Colocalization of vitiligo and alopecia areata

Videodermoscopic Changes of the Hair in Vitiligo Lesions in Relation to Disease Duration

INTRODUCTION

Vitiligo is an acquired disease of complex pathogenesis, in which the immunologic attack to the skin and hair follicle melanocytes leads to areas of depigmentation and leukotrichia, respectively.

OBJECTIVES

To study the dermoscopic features of the hair changes in vitiligo lesions in comparison to perilesional control areas and in relation to disease duration.

METHODS

Forty-seven patients with both old and recent vitiligo lesions were included. Dermoscopic features of hair within the lesions were examined and compared to those in perilesional non depigmented skin of the same patient.

RESULTS

Hair density (P < 0.001), terminal hair rate (P = 0.011), terminal to vellus hair ratio (P = 0.029) and mean hair shaft thickness (P = 0.031) were significantly decreased, whereas vellus hair rate (P = 0.011) was significantly increased in old vitiligo lesions compared to their respective control areas. The frequency of broken hair was significantly higher in old lesions (P < 0.001), while that of upright re-growing hair was significantly higher in recent lesions (P = 0.016).

CONCLUSIONS

Hair involvement in vitiligo lesions is not only limited to the development of leukotrichia. Other subtle changes in hair density, anagen and telogen hair rates, and mean hair thickness can be detected. These changes may serve as objective clues to the duration of the lesions.

Colocalization of vitiligo and alopecia areata presenting as poliosis

Vitiligo and alopecia areata are two cutaneous diseases believed to be primarily autoimmune in pathogenesis. While the coexistence of the two conditions in the same patient has been well-described, reports of the two disease processes occurring in the same location are rare. We report the case of a 10-year-old male with an unremarkable past medical history who presented with a single localized area of poliosis with depigmented underlying skin on the frontal scalp. The hair in the affected area was relatively decreased in density. A punch biopsy of the depigmented patch demonstrated features consistent with both vitiligo and alopecia areata. The decreased number of large hair follicles and a focal peribulbar lymphocytic infiltrate around an anagen follicle were suggestive of alopecia areata. A panel of melanocyte-specific stains revealed absent melanocytes in the epidermis, consistent with vitiligo. Loss of microphthalmia-associated transcription factor-positive root sheath cells was seen, suggestive of loss of melanocyte stem cells. The combination of clinical and histopathologic findings supports the theory of a common pathogenesis of alopecia areata and vitiligo.

Vitiligo and alopecia areata: apples and oranges?

Vitiligo and alopecia areata are common autoimmune diseases of the skin. Vitiligo is caused by the destruction of melanocytes and results in the appearance of white patches on any part of the body, while alopecia areata is characterized by patchy hair loss primarily on the scalp, but may also involve other areas as well. At first glance, the two diseases appear to be quite different, targeting different cell types and managed using different treatment approaches. However, the immune cell populations and cytokines that drive each disease are similar, they are closely associated within patients and their family members, and vitiligo and alopecia areata have common genetic risk factors, suggesting that they share a similar pathogenesis. Like apples and oranges, vitiligo and alopecia areata have some obvious differences, but similarities abound. Recognizing both similarities and differences will promote research into the pathogenesis of each disease, as well as the development of new treatments.

Colocalization of vitiligo and alopecia areata: coincidence or consequence?

Both alopecia areata (AA) and vitiligo are autoimmune diseases, and their coexistence in the same patient is not uncommon, as vitiligo has been reported to occur in 4.1% of patients of AA. We present a case of a 15-year-old male child who had vitiligo and later developed AA over the existing lesions of vitiligo over face and scalp and have attempted to elucidate the current understanding of mechanisms of coexistence of these two diseases. Our case lends support to the hypothesis that AA and vitiligo share a common pathogenic pathway including autoimmune response against some common antigens like those derived from the bulb melanocytes. Stimulation of proinflammatory T-helper(Th)-1 cell mediated immunological response or inactivation of a suppressor T-cell mediated response could be the common underlying phenomenon. However, the striking rarity of colocalization of these two diseases has led to the recent debate over current understanding of their pathogenesis, and whether this association is merely a coincidence. As both AA and vitiligo are frequent and chronic dermatological disorders, it is of utmost importance to gain more understanding into their pathogenic mechanisms so that more definitive treatment modalities may be devised and the quality of life of these patients can be improved.

Diphenylcyclopropenone-induced vitiligo in a patient with alopecia universalis

Alopecia areata and vitiligo are autoimmune diseases, both associated with multiple autoimmune comorbidities. Many studies show colocalization of these diseases at the same anatomical site. Here, we have a case where both disorders were reported to present in the same patient. Diphenylcyclopropenone (diphencyprone, DCP) is used in the treatment of alopecia areata and may induce vitiligo in some patients. We report on one case of vitiligo that was induced by DCP during therapy for alopecia universalis. Alopecia areata and vitiligo share many susceptibility genes. Follicular melanocyte destruction may represent the link between the two diseases.

