|Year : 1997 | Volume
| Issue : 2 | Page : 95-98
Vitiligo : a study of 998 cases attending KEM Hospital in Pune
YV Tawade, AP Parakh, PR Bharatia, BB Gokhale, Ran
Y V Tawade
Source of Support: None, Conflict of Interest: None
Background : Vitiligo is a condition of major social and cosmetic concern in India. An epidemiological study of large number of patients from India was indicated.
Keywords: Hereditary factors, Vitiligo
|How to cite this article:|
Tawade Y V, Parakh A P, Bharatia P R, Gokhale B B, Ran. Vitiligo : a study of 998 cases attending KEM Hospital in Pune. Indian J Dermatol Venereol Leprol 1997;63:95-8
|How to cite this URL:|
Tawade Y V, Parakh A P, Bharatia P R, Gokhale B B, Ran. Vitiligo : a study of 998 cases attending KEM Hospital in Pune. Indian J Dermatol Venereol Leprol [serial online] 1997 [cited 2019 Jun 24];63:95-8. Available from: http://www.ijdvl.com/text.asp?1997/63/2/95/4527
| Introduction|| |
Vitiligo is a common idiopathic acquired heritable melanocytopenic depigmentation disorder. In India great social stigma is attached to the condition. It appears to be a common condition with general incidence reported to be between 1 to 2 percent. Also, in India the incidence of vitiligo appears to be higher in SSK (Somavamsh Sahasrarjun Kshatriya) community.
We, at Department of Dermatology, KEM Hospital, Pune, come across significantly high number of cases of vitiligo. An OPD based study of analysis of basic data like age, sex, occurrence in family and associations of vitiligo in 998 cases has been carried out and presented here to add to our existing knowledge of vitiligo and to note striking differences, if any, in this geographical area and population.
| Materials and Methods|| |
All fresh cases of vitiligo attending skin OPD at KEM Hopital, Pune were serially enrolled for the study. Patients with depigmentation caused by chemicals, burns or other disease were excluded. A proforma was prepared which included Name, Age at onset, Sex, Family history in detail, history of precipitating factors if any etc. Family history was probed into details like exact relation with proband, 3 generations on both sides were traced. History of associated diseases notably diabetes mellitus, thyroid disorder, pernicious anaemia, alopecia areata were noted. If positive, details were recorded. History of precipitating / initiating factors especially physical trauma, sun exposure, acute mental / emotional stress, contact with chemicals / synthetic footwear, disease like burns, herpes zoster etc were noted. History of therapy undergone so far, if any and its response was recorded. It was noted whether trauma, PUVA treatment precipitated a relapse in patients. Detailed dermatological examination was performed to classify the type of vitiligo and to note presence of any other associated dermatological condition like psoriasis, alopecia areata. Detailed general and systemic physical examination was carried out and significant positive findings were noted down. All the patients were subjected to the following investigations: haemogram, urine, stool analysis blood sugar and relevant thyroid function tests etc.
| Results|| |
Out of 998 cases 429 were males(43%) and 569 (57%) were females. The mean age at onset for males was found to be 23.3 years and for females it was 17.4 years. The median age at onset in males was 18 years and it was 13.6 years in females. The earliest age at onset was found at birth and oldest was 73 years. The percent distribution of age at onset of vitiligo cases by sex is shown in [Table - 1] and [Figure - 1].
Out of 998 cases 272 (27.3%) had one or more relative with vitiligo. Among these 207 (76.1%) cases had only one relative affected whereas 65(28%) cases had more than one relative had vitiligo. The details of affected relative and its percentage are shown in [Table - 2].
The clinical types were classified into 2 main subtypes namely localized and generalised. They were further subdivided into 3 subgroups each. Among these, vitiligo vulgaris with multiple macules distributed all over the body in random fashion was found to occur most commonly. The details of subtypes and frequency of occurrence are shown in [Table - 3]. Certain conditions appear to be associated with vitiligo, found either on history taking, examination or investigations. Also certain factors were found to initiate/spread the disease. All these are enlisted in [Table - 4] with frequency of their occurrence.
| Discussion|| |
Pune is an industrial city with rapidly growing cosmopolitan population. KEM hospital is a renowned NGO institution, where patients are referred from all over the city. Though the majority of index cases resided in and around the city, some of them had migrated to Pune from several parts of India. Hence this study may not reflect the characteristics of local Marathi population only.
