History Of Vitiligo Research Articles

Vitiligo-associated ocular abnormalities in Egyptian patients

Background Vitiligo is a skin disorder in which the melanocytes are destroyed. Melanocytes can be destroyed anywhere in the body, compromis ing the function of the organs where they are found. Melanocytes in the epidermis and the uveal tract share a common embryological origin in addition to physiological and morphological similarities. Objective To evaluate the vitiligo-associated ocular abnormalities in Egyptian patients. Patients and methods The study included 30 vitiligo patients and 30 age and sex-matched healthy volunteers as a control. Complete history taking, general, dermatological, and ophthalmic examination including visual acuity test and dilated fundoscopy were performed on all patients as well as controls. Results Regarding ocular changes, it was significantly higher in cases than controls. Also, there was a significant relation between the presence of ocular changes and certain types of vitiligo (the facial then the acrofacial). Moreover, there was a significant relation between VASI score and family history. Conclusions There is a reasonable percentage of Egyptian vitiligo patients who are found to have ocular changes. Also, there is an important relationship between ocular changes and the history of vitiligo in the family. It is possible to predict ocular changes in some patients because we know that they are associated with a certain type of vitiligo which is the facial then the acrofacial.

Radiotherapy-induced vitiligo in a patient with breast cancer, a case report.

Vitiligo is a disease characterised by the autoimmune destruction of melanocytes, manifesting as depigmentation of the skin. We present the case of a female patient with a history of breast cancer who developed vitiligo in the area of the treatment field 12 months after the end of radiotherapy. It has been reported in the literature that vitiligo can occur in patients with a history of vitiligo after radiotherapy, attributable to the Koebner phenomenon, where some treatments can induce new vitiligo lesions in the patient.

Early Canities among Undergraduate Medical Students of a Medical College: A Descriptive Cross-sectional Study

Early canities are the premature greying of hair before the age of 25 years in Asians. The condition is a matter of concern for young adults aesthetically. This study aimed to find out the prevalence of early canities among undergraduate medical students of a medical college. A descriptive cross-sectional study was carried out from 1 December 2021 to 30 June 2022 among undergraduate medical students at a medical college. The study was conducted after receiving ethical approval from the Institutional Review Committee [Reference number: 146(6-11)C-2 078/079]. The participants with ages less than 25 years without a history of vitiligo, intake of chemotherapeutic drugs, progeria, pangeria and recent dyeing of hair were enrolled. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Out of 235 students, 95 (40.42%) (34.15-46.69, 95% Confidence Interval) had early canities. The most prevalent premature greying was grade I early canities i.e.79 (83.15%) of participants. Among the participants with early canities, 56 (58.94%) were male, 41 (43.15%) had a positive family history for early canities, 67 (70.52%) had normal body mass index and 38 (40%) had O+ve blood group. The prevalence of early canities among undergraduate medical students was lower than in other studies done in similar settings. The grade I early canities was seen more among the participants with premature greying of hair. epidemiology; hair colour; medical students; physiology.

Pigmentary complications after non-medical male circumcision

BackgroundA wide spectrum of complications are reported after male circumcision (MC), the non-aesthetic complications are well known, but the pigmentary complications scale are not reported precisely.MethodsThis is a prospective cohort study of 550 circumcised boys; aged from 6 months to 14 years (62% aged 5 years) who were examined and appropriately investigated for the incidence of pigmentary complications after circumcision. Most diagnoses were clinically, but dermoscopy was done for 17 case and a skin biopsy for 14 cases. Patients with personal or family history of vitiligo, or congenital nevi were excluded. Available hospital records details and parents' statements were revised. The main outcome measures are the incidence of different pigmentary complications and circumcision details; data were analyzed by a non-parametric tests including the Mann–Whitney U test.Results69 cases had 72 confirmed pigmentary complications discovered at 2–36 months after commencement of circumcision (mean 18). 48 cases had pigmentary complications directly related to MC, 11 cases were probably related and 10 unrelated to MC. The most common lesion is the circular hyperpigmented scar (29 cases); liner hyperpigmented scar in 13, spotted exogenous melanosis in 18 cases, melanocytic nevi (7), hypopigmentation diagnosed in 3 cases, but kissing nevus is the rarest finding (2). Topical corticosteroid was tried in 15 cases, surgical excision of pigmented scar were done for 19 cases, local laser used for 4 resistant cases and reassurance with follow up for the rest.ConclusionPigmentary complications after male circumcision are not rare and its management is challenging.

