Fenómeno infrecuente la co-localización de alopecia frontal fibrosante y vitiligo en un varón: informe de un caso / Infrequent phenomenon the co-localization of fibrosing frontal alopecia and vitiligo in a male: case repor

La alopecia frontal fibrosante es una alopecia cicatricial que se caracteriza por la recesión de la línea de implantación frontotemporal que afecta principalmente a mujeres caucásicas en edad posmenopáusica y rara vez a hombres. Actualmente los mecanismos específicos de desarrollo continúan en estudio; sin embargo hay varias hipótesis sobre la asociación de la alopecia frontal fibrosante con otros trastornos autoinmunitarios. Se comunica el caso de un paciente masculino de 58 años con alopecia frontal fibrosante en áreas comprometidas por vitiligo. (AU)

Frontal fibrosing alopecia is a cicatricial alopecic characterized by progressive regression of the frontotemporal hairline. It usually affects postmenopausal caucasian women, and rarely men. Currently the specific mechanisms of development remain unknown, however there are several hypotheses about the association of frontal fibrosing alopecia with other autoimmune disorders. The case of a 58-year-old male patient with frontal fibrosing alopecia in areas affected by vitiligo. (AU)

Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study

Abstract Background/Objectives: To investigate the association between vitiligo and metabolic syndrome. Methods: A prospective cross-sectional study was conducted between 2014 and 2016. Study (n = 155) and control groups (n = 155) were evaluated for metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation criteria. Study group was divided into three groups according to their vitiligo area severity index and vitiligo disease activity score values (Group 1: 6.89 for VASI score, Group A: −1-0, Group B: 1-2 and Group C: 3-4 for vitiligo disease activity score respectively). MetS rates according to both criteria were compared between the vitiligo disease activity score and vitiligo area severity index groups. Results: Metabolic syndrome rates were 37.4% and 40% in the study group and 19.4% and 26.5% in the control group according to National CholesterolEducation Program Adult Treatment Panel III and International Diabetes Federation criteria, respectively (p < 001 and p = 0.011). Metabolic syndrome was more frequent in vitiligo area severity index Groups 2 and 3 compared to vitiligo area severity index Group 1, and in vitiligo disease activity score Group C compared to vitiligo disease activity score Groups A and B. Study limitations: Single center experience, absence of more specific oxidative-stress markers and lack of long-term follow-up of the patients. Conclusions: Frequency of metabolic syndrome was higher in patients with non-segmental vitiligo and the rate was higher in active/severe form of the disease.

Association between three autoimmune diseases: vitiligo, primary biliary cirrhosis, and Sjögren's syndrome

Abstract Although the association of multiple autoimmune diseases has already been widely described, no reports of the association between vitiligo, primary biliary cirrhosis and Sjogren's syndrome were retrieved in the SciELO and PubMed databases. The authors describe the case of a female patient who was diagnosed with primary biliary cirrhosis and Sjogren's syndrome at age 54. At age 58, she developed vitiligo restricted to the face, associated with significant impairment of self-esteem and quality of life. Antinuclear antibody was negative at the onset of the condition, but became positive after phototherapy initiation. In general, the occurrence of multiple autoimmune diseases in the same patient is known as a mosaic of autoimmunity. However, specific mechanisms appear to interconnect primary biliary cirrhosis and Sjogren's syndrome, such as PDC-E2-mediated generalized epithelitis.

Nail abnormalities in patients with vitiligo

Abstract: Background: Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. Objective: We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. Methods: This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Results: Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (p<0.001). Conclusions: Nail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.

Syndrome in Question

Multiple autoimmune syndrome is a rare condition, described by Humbert and Dupond in 1988. It is defined by the association of at least 3 autoimmune diseases in the same patient. Vitiligo is the most common skin condition in this syndrome. This article presents the case of a 31-year-old male with vitiligo, alopecia areata, Crohn's disease, psoriasis vulgaris and oral lichen planus. The rarity of this case is highlighted by the coexistence of four autoimmune skin diseases in association with Crohn's disease, never described in the literature.

Association of giant congenital melanocytic nevus, halo nevus and vitiligo in a 75-year-old patient / Associação de nevo melanocítico congênito gigante, nevo halo e vitiligo. Relato de caso em paciente de 75 anos

A giant congenital melanocytic nevus represents a rare condition. The halo phenomenon may be seen in congenital or acquired melanocytic nevi. In the literature, association of halo nevus and giant congenital melanocytic nevus is rare and the association of both with vitiligo even more rare. A 75-yearold woman at first consultation complained of a hyperchromic bluish-brown hairy macula on the lower back, buttocks and thighs present since birth and an achromic halo of onset three years ago. The histological features were consistent with congenital melanocytic nevus and halo nevus, respectively. After two years the patient developed achromic areas in normal skin, histologically consistent with vitiligo. The authors emphasize the rarity of this triple combination, the patient's age and the absence of malignant degeneration to date.

