A clinical study of vitiligo

Introduction

Vitiligo is a common pigmentary disorder of the skin. World wide incidence of vitiligo is 1%.[1] Widespread prejudices, ignorance, taboos, lack of scientific appraisal and confusion of vitiligo with leprosy all make it a social embarrassment for the patient.[2] However the life expectancy is unaffected.[3],[4] The present study was conducted to know the various clinical patterns, triggering factors and to find out the various diseases associated with it.

Materials and Methods

The study was conducted for a period of one and a half years from October 1996 to March 1998. One hundred patients with vitiligo attending OPD of our hospital were included in the study and the diagnosis of vitiligo in all cases was made based on the clinical features alone. All the patients were interrogated for a detailed history and a meticulous examination of each case carried out and recorded giving special emphasis to the duration of the disease, age of onset, precipitating factors, positive family history and any other cutaneous or systemic illness. Apart from routine blood and urine examination, blood sugar and thyroid function tests were done wherever necessary.

Results

Incidence of vitiligo among the new patients was 1.84%. Females (55%) were affected more than males (45%) giving a male female ratio of 1:1. 22. The age at onset was found to be in the 3rd decade in majority of the patients (20%). A positive family history was available in 8 patients (8%). Trauma (13%) was the most common precipitating factor followed by emotional upset (8%), foot wear (7%), parturition (3%), pregnancy (2%) and surgery (1 %).

The most common site of involvement was found to be the lower extremity (54%). Vitiligo vulgaris (39%) was the commonest morphological pattern, other patterns seen were focal vitiligo (27%), acrofacial vitiligo (18%), lip - tip vitiligo (7%), lip vitiligo (5%), segmental vitiligo (3%) and universal vitiligo (1%) [Table - 1]. The associated cutaneous diseases noted in our study were atopic dermatitis (2%), Hansen′s disease (2%), alopecia areata (1 %), halo naevus (1%), chronic urticria (1%), and lichen planus (1%).

Among the systemic diseases, diabetes mellitus was found in 9 cases (9%), hypertension (4%), hypothyroidism (2%), epilepsy (1%) and ischaemic heart disease (1%).

Discussion

The incidence of 1.84% obtained in the present study of vitiligo corresponds to the observations made by different authors in their studies.[5],[6] Though vitiligo affects both sexes equally,[7] most of the studies[8],[9] show a female preponderance. The cause of female preponderance in our study is probably because of a greater cosmetic awareness among females.

Most of the cases (83%) were less than 5 years in duration regardless of sex, which corresponds to the study done by Hann et al.[10] Eight (8%) patients gave a positive family history, which is less compared to the earlier study.[6] The precipitating factors were noticed in thirty four (34%) patients, trauma being the most common factor (13%). Various studies undertaken to determine the factors preciptating vitiligo include emotional stress, sun burn, major illness, surgical procedure, pregnancy, parturition and physical trauma.[3],[11] The lower extremity was commonly (54%) involved, which supports the findings of other authors.[7],[11]

Vitiligo vulgaris (39%) was most frequently noticed in our study which is in agreement with studies reported earlier.[6] There were four cases of flexural vitiligo and one case of universal vitiligo. The features noticed were leukotrichia, trichrome morphology and koebnerization.

Twenty - five patients (25%) had other cutaneous and systemic diseases associated with vitiligo. Vitiligo has been reported in association with numerous cutaneous and systemic disorders.[12],[14] In some of these conditions, such as the autoimmune diseases,[14],[15] the incidence of vitiligo is significantly higher than in the population at large.