Active vitiligo vulgaris following the administration of the Oxford–AstraZeneca (AZD1222) vaccine against SARS-CoV-2

Sir, There is significant uncertainty surrounding vaccines against COVID-19. Due to the critical need, these vaccines are being developed and approved at a uniquely fast pace [1]. Currently, the approved vaccines take their action by administering the host with sequences encoding the viral spike protein. This essentially means that these gene-therapy-based vaccines, whose long-term effects remain unknown, are going to be administered globally [2]. Therefore, despite their safety and efficacy demonstrated in respective clinical trials, it is reasonable to be cautious and adopt more intensive post-marketing vigilance [3]. A forty-nine-year-old diabetic male presented with asymptomatic, rapidly growing, leukodermal patches on the scalp (Fig. 1), which began to appear suddenly fourteen days following the administration of the first dose of the Oxford–AstraZeneca (AZD1222) vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patches were clinically consistent with vitiligo and were confirmed with their well-defined, ivory-white patches by Wood’s lamp examination (Fig. 2).There were no leucodermic patches anywhere else on the body, no family history of vitiligo, and no history of COVID-19 viral infection. After one week of reevaluation, the patch increased in size. The patient also presented with cellulitis on the right groin persistent for three days and was treated with an antibiotic with a follow-up. All baseline investigations, including a full blood count and renal and liver function tests, were normal. The patient is currently on follow-up. Cytokines play a role in regulating the immune response and the depigmentation process in vitiligo. There is an imbalance in cytokine levels in patients with vitiligo. IFN-g expression plays a role in the autoimmune process in vitiligo. The expression of the cytokine IFN-g is associated with melanocyte destruction in the active phase of vitiligo lesions [4]. IFN-g interacts with the viral receptor, resulting in the consequent reduction of several virus replicating, down-regulating genes and gene products [5]. Li et al. [6] demonstrated that IFNs are potential drug choices for SARS-CoV-2 infection. Here, we hypothesize that patients with non-segmental vitiligo (NSV), an autoimmune skin (and mucosal) disorder, may clear SARS-CoV-2 infection more efficiently and have a lower risk of COVID-19 development. Conversely, in the case of COVID-19 development, vitiligo autoimmunity may influence the cytokine storm-related disease burden. In addition, immune activation during SARS-CoV-2 infection or COVID-19 disease may increase vitiligo disease activity. Our hypothesis is based on the shift of the immune system in NSV toward adaptive type 1 (IFNg and CD8 T cells) and innate immune responses [7]. It is unclear whether the vitiligo in our patient was caused by vaccination, However, the temporal relationship between the vaccine and the development of the disease is interesting. We may, therefore, conclude that our patient had his latent vitiligo activated by the vaccine. Yet, further work is needed to demonstrate a causal relationship between vitiligo and COVID-19 vaccination. To the best of our knowledge, this is the first reported case of vitiligo associated with the administration of the Oxford–AstraZeneca (AZD1222) vaccine.

An observational study of Vitiligo

: Vitiligo is a common form of localised depigmentation. It is a non-contagious acquired condition resulting from the progressive loss of melanocytes which is characterised by totally amelanotic, non scaly, chalky-white macule with distinct margins.To study the clinical and epidemiological profile of vitiligo patients.: In this observational cross-sectional study total 40 vitiligo patients were included in this study. Detail history and clinical examination of patients were done.: In this study majority of the vitiligo patient belonged to the age group of 21-40 years. The mean age of vitiligo cases in this study was 24 years. In the present study the male: female ratio was 1:1. Among 40 cases, about 26 cases were unstable and only 14 were stable. In the present study, the most common type of vitiligo found was vulgaris type and the mean duration of disease in vitiligo cases was around 9 years. In our study, 10 patients had positive family history of vitiligo. Our observations are essentially consistent with the literature, there was no difference in clinico-epidemiological features of vitiligo.

