Vitiligo Clinic Research Articles

Study of thyroid disorders in vitiligo.

Vitiligo, an acquired sometimes familial depigmentary disorder of the skin and hair that results from selective destruction of melanocytes or pigment cells. It is the single most important non-neo plastic disease that involves both the immune system and melanocytes which are subsequently destroyed and the affected area turns pale and becomes white. The prevalence of the disease is between 1% and 2% in general population. It is a prospective, randomized, and controlled study. Over 90 vitiligo patients attending Dermatology OPD and vitiligo clinic are enrolled in the study. About 35 apparently healthy, age and sex matched individuals are selected to serve as control. A prescribed proforma containing all the demographic data, relevant questionnaire were recorded for each and every case with brief clinical history suggestive of any thyroid disease as well as those referred by the clinicians. P value <0.05 is considered significant. The Quantitative Determination of Thyroglobulin (Tg) Autoantibodies in Human Serum or Plasma by a Microplate Enzyme Immunoassay. Vitiligo group, thirty four (37.78%) patients have clinical hypothyroidism while 9 (10%) patients have clinical hyperthyroidism. This difference in the distribution is statistically significant (P < 0.05) with a Chi-square value of 10.08. The data are entered, analyzed and computed with SPSS version 15 software and well-known statistical test like Chi-square, students' 't' test have been advocated wherever found applicable. P value <0.05 is considered significant. There is increased incidence of autoimmune thyroid diseases among vitiligo patients. The reason being vitiligo usually precedes the onset of thyroid dysfunction.

SCREENING OF THYROID AUTOANTIBODIES ANTI-TG, ANTI-TPO AND ITS CORRELATION WITH CLINICAL THYROID DISEASES IN VITILIGO IN THE NORTH-EASTERN REGION OF INDIA

Background and aims: Vitiligo is an acquired sometimes familial depigmentary disorder of the skin and hair that results from selective destruction of melanocytes or pigment cells. It is the single most important non-neo plastic disease that involves both the immune system and melanocytes which are subsequently destroyed and the affected area turns pale and becomes white. The precise cause of vitiligo is complex but some evidences are always suggesting that it is caused by a combination of autoimmune, genetic and environmental factors. Over half of the people with vitiligo have acquired some loss of pigment cells before the age of 20 years. The prevalence of the disease is between 1-2% in general population. Therefore, the present study is taken up to evaluate the prevalence of thyroid diseases in vitiligo patients. Methods:It is a prospective, randomized and controlled study. 90 vitiligo patients attending the Dermatology OPD and vitiligo clinic are enrolled in the study. Thirty five apparently healthy, age and sex matched individuals are selected to serve as control. A prescribed proforma containing all the demographic data, relevant questionnaire were recorded for each and every case with brief clinical history suggestive of any thyroid disease as well as those referred by the clinicians.interpretationsare made. P value &lt; 0.05 is considered significant. The Quantitative Determination of Thyroglobulin (Tg) Autoantibodies in Human Serum or Plasma by a Microplate Enzyme Immunoassay. Results:Vitiligo group, thirty four (37.78%) patients have clinical hypothyroidism while 9(10%) patients have clinical hyperthyroidism. This difference in the distribution is statistically significant (P&lt;0.05) with a chi-square value of 10.08. The datas are entered, analysed and computed with SPSS version 15 software and well known statistical test like Chi-square, students t test have been advocated wherever found applicable. The necessary interpretations are made. P value &lt; 0.05 is considered significant. Conclusion:There is increased incidence of autoimmune thyroid diseases among vitiligopatients. Various thyroid antibodies were detected in thyroid disorders, suggesting that these thyroid antibodies could act as sensitive markers for detection of early and subclinical autoimmune disorders of thyroid gland including Graves disease and Hashimotos thyroiditis. The reason beingvitiligo usually precedes the onset of thyroid dysfunction. Therefore, these thyroid autoantibodies specially anti-TPO, anti-TG should be included along with thyroid parameters TSH, T3,T4 in routine investigation of vitiligo, as association of vitiligo with autoimmune thyroid disease is very much common in the North - Eastern region of India.

