Vitiligo comorbities by Prof. Michael Tharp
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Vitiligo comorbities by Prof. Michael Tharp



by Prof. Michael Tharp

by Prof. Michael Tharp

Presentation from the World Vitiligo Symposium 2011. Sponsored by the VR Foundation.



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Vitiligo comorbities by Prof. Michael Tharp Presentation Transcript

  • 1. Michael D. TharpThe Clark W. Finnerud, M.D.Professor and ChairDepartment of DermatologyRush University Medical CenterChicago, Illinois, USA
  • 2.  Most common pigmentary disorder Patchy loss of pigment from the skin, hair and oral mucosa Reported frequency 0.1-2.0% in various populations Familial tendency with approximately 20% of probands having at least one affected first degree relative Autoimmune mediated?
  • 3. Segmental Clinical FeaturesZosteriformis macules distributed along a dermatomeNon Segmental Clinical FeaturesLocalized or partial few scattered maculesAcrofacialis macules localized to face, distal hands and feetMucosal macules on mucous membranesGeneralized more widespread macules (face, hands, feet, axillae, limbs)
  • 4.  Thyroid disease Diabetes mellitus Adrenal insufficiency Lupus erythematosus Alopecia areata Myasthenia gravis Pernicious anemia Rheumatoid arthritis Sarcoidosis Chronic active hepatitis Vogt–Koyanagi–Harada syndrome Psoriasis Lichen planus C2 and C4 deficiency APS, autoimmune polyglandular syndromes Skin cancer/melanoma?
  • 5.  A questionnaire was given to 2546 pts with vitiligo from the United Kingdom and U.S. Vitiligo pt groups:  Vitiligo Society: UK  National Vitiligo Society: USA
  • 6.  A questionnaire was given to 2546 pts with vitiligo from the United Kingdom and U.S.  Approx 70% female  18% of first degree relatives had vitiligo 19.4% of probands had autoimmune thyroid disease (88% hypothyroidism and 12% hyperthyroidism) 5.7% of first degree relatives with autoimmune thyroid disease
  • 7.  1.9% had pernicious anemia  13 fold increase over the general population 0.38% with Addison’s disease  76 fold increase over the general population 8 fold increase in SLE 2 fold increase in Crohn’s disease No increase in:  alopecia areata  diabetes mellitus  multiple sclerosis  myasthenia gravis  psoriasis  RA  Scleroderma  Sjogren’s synd.
  • 8. CONCLUSIONS Vitiligo is associated with other autoimmune disorders Thyroid disease and pernicious anemia were frequent Addison’s dis, SLE and inflammatory bowel dis uncommon The above disorders also increased in probands’ first degree relatives: suggesting shared common susceptibility genes
  • 9.  204 with vitiligo (0.61%) were obtained from 33,252 medical records:  66% pts: localized vitiligo  15% with generalized vitiligo  13% with acromucosal vitiligo  6% with segmental vitiligo Autoimmune disorders were found in 6 (2.9%) of patients
  • 10.  113 vitiligo pts were tested for diseases associated with polyglanduar autoimmune syndrome (APS) 58% generalized vitiligo 38% acrofacial vitiligo 3% segmental vitiligo
  • 11. Betterle, Acta Bio Med 74:9, 2003
  • 12.  22 pts: APS-3C (thyroid and vitiligo) 3 pts: APS-3B+C (thyroid, vitiligo and autoimmune gastritis) 1 pt: APS-3C+A (thyroid, vitiligo, alopecia areata and anti-adrenal gland abs, + ANA 5 pts: APS-4(vitiligo, myasthenia gravis, bullous pemphigoid, alopecia, autoimmune gastritis, +ANA)
  • 13. Vitiligo APS APS APS APSType 3C 3B+C 4 3C+AGeneralized 11 3 3 1Acrofacial 10 0 2 0Segmental 1 0 0 0
  • 14. (Anti-thyroid) (Anti-gastic)
  • 15.  22/113 pts with vitiligo had 3 or more autoimmune disorders (APS) Thyroid disease was common (39%) Addison’s disease rare (1/113) but higher frequency than the reported general population ANA positivity was seen in 3% of pts which is typical for the general population Recommend periodic screening of vitiligo pts for other autoimmune diseases
  • 16. Clin Exp Dermatol 31,746,2006
  • 17.  156 pts with vitiligo underwent an eye exam 40% had some fundal abnormality Transillumination of the iris  Whites 23%  Blacks 5% Fundiscopic findings  Focal pigment hypertrophy (18%)  Hypopigmented spots (9%)  Retinal scars (6%)  Chorodial nevi (4%)  Uveitis (1%): inflammation rarely seen
  • 18.  Uveitis has been reported to be another ocular abnormality associated with vitiligo Vogt-Koyanagi_Harada syndrome (3 phases)  Meningocephalic phase ( headache, meningismus, seizures and/or muscle weakness or paralysis) preceded by fever, nausea/vomiting : aspectic meningitis  Acute ophthalmic phase (eye pain, photophobia, altered visual acuity): uveitis, iriditis, retinal detachment  Otic involvement (dysacousia)  Poliosis  Vitiligo Alezzandrini syndrome  Whitening of the hair, eyebrows and eyelashes  Unilateral depigmentation of the skin on the forehead, nose, cheek, upper lip and chin along with decreased visual acuity and atropic iris Non-inflammatory depigmented lesions in the fundus seen in vitiligo
  • 19. Thyroid diseaseDiabetes mellitusAdrenal insufficiencyLupus erythematosusAlopecia areataMyasthenia gravisPernicious anemiaRheumatoid arthritisSarcoidosisChronic active hepatitisVogt–Koyanagi–HaradasyndromePsoriasisLichen planusC2 and C4 deficiencyAPS, autoimmunepolyglandular syndromes.