Reduced risk of skin cancer and internal malignancies in vitiligo patients: a retrospective population-based cohort study in Taiwan

The relationship between cancer and vitiligo has been explored but with inconsistent results. To examine the long-term cancer risk in vitiligo patients, we conducted a retrospective nationwide cohort study. From the National Health Insurance Research Database of Taiwan, a total of 13,824 vitiligo patients were identified and matched with 55,296 reference subjects without vitiligo by age, gender, and propensity score estimated by major comorbidities from 1997 to 2013. Demographic characteristics and comorbidities were compared between these two groups. Incidence rate ratios and hazard ratios (HRs) were calculated to examine cancer risks. The 16-year incidence rates of overall cancers were 621.06 (566.56–675.55) and 726.99 (697.24–756.74) per 100,000 person-years in the vitiligo and reference groups. Patients with vitiligo showed a significantly decreased risk of overall cancers [adjusted HR, 0.85; 95% confidence interval (CI), 0.77 to 0.93, p < 0.001] compared with reference subjects without vitiligo after adjusting for age, sex, comorbidities, and treatments. The risks of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were significantly reduced (adjusted HR 0.21, 95% CI 0.11–0.38, p < 0.001), as well as internal malignancies (adjusted HR 0.89, 95% CI 0.81–0.99, p = 0.026). The results were consistent across different subgroups of patients, including male gender, ages more than 40 years, and those receiving long-term systemic disease-modifying antirheumatic drugs and phototherapies. Information related to phenotype, disease duration, vitiligo lesion sites, family history of vitiligo or cancer, occupation, and personal lifestyle was not included in the database. Vitiligo is associated with reduced risks of BCC and SCC, as well as internal malignancies.

Breast contracture and skin sclerosis following 20\xa0years of polyacrylamide hydrogel migration in a patient with familial vitiligo: a case report

BackgroundBreast augmentation with polyacrylamide gel (PAAG) injection was approved in China in 1998 and later banned in 2006. The ban ensued numerous complaints from patients such as pain, induration, deformation, infection, displacement, and milk deposition associated with PAAG injection. To date, no study has investigated the long-term effect of PAAG migration on autoimmune diseases.Case presentationWe report a rare case of a 49-year-old female patient with familial vitiligo who receiving PAAG injection for breast augmentation. The patient reported to have felt persistent movement of PAAG in her thoracoabdominal area for almost 20 years. Furthermore, the PAAG-induced chronic inflammation that aggravated vitiligo, which in turn promoted skin sclerosis. This damaged the breast contracture, increased chest tightness and induced mild breathing problems.ConclusionHere, we present a rare case in which a patient with a family history of vitiligo experienced long-term complications after receiving PAAG injection for breast augmentation. This case highlights the relationship between vitiligo, migration of PAAG and tissue hardening and skin contraction.Level of evidence: Level V

Syringocystadenoma Papilliferum Growth in a Nevus Sebaceous

A 24-year-old woman with a history of vitiligo and moderate intellectual disability had initially presented to her primary care provider for a pruritic, bleeding bump on her left parietal scalp. Photoclinic

Clinico epidemiological study of vitiligo in children

Vitiligo is a common acquired pigmentary disorder characterized by well defined hypopigmented or depigmented macules due to absence or decrease in melanocytes. To study the clinico epidemiological pattern of vitiligo in children. A group of 50 consecutive children attending out patient in the department of DVL at Shadan Institute of Medical Sciences will be included. All the patients meeting the inclusion criteria were taken into the study. A designed, coded proforma was used for recording all the findings. Almost half of the children taken for study belongs to age group of 9-11 years. Majority of the study population were females. The most common pattern of vitiligo was vitiligo vulgaris. Common site of involvement was lower limbs. The most common associated feature was leukotrichia. The most common associated condition was photosensitivity. Family history was positive in only 4% of cases. Most of them were in the active stage of disease. The female predominance was high in prevalence of vitiligo in children and an earlier age of onset seen among children with family history of vitiligo or autoimmune disorders. Vitiligo vulgaris is the most common presentation, and lower limbs being the most common site of involvement in children