Evaluation of Ocular Findings in Vitiligo

Vitiligo is a pigmentary disorder of the skin and mucous membranes with worldwide incidence of 0.5-2%. The aim of this cross sectional study was to assess the ocular involvement in vitiligo patients. Two hundred patients clinically diagnosed vitiligo attending vitiligo clinic, dermatology department, Jomhorya hospital, Benghazi-Libya over a period of 6 months enrolled in this cross-sectional study. All patients were exposed to detailed disease history and thorough dermatological examination. Out of the total cases, 100 patients had a standard Ophthalmologic examination in cooperation with an ophthalmologist in Benghazi eye hospital. Results of our study showed a slightly higher prevalence of vitiligo in females (male: female ratio 1:2.8). The mean age of onset for males was 22.4 years and for females 24.8 years and 58.5% of patients develop vitiligo below 20 years of age. Generalized vitiligo was the commonest clinical type of vitiligo (57.5%). The relationship between the duration of the disease and its type was statistically significant (P&lt;0.05), there was also a significant relationship between the type of vitiligo and its severity (P&lt; 0.01). Sixteen patients (8%) had segmental vitiligo and the face was the common site involved. The lower limbs were the most commonly affected sites of the body (57%). Ocular changes were seen in 40% of patients and specific ocular abnormalities like uveitis, iritis, and iris and retinal pigmentary abnormalities are present in 15% of patients, nonspecific ocular abnormalities were present in 33% of patients. There was no statistically significant correlation between specific ocular abnormalities, severity and duration of vitiligo.

The Effect of Platelet Rich Plasma on the Treatment Outcome of Minigraft/NB-UVB Therapy in Stable Vitiligo: Clinical Evaluation and Effect on Tissue levels of bFGF

Abstract Background Vitiligo is an acquired pigmentary disorder resulting from loss of melanocytes which causes depigmentation of the skin. Clinically, it is characterized by the progressive loss of melanocytes causing the appearance of well-circumscribed milky white cutaneous macules and patches Aim of the Work to evaluate the efficacy of PRP as an additive treatment to the minigraft/NB-UVB treatments for stable localized vitiligo and the effect of this treatment on the expression of bFGF in the lesional treated vitiliginous skin compared before and after the course of treatment. Patients and Methods The study represents a prospective interventional comparative study. It was conducted on 17 patients diagnosed as stable vitiligo. All patients were selected from the dermatology outpatient vitiligo clinic of Ain-Shams University hospital from April 2018 to June 2019. All subjects who participated in this study gave written informed consents. The study was approved by the research ethical committee of Ain-Shams University (Approval Number: FWA 000017585) and fulfilled all the ethical aspects required in human research. Results We found that the addition of PRP to minigraft resulted in earlier repigmentation as assessed by VESTA score; however, at the follow up end (one month following the end of treatment), both modalities resulted in a similar response as regards the repigmentation percent and improvement in VESTA score. The addition of the PRP to the minigraft didn’t result in a superior improvement than minigraft alone. Conclusion Both minigraft and PRP-assisted minigraft followed by NB-UVB sessions are effective method to induce repigmentation in stable vitiligo.

Patient satisfaction and physician productivity in shared medical appointments for vitiligo

The shared medical appointment (SMA) allows patients with a similar diagnosis to be simultaneously cared for and educated by 1 provider, which has had success in dermatology and other fields of specialty. The SMA provides a potential solution to improve patient access to dermatologists. The purpose of this study was to implement the SMA for patients with vitiligo and compare it to traditional appointments with regard to patient satisfaction, time to appointment, number of new patients seen per month, and generated revenue. A vitiligo SMA was implemented, and a 12-question survey was used to assess satisfaction in both SMA and traditional appointment settings. Satisfaction, revenue, and appointment logistic data for SMAs were compared with those for traditional appointments for new patients. Patients were highly satisfied with both SMAs and traditional appointments (P>.05). Time to appointment was faster for the SMA, and significantly more new patients were seen monthly with the SMA (P=.009). Limitations include small sample size, inability to correlate responder characteristics with survey responses, potential response bias, and selection bias due to absence of randomization. SMAs were successful in a vitiligo clinic for both patient and provider. The SMA is a solution to improve access to dermatologists without compromising patient benefit, experience, orsatisfaction.

Vitiligo and Psychiatric Morbidity: A Profile from a Vitiligo Clinic of a Rural-based Tertiary Care Center of Eastern India.