Nevo melanocitico congênito gigante constitui uma condição rara. O fenômeno halo pode ser observado em nevos melanocíticos congênitos ou adquiridos. Na literatura a associação nevo halo e nevo melanocítico congênito gigante é rara e a associação de ambos com vitiligo ainda mais rara. Mulher de 75 anos que à primeira consulta apresentava mácula hipercrômica castanho-azulada pilosa na região lombar, nádegas e coxas desde o nascimento e halo acrômico de aparecimento há 3 anos. Os histológicos foram compatíveis com nevo melanocítico congênito e nevo halo respectivamente. Após dois anos evoluiu com áreas de acromia à distância, com histológico de vitiligo. Os autores ressaltam a raridade desta tripla associação; a idade da paciente e a ausência de degeneração maligna até o presente momento.

Abordagem multiprofissional na visão integral do paciente com vitiligo / Multidisciplinary approach in the patient's integral vision with vitiligo

A psicodermatologia é uma área que estuda e integra o trabalho de médicos e psicólogos, objetivando um melhor entendimento das doenças cutâneas. O vitiligo, caracterizado por máculas acrômicas, é causado por destruição adquirida de melanócitos, sendo associado com fatores emocionais. Há três teorias para explicar a destruição dos melanócitos no vitiligo: a imunológica, a citotóxica e a neural. Independentemente da origem, existe a percepção nítida da sua relação com aspectos emocionais. O aparecimento e o alastramento da doença cursam com o aumento das frustrações e preocupações. Vários doentes relatam o aparecimento após traumas emocionais significativos. Quanto maior a área corporal afetada, maior o nível de estresse, depressão e tensão emocional. Provavalmente, alterações emocionais desequilibram o organismo, favorecendo alterações hormanais e imunológicas, podendo desencadear e piorar o vitiligo. A pessoa deve ser vista com um todo, constituída de outras dimensões, como a psíquica, social, econômica e cultural. Este trabalho objetiva demonstrar a visão de homem integral, considerando as influências biopsicossociais e aimportância do trabalho multiprofissional.

Tha Psychodermatology is an area that studies and integrate the doctor's work, psychologists, looking for a better understanding of skin diseases. The vitiligo, marked by achromatic maculates, is caused because there is an adquire destruction of melanocytes, so related with emotional components. There are three theories that explain the destruction of the melanocytes in vitiligo: an immunological response, one that is citolitic and the last one, neural. Causes apart, that is a clear perception about the relation with emotional aspects. The beginning and spreading of the disease courses with frustrations and concerns, both always increasing. A lot of sick people relates the beginning of the disease after some important emotional stress. The higher is the body area affected, higher is the leval of stress, depression and emotional tension. Probably, emotional changing unbalance the organism, favoring hormonal and immunological changes, and it may trigger de vitiligo. The person must be seen as a whole person, consists of other dimensions, such as psychological, social, economic and cultural. This work shows the integral vision of man, considering the influences biopsychosocial and the importance of multidisciplinary working.

Vitiligo na criança e doença da tireóide / Childhood vitiligo and thyroid disease

A associação entre vitiligo e tireoidopatia na criança é discutível. Cinquenta crianças com vitiligo e 40 sem vitiligo foram submetidas às dosagens séricas de anticorpos antitireoide e hormônio tireoestimulante. Um caso (grupo teste) e um caso controle mostraram títulos de TSH acima do limite normal; o vitiligo não representou maior risco para tireoidopatia.

The association of vitiligo / thyroid disease in childhood is debatable; 50 children with vitiligo and 40 without it were submitted to serum dosage of antithyroid antibodies and thyrostimulating hormone. One case (test group) and one control showed a serum titer of TSH above the normal limit; vitiligo did not represent a greater risk for thyroid disease.

