vitiligo comorbities by prof. michael tharp
DESCRIPTION
by Prof. Michael TharpPresentation from the World Vitiligo Symposium 2011. Sponsored by the VR Foundation.TRANSCRIPT
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Michael D. Tharp The Clark W. Finnerud, M.D. Professor and Chair Department of Dermatology Rush University Medical Center Chicago, Illinois, USA
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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?
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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)
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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?
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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
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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
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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.
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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
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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
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113 vitiligo pts were tested for diseases associated with polyglanduar autoimmune syndrome (APS)
58% generalized vitiligo 38% acrofacial vitiligo 3% segmental vitiligo
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Betterle, Acta Bio Med 74:9, 2003
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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)
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Vitiligo APS APS APS APS Type 3C 3B+C 4 3C+A
Generalized 11 3 3 1 Acrofacial 10 0 2 0 Segmental 1 0 0 0
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(Anti-thyroid) (Anti-gastic)
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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
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Clin Exp Dermatol 31,746,2006
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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
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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
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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.