1 125例非节段型白癜风皮损分布的相关因素分析

Objective To analyze correlations of the distribution of non-segmental vitiligo lesions with gender, age of onset, duration of disease, personal and family history of autoimmune diseases, family history of vitiligo, and so on. Methods Clinical data were collected from 1 125 patients with confirmed non-segmental vitiligo in Department of Dermatology, Beijing Hospital from January 2009 to January 2019, and analyzed retrospectively. Statistical analysis was carried out with SPSS 20.0 software by using independent-sample t test and chi- square test. Results Of the 1 125 patients with non-segmental vitiligo, 599 were males and 526 were females, with a male - to - female ratio of 1.14∶1. Their age of onset was 27.9 ± 17.1 years, and duration of disease was 5.2 ± 8.0 years. Skin lesions mostly occurred on the trunk (544 cases, 48.4%) and face (535 cases, 47.6%) , followed by acral regions (430 cases, 38.2%) , extremities (297 cases, 26.4%) and neck (231 cases, 20.5%) . The perioral region (17.2%) , hands (47.9%) and genital region (14.5%) in the 599 male patients were more frequently affected than those in the 526 females (9.7%, 22.6%, 6.3%, χ2 = 13.33, 77.66, 20.01, respectively, all P < 0.001) , while the neck (27.0%) was more frequently affected in the female patients than in the male patients (14.9%, χ2 = 25.29, P < 0.001) . The age of onset was significantly lower in the patients with vitiligo lesions involving the legs, knees, feet, trunk, genital and periocular regions than in those without skin lesions on the above corresponding body sites (all P < 0.05) , but significantly higher in the patients with vitiligo lesions involving the arms and hands than in those without lesions on the above 2 sites (both P < 0.05) . Vitiligo lesions more likely occurred on the hands of patients with a personal or family history of autoimmune thyroid diseases compared with those without the personal or family history (50.0% vs. 27.9%, χ2 = 6.62, P = 0.010) . The trunk was more frequently affected in the patients with a family history of vitiligo than in those without (59.6% vs. 45.7%, χ2 = 13.36, P < 0.001) . Conclusion The distribution of non-segmental vitiligo lesions are correlated to some extent with gender, age of onset, personal and family history of autoimmune diseases and family history of vitiligo. Key words: Vitiligo; Age distribution; Sex distribution; Non-segmental vitiligo; Distribution pattern; Autoimmune diseases; Family history

Efficacy and Safety of Lanabecestat for Treatment of Early and Mild Alzheimer Disease

Alzheimer disease (AD) is a neurodegenerative disorder characterized by cognitive deterioration and impaired activities of daily living. Current treatments provide only minor symptomatic improvements with limited benefit duration. Lanabecestat, a brain-permeable inhibitor of human beta-site amyloid precursor protein-cleaving enzyme 1 (BACE1/β-secretase), was developed to modify the clinical course of AD by slowing disease progression. To assess whether lanabecestat slows the progression of AD compared with placebo in patients with early AD (mild cognitive impairment) and mild AD dementia. AMARANTH (first patient visit on September 30, 2014; last patient visit on October 4, 2018) and DAYBREAK-ALZ (first patient visit on July 1, 2016; last patient visit on September 28, 2018) were randomized, placebo-controlled, phase 2/3 and phase 3 clinical trials lasting 104 weeks and 78 weeks, respectively. AMARANTH and DAYBREAK-ALZ were multicenter, global, double-blind studies conducted at 257 and 251 centers, respectively, located in 15 and 18 countries or territories, respectively. A population-based sample of men and women aged 55 to 85 years who met National Institute on Aging-Alzheimer's Association criteria for early AD or mild AD dementia was screened using cognitive assessments, and the presence of amyloid was confirmed. Patients were excluded for unstable medical conditions or medication use, significant cerebrovascular pathologic findings, or a history of vitiligo and/or current evidence of postinflammatory hypopigmentation. AMARANTH screened 6871 patients; 2218 (32.3%) were randomized, and 539 patients completed the study. DAYBREAK-ALZ screened 5706 patients; 1722 (30.2%) were randomized, and 76 patients completed the study. Patients were randomized (1:1:1) to once-daily oral doses of lanabecestat (20 mg), lanabecestat (50 mg), or placebo. The primary outcome measure was change from baseline on the 13-item Alzheimer Disease Assessment Scale-cognitive subscale. Secondary outcomes included Alzheimer's Disease Cooperative Study-Instrumental Activities of Daily Living Inventory, Clinical Dementia Rating, Functional Activities Questionnaire, Mini-Mental State Examination, and Neuropsychiatric Inventory. Efficacy analyses were conducted on the intent-to-treat population. Among 2218 AMARANTH patients, the mean (SD) age was 71.3 (7.1) years, and 1177 of 2218 (53.1%) were women. Among 1722 DAYBREAK-ALZ patients, the mean (SD) age was 72.3 (7.0) years, and 1023 of 1722 (59.4%) were women. Both studies were terminated early after futility analysis. There were no consistent, reproducible dose-related findings on primary or secondary efficacy measures. Psychiatric adverse events, weight loss, and hair color changes were reported in a higher percentage of patients receiving lanabecestat than placebo. Treatment with lanabecestat was well tolerated and did not slow cognitive or functional decline. ClinicalTrials.gov identifiers: NCT02245737 and NCT02783573.