Portadores de vitiligo: estudo das emissões otoacústicas e efeito de supressão / A study on otoacoustic emissions and supression effects in patients with vitiligo

Vitiligo é uma doença cutânea, caracterizada pela ausência da melanina, por destruição de melanócitos. Objetivo: Verificar a ocorrência de alteração auditiva em indivíduos com vitiligo. Método: Avaliação audiológica, pesquisa das emissões otoacústicas evocadas transientes e do efeito de supressão em estudo prospectivo de 24 pacientes com vitiligo. A faixa etária variou de 15 a 45 anos. Resultados: 21 pacientes (87.5%) apresentaram audiometria normal; dois apresentaram perda auditiva unilateral em freqüências altas e um apresentou perda coclear de grau moderado à esquerda. Destes 21 sujeitos, 66,7% tiveram ausência de emissões, sugerindo disfunção coclear. As emissões estiveram presentes em todas as bandas de freqüência em apenas 7 pacientes (29,2%) e ausentes em 17 (70,8%), com maior ocorrência de falha no sexo masculino, na orelha direita. Na pesquisa da supressão, seis indivíduos falharam, todos do sexo feminino, sendo a orelha esquerda a mais afetada. Conclusão: Pela análise das emissões otoacústicas verificou-se que os portadores de vitiligo possuem maior predisposição à disfunção coclear, com maior ocorrência no sexo masculino na orelha direita. Quanto ao efeito de supressão, houve maior alteração no sistema eferente em mulheres, com maior ausência à esquerda. As alterações auditivas não diferiram quanto à idade, tipo de vitiligo e tempo de evolução da doença.

Vitiligo is a skin disease characterized by absence of melanin due to melanocytes destruction. Aim: to study the incidence of hearing alterations in patients with vitiligo. Method: prospective audiological evaluation, transient-evoked otoacoustic emission recordings and study the effects of suppression in 24 patients with vitiligo. Their ages ranged from 15 to 45 years. Results: 21 patients (87.5%) had normal audiometry; 2 had unilateral hearing loss in the high frequencies and 1 had cochlear moderate hearing loss in the left ear. Of these 21 subjects, 66.7% had no otoacoustic emissions, suggesting cochlear dysfunction. Only 7 patients had otoacoustic emissions present in all frequencies (29.2%) and 17 (70.8%) did not have them, and the highest rate of no otoacoustic emissions happened in the right ear of males. Regarding the suppression study, 6 subjects failed, all of them were females, and their left ears were the most affected. Conclusion: the findings show that patients with vitiligo, particularly males, have a greater predisposition to cochlear dysfunction, especially in the right ear. As far as the suppression effect was concerned, there was a greater alteration in the female efferent system, particularly in the left ear. Hearing alterations did not vary as far as age is concerned, type of vitiligo and time of disease progression.

socio-demography and clinical profile of vitiligo in Sudan

Vitiligo is a chronic skin disease that causes loss of pigment, resulting in irregular pale patches of skin. The precise cause of vitiligo is complex and not fully understood. There is some evidence suggesting it is caused by a combination of auto-immune, genetic, and environmental factors. The population incidence worldwide is considered to be between 0.1% and 2%. The disease has different clinical types but generally, it consists of areas of macular depigmentation, commonly on extensor aspects of extremities, on the face or neck, and in skin folds. Age of onset is often in young adulthood and the condition tends to progress gradually with lesions enlarging and extending until a quiescent state is reached. To define the socio-demography and clinical profile of vitiligo in Sudan. This study is a cross-sectional, clinico-epidemiological and hospital-based study, done in Khartoum Dermatologic Hospital [KDH]. The data were collected between June 2007 and November 2007. The total number of patients with vitiligo in the study was 113. Male patients were 47 [42%]. Children were 13 [11%], adults were 90 [80%] and elderlies were 10 [9%]. The mean age of onset of the disease was found to be 11.5 yrs in 22.5% of the patients. Patients with acute [< 1 yr] disease were 6 [5.4%], while those with chronic [>/= 1 yr] disease were 107 [94.6%]. The most commonly affected tribe was Algaa/'liyeen tribe [27%]. The commonest precipitating factor for vitiligo has been found to be emotional disturbances [in 27% of patients]. Commonest symptom of the disease was depigmented patch/es [64.8%]. Severe [>/= 10%] involvement of skin surface area was found in 59% of patients, while mild [<10%] involvment was found in 41% Koebner sign was found to be present in 42% of patients. The disease was active in 47.3% of patients. The bilaterally symmetrical pattern of distribution was the commonest pattern [in 85%]. The commonest clinical type of vitiligo was the generalized type [82.3%]. 35% of patients with vitiligo had positive family history. The clinical profile of vitiligo in Sudan was not so different from that found worldwide

Vitiligo: a part of a systemic autoimmune process.

