Call Girl Number in Panvel Mumbai📲 9833363713 💞 Full Night Enjoy
Vitiligo comorbities by Prof. Michael Tharp
1. Michael D. Tharp
The Clark W. Finnerud, M.D.
Professor and Chair
Department of Dermatology
Rush University Medical Center
Chicago, 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 Features
Zosteriformis macules distributed
along a dermatome
Non Segmental Clinical Features
Localized or partial few scattered macules
Acrofacialis macules localized to
face, distal hands and
feet
Mucosal macules on mucous
membranes
Generalized more widespread
macules (face, hands,
feet, axillae, limbs)
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.
7.
8. 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
9. 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.
10. 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
11. 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
12.
13. 113 vitiligo pts were tested for diseases
associated with polyglanduar autoimmune
syndrome (APS)
58% generalized vitiligo
38% acrofacial vitiligo
3% segmental vitiligo
19. 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
21. 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
22. 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