T-cell reconstitution after thymus xenotransplantation induces hair depigmentation and loss

Here we present a mouse model for T-cell targeting of hair follicles, linking the pathogenesis of alopecia to that of depigmentation disorders. Clinically, thymus transplantation has been successfully used to treat T-cell immunodeficiency in congenital athymia, but is associated with autoimmunity. We established a mouse model of thymus transplantation by subcutaneously implanting human thymus tissue into athymic C57BL/6 nude mice. These xenografts supported mouse T-cell development. Surprisingly, we did not detect multiorgan autoimmune disease. However, in all transplanted mice, we noted a striking depigmentation and loss of hair follicles. Transfer of T cells from transplanted nudes to syngeneic black-coated RAG^−/− recipients caused progressive, persistent coat-hair whitening, which preceded patchy hair loss in depigmented areas. Further transfer experiments revealed that these phenomena could be induced by CD4+ T cells alone. Immunofluorescent analysis suggested that Trp2+ melanocyte-lineage cells were decreased in depigmented hair follicles, and pathogenic T cells upregulated activation markers when exposed to C57BL/6 melanocytes in vitro, suggesting that these T cells are not tolerant to self-melanocyte antigens. Our data raise interesting questions about the mechanisms underlying tissue-specific tolerance to skin antigens.

Diphencyprone induced vitiligo: a case report

Diphencyprone (DCP) is a contact sensitizer which is used to treat dermatological disorders with an immunological origin, such as extensive alopecia areata (AA). Vitiligo is a rare but known side effect of DPCP therapy which is formed in the treatment site or remote areas. In this paper a 37-year-old man developed alopecia totalis with loss of eyebrows and eyelashes who presented some vitiligo patches on his scalp and arm distant from the location of DPCP application and a 42-year-old woman with 25 years history of hair loss and 3 months DPCP application who revealed some vitiligo patches on the scalp with distant to the site of application at the 6th week are reported. Considering the absence of personal and family history of Vitiligo in our two cases, the hypothesis of latent Vitiligo is not proved. The positive patch test in left arm of one of the patients also suggests the direct role of DPCP as the cause of Vitiligo occurrence. As the development of vitiligo by DCP is unpredictable and the depigmentation may persist indefinitely, it is important to inform all patients about this potential adverse effect before starting the treatment.

An extraordinary colocalization of alopecia areata and vitiligo

Although the association of alopecia areata (AA) and vitiligo occurring in the same patient has been frequently reported in the literature, the colocalization of AA and vitiligo is very rare. We report for the first time an adult patient with anatomic concurrence of AA and vitiligo on the scalp. Even though both AA and vitiligo are thought to have the same underlying pathophysiologic mechanisms, the striking rarity of their colocalization challenges this postulated common pathogenesis, and raises the question if autoimmunity is responsible for only a fraction of AA or vitiligo.

Melanocyte and gonad activity as potential severity modifying factors in C3H/HeJ mouse alopecia areata

Circumstantial evidence has previously suggested gonad derived steroid hormones and melanogenesis related antigens may modify human alopecia areata (AA). AA-like hair loss can be induced in C3H/HeJ mice after skin allografts from spontaneous AA-affected mice. This inducible model was used to evaluate hormones and hair follicle melanocyte presence as disease-severity modifiers. Ten females and 9 males were gonadectomized and received AA-affected allografts. All gonadectomized mice had 2-4 weeks delay in AA onset relative to non-gonadectomized controls. Two females and 4 males failed to develop any AA by 25 weeks after grafting. The experiment was repeated with gonadectomized female and male mice plus non-gonadectomized mice subcutaneously implanted with silastic capsules containing 80 microg 17beta estradiol or 10 mg 5alpha dihydrotestosterone, respectively. Five of 11 ovariectomized and 9 of 11 non-ovariectomized, estradiol supplemented females developed AA with extremely rapid progression. Three of 8 castrated, but none of 11 non-castrated, dihydrotestosterone-supplemented males expressed AA. In a separate study, 14 mice were freeze-branded, producing white hair on the dorsal lumbar region, and later received full-thickness allografts. Thirteen mice developed patchy pigmented and non-pigmented hair loss. One mouse developed diffuse, pigmented hair loss, but with white hair survival persisting 25 weeks after grafting. The results suggest that gonadal steroid hormones can modulate C3H/HeJ mouse AA where estradiol promoted rapid progression of AA while dihydrotestosterone increased resistance to AA onset. In general, both pigmented and non-pigmented C3H/HeJ mouse hair is susceptible to AA. Murine AA susceptibility and severity clearly involves an interplay between genetic and epigenetic factors.

Colocalization of alopecia areata and vitiligo

We report an 18-year-old woman who had a 4-month history of colocalization of alopecia areata and vitiligo, principally on the occipital portion of the scalp.

[Vitiligo in multiple autoimmune syndrome: a retrospective study of 11 cases and a review of the literature]

PURPOSE

The occurrence in the same patient of three or more autoimmune diseases defines multiple autoimmune disease. Multiple autoimmune disease is an unusual condition in which dermatological autoimmune diseases and especially vitiligo have an important place.

METHODS

We examined retrospectively 11 cases of multiple autoimmune diseases associating vitiligo. We studied the clinical characteristics of vitiligo and those of the associated autoimmune disorders.

RESULTS

Type III multiple autoimmune disease was diagnosed in all the 11 cases observed. Autoimmune vitiligo was the first autoimmune disorder observed in seven cases and was bilateral, symmetrical and acrofacial in eight cases. Autoimmune thyroid disorder was associated in ten cases. Our data confirms the important association between vitiligo and thyroid autoimmune disorders.

CONCLUSION

The predominant female ratio and the acrofacial topography of skin lesions could predict association with others autoimmune disorders in patients with vitiligo.