BACKGROUND: Recent clinical and animal experimental studies postulate that the pathogenetic mechanisms of vitiligo could be of systemic origin as vitiligo is associated with ocular and auditory abnormalities as well as other autoimmune disorders.Hence, we studied genetic factors, systemic associations, ocular and auditory abnormalities of vitiligo. METHODS: The study group included 150 new cases of various types of vitiligo. One hundred age- and sex-matched nonvitiligo cases were included as controls in the study. A complete family history was taken for all patients. Examination was carried out taking note of the type of vitiligo and approximate percentage of body surface involved. All relevant laboratory investigations, a thorough audiological examination including pure tone audiometry and a complete ophthalmologic examination were carried out in all patients and controls. Statistical analysis was done using the Chi square test. RESULTS: Fifty-four vitiligo patients (36%) had a family history of vitiligo. Anemia was present in 30 (20%) vitiligo patients but only in five (5%) controls, a difference that was statistically significant (c2 = 15.8, P < 0.001). Diabetes mellitus was present in 24 (16%) vitiligo patients and only 2 (2%) of controls (Chi square, c2 = 12.4, P < 0.001). Hypothyroidism and alopecia areata were present in 18 (12%) and 11 (7.4%) vitiligo patients respectively and none of the controls. Hypoacusis was seen in 30 (20%) vitiligo patients and two (2%) controls (c2 = 8.19, P < 0.005). Twenty-four vitiligo patients (16%) and five controls (5%) had specific ocular abnormalities like uveitis, iris and retinal pigmentary abnormalities (c2 = 7.39, P < 0.001). CONCLUSION: This study demonstrates statistically significant clinical evidence confirming that vitiligo is a part of systemic autoimmune process.

Clinical pattern of ocular manifestations in vitiligo.

To study the ocular abnormalities in cases of vitiligo, 100 patients were examined who underwent a series of investigations e.g., complete haemogram, urine analysis, blood biochemistry and chest x-ray and 70 cases were taken as control. Patients with systemic diseases such as diabetes mellitus, thyroid and auto-immune disorders were excluded. Detailed ocular examinations including recording of vision, slit-lamp biomicroscopy, gonioscopy, ophthalmoscopy and examination of fundus by 90 D lens were done. Of 100 vitiligo patients, 23% showed hypopigmented sports on the iris, 18% pigmentation on anterior chamber, 9% retinal pigment epithelium hypopigmentation, 5% uveitis, 11% had chorioretinal degeneration and 34% had no ocular findings. There lies a strong association of ocular disorder in patients with vitiligo.

Vitiligo y tiroiditis de Hashimoto: asociación o síndrome autoinmune? / Vitiligo and Hashimoto's thyroiditis: an association or an autoimmune syndrome?

Se sospecha de ciertos virus y otros agentes como causantes de la tiroiditis de Hashimoto, siendo bien conocida la asociación con otras entidades inmunes, entre ellas el vitiligo. Una vez disparados los fenómenos inmunológicos se generan anticuerpos contra los antígenos microbianos (o de otro tipo), pero también Ac. contra antígenos propios como los de la estructura tiroidea y la piel. En el vitiligo hay alta incidencia de anticuerpos organoespecíficos, pero también otros anticuerpos no organoespecíficos, sugiriéndose para los síndromes autoinmunes múltiples y las colagenopatías un fuerte parentesco clínico, laboratorial y quizá etiológico. En este caso clínico en particular la tarea del dermatólogo cobró importancia pues toda la investigación generada se debió a la repentina aparición de vitiligo en un paciente con síntomas vagos

Malignant melanoma of the choroid with vitiligo.

An unusual case of an Asian patient with malignant melanoma of the choroid with vitiligo is reported. Other uncommon features of this case are metastasis to an extrahepatic site without liver metastasis and infiltration of the optic nerve.

Vogt-Koyanagi-Harada syndrome following injury-induced progressive vitiligo.

We report a case of Vogt-Koyanagi-Harada (VKH), Syndrome wherein the patient developed ocular symptoms following injury-induced progressive vitiligo with immunologic evidence from the skin biopsy specimen of the vitiligo. This case supports the hypothesis that the cell-mediated immune process against a common melanocyte antigen plays an important role in the development and progression of the disease.

Neurofibromatosis y vitiligo: relato de un caso / Neurofibromatoses and vitiligo: 1 case

Los autores discuten las dos patologías, abordando sus etiologías y manifestaciones clínicas. Relatan un caso clínico donde se evidencia la presencia simultánea de estas dos enfermedades, considerendo sus distintas etiologías