Background:Vitiligo is an idiopathic acquired progressive de/hypopigmentary disorder of skin and mucosae. In Indian skin depigmentaion is very much obvious and can cause psychological distress, low self esteem and social stigmatization.Aims:The primary objective of this study was to evaluate the psychiatric morbidity in vitiligo patients and secondary objective was to assess the morbidity in all eight dimensions of psychosocial and physical aspects, i.e. cognitive, social, discomfort, limitations, depression, fear, embarrassment and anger.Materials and Methods:An institution based case-control study with sixty-one patients of vitiligo and equal number of healthy age and sex matched controls was undertaken. The self-reporting questionnaire-24 (SRQ-24) and skindex (A 61-item survey questionnaire) were used to assess the psychiatric morbidity in both the groups.Results:The SRQ-assessed psychiatric morbidity in the study group was 63.93%, compared with 24.59% in the control group (P<0.0001). Acral vitiligo had maximum association with psychiatric morbidity (86.67%) followed by vitiligo vulgaris (68%), mucosal vitiligo (62.5%) and others. According to the skindex, the most common psychiatric morbidity in vitiligo patients was depression (62.29%) followed by embarrassment (55.73%), social problem (54.09%), cognitive impairment (50.81%), physical limitation (47.54%), discomfort (40.98%), anger (36.06%) and fear (24.59%). The difference in Skindex scoring that marked the psychiatric morbidity among the case and control groups was statistically significant for depression, discomfort, social problem, cognitive impairment, embarrassment (P<0.0001) and physical limitation (P=0.0044).Conclusion:Vitiligo has a high degree of psychiatric morbidity.

Treatment of vitiligo with 308-nm excimer laser: our experience from a 2-year follow-up of 979 Chinese patients.

The 308-nm excimer laser had been proved to be a time-efficient and potent therapeutic alternative for the management of vitiligo. Different results had been reported in different ethnic populations. To investigate the efficacy and related contributing factors of 308-nm excimer laser in Chinese vitiligo patients. A total of 979 Chinese patients (3478 lesions) with progressive-stage vitiligo who had received 308-nm excimer laser treatment were recruited from the vitiligo clinic of Shandong Provincial Hospital of Dermatology &Venereology from 2012 to 2014. Efficacy of treatment was evaluated at the end of session by two independent dermatologists based on the before and after images taken. Repigmentation was graded on a 4-point scale: grade 1, poor repigmentation (0-25%); grade 2, moderate repigmentation (26-50%); grade 3, good repigmentation (51-75%); grade 4, excellent repigmentation (76-100%). The mean grade of repigmentation was 2.29, 44.22% showed less than 25% repigmentation, 16.27% showed 26-50% repigmentation, 5.95% showed 51-75% repigmentation and 33.55% showed more than 76% repigmentation. The repigmentation of facial lesions was better than lesions located elsewhere (P < 0.0001), the best response was noted in the periorbital region, while lesions on hands and feet showed poor repigmentation (P < 0.0001). The degree of repigmentation was negatively correlated with disease duration (r = -0.268, P < 0.001), age (r = -0.095, P < 0.001) and shape of lesions (r = -0.114, P < 0.001), whereas it was positively correlated with treatment frequency (r = 0.270, P < 0.001). Lesions with concurrent poliosis were more likely resistant to treatments. 308-nm excimer laser appears to be an effective and safe treatment in Chinese vitiligo patients. The clinical response and treatment efficacy was affected by many factors such as age, affected anatomical area, shape of the lesion, disease duration and treatment frequencies.

Follicular vitiligo: A report of 8 cases

Follicular vitiligo, a recently proposed new subtype of vitiligo, has primary involvement of the hair follicle melanocytic reservoir. We sought to characterize follicular vitiligo through a case series of 8 patients. Patients with features of follicular vitiligo who were seen at the vitiligo clinic in the National Center for Rare Skin Disorders in Bordeaux, France, were recruited. A retrospective review of case records and clinical photographs was carried out. There were 8 male patients with a mean age of 48years. All patients reported significant whitening of their body and, in some, scalp hairs before cutaneous depigmentation. Examination revealed classic generalized depigmented lesions of vitiligo and an impressive presence of leukotrichia, not only in the vitiliginous areas, but also in areas with clinically normal-appearing skin. Punch biopsy specimen of the leukotrichia and vitiligo lesions demonstrated loss of melanocytes and precursors in the basal epidermis and hair follicle. This was a cross-sectional study based on a single-center experience. Follicular vitiligo is a distinct entity within the spectrum of vitiligo. This entity may serve as the missing link between alopecia areata and vitiligo, with probable physiopathological similarities between these conditions.