Decreased serum levels of immunoglobulin M and increased complement 3 in Egyptian vitiligo patients

Background Vitiligo is a common, acquired, depigmenting disorder that results from loss of functional melanocytes in the skin and mucous membranes. It is occasionally associated with autoantibodies against the melanocyte-specific proteins such as tyrosine-related protein-1 tyrosine-related protein-2. These antibodies could induce melanocyte damage in vitro by a complement-mediated mechanism and antibody-dependent cellular cytotoxicity might play an active role in the stimulation and inappropriate expression of HLA-DR and induction of intercellular adhesion molecule-1 on melanocytes. Objective Our aim was to assess the serum levels of different immunoglobulins (Ig) in addition to C3 and C4 in vitiligo patients and to determine their correlation with different clinical aspects of the disease. Patients and methods Serum levels of IgG, IgA, and IgM as well as C3 and C4 were estimated in 24 vitiligo patients and 24 healthy controls using the Radial Immuno-Diffusion (immunoprecipitation) technique. Results Serum IgM levels were found to be significantly decreased and C3 levels were significantly increased among patients compared with the controls. No significant difference was found in the serum levels of IgA, IgG, or C4 between both groups. Also, a significant positive correlation was found between serum IgA levels and the age of the patients, as well as between C3 and C4 and a family history of vitiligo. Conclusion Changes in Ig serum levels might be a cause or an effect in the pathogenesis of vitiligo, as well as alterations in the complement system. These ffindings suggest that altered immunity is to be considered in the therapeutic management of these patients.

Generalized eruptive keratoacanthoma with vitiligo followed by the development of prurigo nodularis: A case report and published work review.

Herein, we report a unique case of generalized eruptive keratoacanthoma (GEKA) in a 47-year-old Chinese man presenting with extensive pruritic papules and nodules accompanied by oral lesions. He also had a 2-year history of vitiligo and long-term experience of working outdoors. Biopsies were consistent with keratoacanthoma . Interestingly, prurigo nodularis (PN) was found in histopathology at 1-year follow up. To our knowledge, this is the first report describing a case of GEKA with oral lesions complicated with vitiligo and developed with PN.

Isolated Angiotensin Converting Enzyme (ACE) Inhibitor Induced Small Bowel Angioedema After 10 Years of Oral Lisinopril Therapy

A 65-year-old male presented to the emergency room for one episode of “coffee colored” emesis and nausea 5 hours prior to admission. He has a history of Vitiligo and hypertension for which he has been taking Lisinopril for 10 years. He has had occasional abdominal pain over the last few years for which he has been placed on protonix. He has no prior surgical history and is otherwise healthy. On physical exam he had hypoactive bowel sounds, minimal generalized tenderness with no guarding or rebound. Laboratory studies revealed leukocytosis (18.6 k/uL) with neutrophilia (83%). An abdominal computed tomography (CT) scan revealed segments of edema and elongation of loops of small bowel with associated wall thickening consistent with the diagnosis. Isolated ACE Inhibitor angioedema of the small intestine is a rare phenomenon, with limited case representation in the literature. In the time period 1982-2010 there have been only 27 individual case reports documenting ACE inhibitor associated small bowel angioedema. Upon further review, in the period between 2011-2016 there were 17 additional case reports in the literature. The majority of cases reported were associated with Lisinopril (35) and Enalapril (4). In a retrospective study conducted on 20 patients from two separate facilities from 1996 through 2012 with clinical consistent with ACE inhibitor angioedema of the small bowel, 19/20 were taking Lisinopril, and one with Enalapril2. The average patient was a middle aged female presenting with acute abdominal symptoms including nausea, vomiting and abdominal pain with a mild leukocytosis. The diagnosis was made by CT of the abdomen and pelvis with characteristic finings of isolated small bowel wall thickening, edema, and straightening with abdominal ascites present1,2,3. 1 Vedra A. Augenstein, MD B. Todd Heniford, MD Ronald F. Sing, DO Intestinal Angioedema Induced by Angiotensin-Converting Enzyme Inhibitors: An Underrecognized Cause of Abdominal Pain? The Journal of the American Osteopathic Association March 2013 | Vol 113 | No. 3 2 Christopher D. Scheirey, Francis J Scholz, Michael J Shortsleeve, Douglas S. Katz. Angiotensin-Convertin Eznyme Inhibitor-Induced Small Boel Anioedema: Clinical and Imaging Findins in 20 Patients. American Journal of Roentgenology. 2011;197: 393-398. 10.2214/AJR.10.4451 3.Campbell T, Peckler B, Hackstadt RD, Payor A. ACE inhibitor induced angioedema of the bowel. Case Report Med. 2010;2010:1-4.Figure 1

