature are available about the ocular findings in vitiligo and the possible associations of the ocular findings in vitiligo patients have not been studied so far. A total of 45 patients with previously documented cutaneous vitiligo were examined for ocular findings. Demographic features including age, gender, duration of vitiligo, presence of associated autoimmune diseases, type of vitiligo and the anatomical distributions of vitiligo were recorded to evaluate a possible relationship with the ocular findings. Univariate and multivariate analyses as well as cluster analysis were performed. After description of the clusters, the Mann-Whitney U-test and Fisher's exact test were used to determine the variables. Concordance among the variables in each group was evaluated with the McNemar test. Ten patients had ocular findings that included anterior segment (iris) involvement, ring-like peripapillary atrophy around the optic nerve, atrophy of pigment epithelium, focal hypopigmented spots and diffuse hypopigmentation. The presence of periorbital vitiligo was significantly related to the ocular findings. Cluster analysis revealed concordances between periorbital and genitalial localizations of vitiligo and ocular findings. The number of patients and the range of ocular findings in our study are insufficient to make definite conclusions but anatomical localizations, primarily periorbital and to a lesser extent genitalial vitiligo, seem to be the most probably alerting features for ocular findings.

Magnetic Resonance Imaging in Vogt-Koyanagi-Harada Syndrome

Vogt - Koyanagi - Harada syndrome (VKH) is a multisystem disorder characterized by chronic bilateral non-rhegmatogenous retinal detachments and granulomatous uveitis associated with meningeal, auditory, and cutaneous findings. 1 The dermatologic findings (poliosis, alopecia, perilimbal and cutaneous vitiligo) and auditory disturbances (tinnitus, dysacousia, and vertigo) may occur weeks to months after the onset of the disease, making the initial diagnosis difficult. 1,2 We report a case where the diagnosis of VKH was aided by the use of surface coil magnetic resonance imaging (MRI). Report of a Case. —A 34-year-old woman of Hispanic/black descent presented with a 3-week history of progressive visual loss, metamorphopsia, photophobia, and headache. Best-corrected visual acuity was 20/400 OD and 20/200 OS. Slit-lamp examination showed 1+ anterior chamber and vitreous cells. Ophthalmoscopy disclosed focal yellow-white lesions at the level of the retinal pigment epithelium with multiple overlying areas of exudative retinal detachment in addition to a mild papillitis. Fluorescein