Psychological Morbidity in Vitiligo-A Case Control Study

Background: Vitiligo is associated with various psychiatric comorbidities. Various studies have showed prevalence ranging from 34% to 75%. Vitiligo can greatly affect the quality of life of patients and psychiatric comorbidities can further worsen it. Thus there is need to recognise psychiatric comorbidities and treat them in these patients. Aims: The aims of our study were to determine the psychiatric morbidity and the Quality of Life (QOL) in patients suffering from vitiligo and to determine the factors related with psychiatric morbidity and those affecting the QOL in these patients. Methods: 50 patients of age range 18 – 65 years with disease duration of 1-26 years attending the vitiligo clinic in dermatology outpatient department of a tertiary care hospital were included and 50 persons with no dermatological or diagnosed psychiatric illness accompanying them served as control group. They were diagnosed for psychiatric disorders as per DSM-IV TR, if present. Scales used were Body Surface Area (BSA), WHO-Quality of Life (WHO-QOL) scale, General Health Questionnaire (GHQ), Hamilton rating scales for Anxiety and Depression (HAM-A and HAM-D). Results: 30% patients in vitiligo group suffered from psychiatric disorder, depression was present in 20% of patients and 8% had anxiety disorders. QOL scores had negative correlation with BSA, GHQ, HAM-A and HAM-D scores and they were statistically significant. Conclusions: Thus it was found that vitiligo patients had more psychiatric comorbidities as compared to control group and it had bearing on their quality of life too.

Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms

Vitiligo/nonsegmental vitiligo (NSV) is often associated with thyroid dysimmunity although very few reports have studied this association using multivariate logistic regression. To identify weighted factors associated with the presence of autoimmune thyroid disease (AITD) in a large cohort of patients with vitiligo/NSV. This was a prospective observational study in 626 patients with a confirmed diagnosis of vitiligo/NSV attending the vitiligo clinic of the University Hospital Department of Dermatology, Bordeaux, France, from 1 January 2006 to 1 May 2012. The Vitiligo European Task Force (VETF) questionnaire was completed for each consecutive patient. AITD was defined as the presence of significant levels of serum antithyroperoxidase antibodies or evidence of autoimmune thyroiditis. Univariate and multivariate logistic regression procedures were conducted to identify factors associated with AITD in this cohort of patients with vitiligo/NSV. A total of 626 patients with vitiligo/NSV were included, of whom 131 had AITD (AITD-vitiligo). Stress as an onset factor, familial history of AITD, body surface involvement and duration of the disease were positively associated with AITD-vitiligo using univariate analysis, whereas female sex, age at onset of vitiligo, personal history of autoimmune disease and localization on the trunk were found to be independently associated with AITD-vitiligo. Vitiligo associated with AITD has clinical features distinct from vitiligo without AITD. In particular, female patients, and patients with longer duration of disease and greater body surface involvement are more likely to present with AITD and should thus be monitored for thyroid function and antithyroid antibodies on a regular basis.

Halo Nevi Association in Nonsegmental Vitiligo Affects Age at Onset and Depigmentation Pattern

To compare factors associated with halo nevi with nonsegmental vitiligo (NSV) vs NSV alone. Prospective observational study in 553 patients with a confirmed diagnosis of NSV attending a vitiligo clinic between January 1, 2006, and July 1, 2010. Vitiligo Clinic at the Department of Dermatology, University Hospital Center of Bordeaux, Bordeaux, France. The Vitiligo European Task Force questionnaire was informed for each patient attending the clinic with a confirmed diagnosis of NSV after the exclusion of other forms of vitiligo (focal, mucosal, and not classifiable). Thyroid function and antithyroid antibodies were screened if not obtained in the previous year. Extent of disease and markers of autoimmunity or autoinflammation. Of the 553 patients, 130 had halo nevi-NSV and 423 had NSV. Family history of premature hair graying (odds ratio, 1.74; P < .01) was positively associated with halo nevi-NSV by univariate analysis. Using multivariate analysis, age at onset younger than 18 years, phototype, total body area, localization on the trunk, involvement of hands and feet, and total staging were found to be independent factors. Age at onset younger than 18 years; phototypes I, II, and III; trunk involvement; and staging were positively associated with halo nevi-NSV, whereas this association was negative for total affected area and involvement of hands and feet. Halo nevi association in NSV affects age at onset and depigmentation pattern and has a stronger link with familial premature hair graying, suggesting that premature hair graying may involve, at least partly, an autoimmune pathway.