Liver X Receptor-α polymorphisms (rs11039155 and rs2279238) are associated with susceptibility to vitiligo

Vitiligo is a complex genetic skin depigmentation disorder caused by the destruction of melanocyte from the lesional site. Liver X Receptor-α (LXR-α) expression is upregulated in the melanocytes from perilesional skin as compared to the normal skin of vitiligo patient suggesting its involvement in vitiligo pathogenesis. Polymorphisms in LXR-α have been associated with several diseases including cardiovascular disease, polycystic ovary syndrome, cancer, inflammatory bowel disease and diabetes. In this study, for the first time, we have investigated the association of LXR-α gene polymorphisms and risk of vitiligo. Sixty six vitiligo patients and 75 matched healthy control subjects who did not have any history of vitiligo or any other autoimmune disorder were recruited. The DNA isolated from patients and healthy controls was genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) for both rs11039155 (−6 G>A) and rs2279238 (+1257 C>T) variants. Our data suggest significant association between the LXR-α gene polymorphisms and vitiligo susceptibility (rs11039155: odds ratio (OR)=1.99, 95% CI=1.07–3.71, p=0.03; rs2279238: OR=1.70, 95% CI=1.06–2.73, p=0.027). Our results provide an evidence that the LXR-α −6A and +1257T alleles contribute to risk of vitiligo in North Indian population and highlight the importance of this gene in the vitiligo pathogenesis.

Understanding Of Nepalese Patients With Vitiligo About Their Disease

Introduction: Vitiligo, a pigmentary disorder, may influence considerably patients’ health-related quality of life (QoL) and psychological wellbeing. Previous reports indicated that the patients' illness understandings influence adherence behaviors and actions in various chronic dermatological conditions. Objectives: To know the understanding of Nepalese patients with vitiligo about their disease by using illness perception questionnaire and also to investigate the potential factors that might influence it. Material and Methods: The illness perception questionnaire consisting of 25 questions about causes, timeline, consequences and control of disease were given to 154 patients with vitiligo of 13 years or more age attending the dermatology OPD. Results: A total of 146 patients completed the questionnaire. The belief about the causes of vitiligo was considered as “germs or virus” by 64.4% patients while half of the patients believed that vitiligo was due to “chance or fate”. Vitiligo was considered to be a serious condition (83.6%) and have had serious consequences on their life (63%). Approximately half of the patients believed that their disease had serious economic and financial consequences more so in female patients and in those with generalized disease. Although 43.8% patients believed that their illness was likely to be permanent rather than temporary, 75% patients believed that vitiligo would improve with the time and their treatments were effective (75.3%). However, females felt that there were very little that could be done to improve their vitiligo. Conclusion: The knowledge about vitiligo is unsatisfactory and needs accessible, accurate, community based education about the natural history of vitiligo and the effectiveness of treatment. DOI: http://dx.doi.org/10.3126/njdvl.v12i1.10590 Nepal Journal of Dermatology, Venereology &amp; Leprology Vol.12(1) 2014 pp.7-13

Profile of childhood vitiligo with associated ocular abnormalities in South India