A slightly higher prevalence in females may not be the true situation, as only self-reporting cases have been enlisted in the present study. Because of the social stigma in the community young females tend to report earlier due to matrimonial anxiety. The age at onset is consistent with previous studies. Onset at birth is not so common. In present study 3 cases had onset of vitiligo at birth. The cases were labelled as vitiligo only when they developed new discrete macules elsewhere and naevus anaemicus and naevus depigmentosus were excluded. One infant's mother had vitiligo. The peak incidence between 5-14 years may reflect cosmetic disfigurement of this age group and parental anxiety leading to early reporting.
Genetic factors play an important role in manifestation of vitiligo. Though various studies indicate involvement of genetic factors, the patterns are not consistent with single locus Mendelian transmission but appear to be polygenic. One hypothesis postulates that recessive alleles at multiple unlinked autosomal loci interact epistatically in pathogenesis of vitiligo. Present study showed 27.3% cases had one or more blood relatives affected with vitiligo. This was dependent only on enquiring the proband or parents. It is likely that they may be unaware of vitiligo on covered parts of relatives who would not like to disclose the condition.
In certain genetically susceptible individuals certain events like trauma; contact with melanotoxic chemicals, conditions like burns, herpes zoster may herald onset of vitiligo [Table - 4].
Among the various types, vitiligo vulgaris or generalized scattered macules variety was found to be the commonest. This indicates that the process of depigmentation (either immune mediated/toxic) may occur simultaneously or subsequently at various unrelated distant sites. Trauma definitely appears to play role in manifestation. Some studies classify vitiligo as unilateral and bilateral and state that they differ substantially in several clinical aspects.
Our study also revealed associations with vitiligo like diabetes mellitus, thyroid disorders which are considered to be autoimmune in origin. Other conditions with proposed autoimmune mechanism like alopecia areata, pernicious anaemia were however not found in any of our cases.
Higher incidence of associations of conditions like amoebiasis, giardiasis and worm infestations is difficult to corelate and may just reflect their high incidence in tropical population. In chronic lichenified eczema, constant scratching or application of certain toxic herbals locally may precipitate onset of vitiligo. This study has thrown some light on the aetiology and pathogenesis of vitiligo.
| Acknowledegements|| |
We are grateful to Dr Banoo Coyaji for encouragement in this research and Dr V N Rao for having read this article and making valuable suggestions. We thank Mrs Vaijayanti Deshpande who kept a very meticulous record of all the cases. We also thank Mr Sunil Patel who prepared this manuscript on computer promptly and methodically.
| References|| |
|1.||Mosher DM, Fitzpatrick TB, et al. Disorders of pigmentation. In: Fitzpatrick TB, Eisen AZ, Wolft K, et al, editors. Dermatology in general medicine. New York: McGraw Hill Company, 1987;810-21. |
|2.||Ramaiah A, Majumdar M, Amarnath VM. Vitiligo in SSK community of Bangalore. Ind J Dermatol Venereol Leprol 1988;54:251-4. |
|3.||Mosher DM, Fitzpatrick TB, et al. Abnormalities of pigmentation. In: Fitzpatrick TB, Eisen AZ, Wolff K, et al, editors. Dermatology in general medicine. New York: McGraw Hill Company, 1979; 583. |
|4.||Majumder PP, Nordlund JJ, Nath SK. Pattern of familial aggregation of vitiligo. Arch Dermatol 1993;129:994-8. [PUBMED] |
|5.||Das SK, Majumder PP, et al. Studies on vitiligo. II. Familial aggregation and genetics. Genetic Epidemiology 1985;2:255-62. [PUBMED] |
|6.||Majumder PP, Das SK, Li CC. Genetic model for vitiligo. Am J Hum Genet 1988;43:119-25. [PUBMED] |
|7.||Barona MI, Arrunategui A, et al. An epidemiologic case control study in a population with vitiligo. J Am Acad Dermatol 1995;33:621-5. [PUBMED] [FULLTEXT]|
[Figure - 1]
[Table - 1], [Table - 2], [Table - 3], [Table - 4]