Halo naevi and leukotrichia are strong predictors of the passage to mixed vitiligo in a subgroup of segmental vitiligo

Until now, segmental vitiligo has been considered as a stable entity and mixed vitiligo, the association of segmental and nonsegmental vitiligo, has been reported rarely. The aim of this study was to search for factors associated with the generalization of vitiligo in patients with segmental vitiligo. This was a prospective observational study conducted in the vitiligo clinic of the Department of Dermatology of Bordeaux, France. The Vitiligo European Task Force questionnaire was completed for each patient attending the clinic with a confirmed diagnosis of segmental vitiligo after exclusion of other forms of vitiligo (focal, mucosal, not classifiable.) Thyroid function and antithyroid antibodies were screened if not obtained in the previous year. One hundred and twenty-seven patients were recruited: 101 had segmental vitiligo and 26 had segmental vitiligo that evolved into mixed vitiligo; 56 were male and 71 were female. Most patients had onset of segmental vitiligo before the age of 18. When conducting multivariate analysis, we found the following to be independent factors associated with the evolution of patients' disease from segmental vitiligo to mixed vitiligo: initial percentage of body surface involvement of the segment >1% [odds ratio (OR) 15·14, P=0·002], the presence of halo naevi (OR 24·82, P=0·0001) and leukotrichia (OR 25·73, P=0·0009). Halo naevi association and leukotrichia at first consultation in segmental vitiligo are risk factors for the progression of segmental vitiligo to mixed vitiligo. In addition, this progression of segmental vitiligo to mixed vitiligo carries a stronger link if initial segmental involvement is situated on the trunk.

Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics

Vitiligo onset during childhood is common. There are limited data regarding childhood-onset vitiligo. We sought to provide an epidemiologic and clinical comparison between childhood- and later-onset vitiligo. Two groups of patients were included in this cross-sectional study. Consecutive patients examined at the Vitiligo Clinic of Andreas Sygros Hospital for Skin and Venereal Diseases, Athens, Greece, from January 2005 to December 2009 with a disease onset before the age of 12 years were included in the childhood-onset group. The later-onset group included randomly selected patients who were examined at the same period and had a disease onset after the age of 12 years. After clinical examination, a standardized questionnaire was completed for each patient. In all, 126 patients were included in the childhood-onset and 107 patients in the later-onset group. Childhood-onset vitiligo: (1) involved different sites at initial presentation, (2) included more cases of segmental type, and (3) was characterized by a higher prevalence of allergic diseases and a lower prevalence of thyroid diseases. Longer duration of disease and a positive family history of thyroid disease were associated with the presence of thyroid disease only in the childhood-onset group. In the later-onset group, only female sex was associated with the presence of thyroid disease. The study was conducted in a hospital specializing in skin diseases and a selection bias toward more severe vitiligo cases is possible. Childhood-onset vitiligo had distinct epidemiologic and clinical characteristics, compared with later-onset disease.

Combination of Microdermabrasion and 5-Fluorouracil to Induce Repigmentation in Vitiligo: An Observational Study

Treatment of resistant vitiligo is challenging. A few well-researched studies have shown variable results with surgical and other therapeutic strategies. To evaluate the usefulness of a less-painful method of repigmentation of vitiligo patches. Forty vitiligo patches in 22 consecutive patients with resistant vitiligo presenting at a vitiligo clinic of a university teaching medical school in New Delhi, India, were treated with microdermabrasion followed by topical 5% 5-fluorouracil (5-FU). One-third of the patches showed more than 50% repigmentation, and one-fourth showed more than 75% repigmentation. Gratifying results were obtained in seven patches after a single session. Microdermabrasion is adjunctive with topical 5% 5-FU in the treatment of resistant vitiligo patches. Further well-controlled randomized trials are required to validate the observations of the study. The authors have indicated no significant interest with commercial supporters.