Background: Vitiligo is a systemic autoimmune disease due to the loss of melanocytes from the epidermis. Very few reports in the literature are available about the ocular findings and associated cutaneous abnormalities in childhood vitiligo. Aims: Objective of this study was to evaluate the ocular findings, various clinical characteristics and associated cutaneous abnormalities of childhood vitiligo. Materials and Methods: We retrospectively analyzed the clinical data of children with vitiligo who presented to the Dermatology Outpatient Department from August 2011 to August 2014. All patients were assessed for the natural history, clinical characteristics, family history, and associated ocular and cutaneous abnormalities. Results: Of the total 180 children with vitiligo studied, 64 (35.6%) were boys and 116 (64.4%) were girls. The mean current age of the children visiting our hospital was 8 years. History of trauma prior to the onset of vitiligo was present in 13 patients (7.2%). The family history of vitiligo was present in 37 patients (20.6%). Most common clinical type of vitiligo seen in our patients was vitiligo vulgaris (n = 68, 37.8%), followed by segmental (n = 41, 22.8%). The most common site of initial lesion was head and neck followed by lower limbs. Leukotrichia was seen in 65 patients (36.1%), while Koebner phenomenon was observed in 48 children (26.7%). Vitiligo disease activity (VIDA) score of +4 was most commonly seen in 108 patients (60%), followed by +3 seen in 20 patients (11.1%). VIDA score 0 and −1 were seen in 15 (8.3%) and 22 (12.2%) patients, respectively. Cutaneous associations with vitiligo were found in 24 patients (13.3%). These were halo nevi in nine patients (5%), atopic dermatitis in six patients (3.3%), alopecia areata in four patients (2.2%), premature canities in three patients (1.7%), and nevus depigmentosus and lichen nitidus in one patient each (0.6%). Thirty-eight patients (21.1%) were found to have periocular depigmentation. Depigmented spots in the iris were seen in two patients (1.1%). Other findings were lamellar cataract and persistent papillary membrane in one patient each (0.6%). Conclusion: Childhood vitiligo in our study showed preponderance in females. Majority of patients (77.9%) had <5% body surface area involvement. Limited number of patients with ocular findings in comparison with adult population might suggest that childhood vitiligo patients do not have ocular pigmentary abnormalities in the beginning, but as they age or as the disease progresses they may develop ocular pigmentary changes. Anatomical localization of vitiligo to periorbital area may alert us to look for ocular findings.

Amyloidosis Cutis Dyschromica: A Rare Reticulate Pigmentary Dermatosis.

We are reporting a rare case of amyloidosis cutis dyschromica in a 41-year-old man. This is a rare form of primary cutaneous amyloidosis characterized by reticulate pigmentation with hypopigmented and hyperpigmented macules, onset in childhood, familial tendency in some, occasional mild itching and deposition of amyloid in the papillary dermis. Our case also had multiple bilaterally symmetrical hyperpigmented keratotic papules abutting the axillary vault resembling those seen in Dowling–Deogs disease. The other unusual feature in this patient was the strong family history of vitiligo, which we are unable to explain. We have also tried to explain the mechanism leading to the hyperpigmentation and hypopigmentation in amyloidosis cutis dyschromica.

Gender Differences in Clinicoepidemiological Features of Vitiligo: A Cross-Sectional Analysis

Background. Vitiligo has important clinical and social consequences particularly in the pigmented skin. The present study was conducted to assess the differences in clinicoepidemiological presentation of vitiligo in males and females and to understand the factors associated with spread of vitiligo in them. Methods. This is a cross-sectional analysis of secondary clinical data of 168 vitiligo patients at a tertiary medical centre at Navi Mumbai. We used logistic regression models to estimate the association between gender and clinical characteristics of vitiligo and to evaluate the factors associated with spread of vitiligo. Results. There were no significant differences between the mean ages of males and females; however, males reported a longer duration of disease (6.9 (10.4) years) compared with females (4.9 (7.4) years). Males were significantly more likely to report a family history of vitiligo compared with females (adjusted OR (aOR): 16.87, 95% CI: 2.16 to 131.69). Even though females were more likely to report spread of lesions, the association was not statistically significant (OR: 1.21, 95% CI: 0.62 to 2.36). Discussion. The differences in the clinical presentations between genders highlight the need to understand the different factors (possibly genetic) that may play a part in the pathogenesis of this multifactorial disease in males and females.