Multivariate analysis of factors associated with early-onset segmental and nonsegmental vitiligo: a prospective observational study of 213 patients

Although mixed forms have been described recently, segmental (SV) and nonsegmental vitiligo (NSV) are considered as clinically distinct. However, limited epidemiological data are available to help distinguish associated factors, and recent genome-wide association studies have been restricted to NSV. The higher prevalence of SV in children is helpful when comparing the two major presentations of the disease. To compare factors associated with SV and NSV, especially for markers of autoimmunity or autoinflammation. We conducted a single-centre prospective observational study in patients aged 17 years or under with a confirmed diagnosis of SV or NSV at the vitiligo clinic between 1 January 2006 and 1 July 2010. The Vitiligo European Task Force questionnaire was completed for each patient, and thyroid function and antithyroid antibodies were screened if not obtained in the previous year. Other forms of vitiligo (focal, mucosal, not classifiable) were excluded. A total of 213 children were included, 142 with NSV, 59 with SV and 12 with mixed vitiligo. There was no significant statistical difference for sex or age at onset between patients with SV and NSV. Halo naevi were significantly more frequent in NSV than in SV [odds ratio (OR) 7·58, P < 0·01). Patients with NSV more frequently had a positive family history of vitiligo (OR 2·25, P=0·02) and a marked familial autoimmunity background (OR 2·22, P = 0·01). Our study clearly shows that features of inflammation (pruritus)/autoimmunity (halo naevi, thyroid antibodies) are strongly linked to NSV, together with a familial background of vitiligo and autoimmunity.

Segmental vitiligo associated with generalized vitiligo (mixed vitiligo): A retrospective case series of 19 patients

Mixed vitiligo (MV), the association of segmental vitiligo (SV) and nonsegmental vitiligo, has been rarely reported. The aim of this study was to delineate the clinical spectrum of MV through a case series of patients with typical SV associated with patchy bilateral vitiligo. This was a cross-sectional evaluation in the setting of a prospective observational study conducted in the vitiligo clinic of the department of dermatology in Bordeaux, France. Nineteen patients with MV were identified. Four were male and 15 were female. Most patients had an onset of SV before the age of 18 years (18 of 19). In all patients, SV preceded nonsegmental vitiligo with a delay ranging from 6 months to more than 24 months. This study was cross-sectional and based on a single-center experience. MV is not yet part of a conventional classification. However, this entity may have been neglected until now and should be included in the classification of vitiligo in addition to SV and nonsegmental vitiligo. Moreover, MV may be essential to the understanding of the pathogenesis of vitiligo as a primary skin disorder.

Vitiligo vulgaris and autoimmune diseases in Japan

We reviewed the causes of "loss of skin color" in 144 patients, who visited Vitiligo Clinic of Kyoto University Hospital between April 2005 and August 2008. The numbers of patients with generalized and segmental Vitiligo vulgaris were 98 (68.1%) and 26 (18.1%), respectively. Small numbers of the patients suffered from Vogt-Koyanagi-Harada disease, piebaldism, congenital albinism, Hypomelanosis of Ito, post-inflammatory hypopigmentation, white leaf-shaped macules associated with tuberous sclerosis and nevus hypopigmentosus. One forth of the patients with generalized vitiligo had complications, while no complications were found in the patients with segmental vitiligo. Among the complications, autoimmune diseases dominated 43% (10 of 23 cases). Autoimmune thyroid diseases explained for the most of the complicated autoimmune diseases and were associated with 7.4% of the patients with generalized vitiligo. Minor autoimmune complications include myasthenia gravis, Sjogren syndrome and autoimmune nephritis. Reflecting the condition that our clinic is located in a university hospital, vitiligo patients with end-stage non-melanoma cancers of internal organs accounted for 8.4% of the patients of generalized vitiligo.

Narrowband ultraviolet B phototherapy for inflammatory vitiligo with raised borders associated with Sjögren’s syndrome

Conflict of interest: none declared. Inflammatory vitiligo with raised borders (IVRB) is considered to be a type of vitiligo vulgaris. Although narrowband ultraviolet B (NB‐UVB) phototherapy is one of the most effective therapies for vitiligo vulgaris, no reports on the effectiveness of NB‐UVB for IVRB had yet been described.1 We present a case of IVRB associated with Sjögren’s syndrome (SS), which showed good response to NB‐UVB therapy. A 53‐year‐old Japanese woman was referred to our vitiligo clinic for evaluation of itchy depigmented areas on the back. She had a 5‐year history of SS with antinuclear antibody (1 : 320) and was positive for anti‐SSA and SSB antibodies. On physical examination, a few lesions of vitiligo (approximately 100 mm in diameter), circumscribed with raised scaly erythema, were found on the back (Fig. 1a). On the neck, small lesions of vitiligo without erythema were also found. Results of repeated potassium hydroxide examinations were negative.