Vitiligo and Autoimmune Thyroid Disease: The Link

Example of vitiligo
Vitiligo Support International, www.vitiligosupport.org

Researchers have found that there is a clear genetic connection between the skin condition vitiligo, and other autoimmune diseases, including autoimmune thyroid conditions such as Hashimoto's thyroiditis and Graves' disease.

The researchers found that vitiligo was highly associated with other autoimmune diseases, including autoimmune thyroid disease, pernicious anemia, rheumatoid arthritis, psoriasis, lupus, Addison's disease, and adult-onset autoimmune diabetes.

The researchers then were able to identify a particular gene that makes people more susceptible to vitiligo and other autoimmune diseases, particularly autoimmune thyroid disease.

What is Vitiligo?

Vitiligo is a condition in which the pigment is lost from areas of the skin, causing whitish, smooth patches. The loss of pigment is from melanocytes -- the cells that produce the pigment. The hair that grows in those affected areas may also be affected, turning white as well. The skin itself suffers no damage. Other names for vitiligo are piebald skin and acquired leukoderma. There are several types of vitiligo:

  • Non-segmental vitiligo - This is the most common type of vitiligo, and occurs in up to 90% of people who have been diagnosed. The patches are visible on both sides of the body, and are typically symmetrical. The spots are most commonly found in areas commonly exposed to the sun. There are five subcategories of non-segmental vitiligo:
    • Generalized – no specific are or size where the patches occur
    • Acrofacial – mostly on fingers and toes
    • Mucosal – found around mucous membranes and lips
    • Universal – covers most of body – this is very rare
    • Focal – a few scattered white patches in a small area, typically found in children
  • Segmental vitiligo – this form of vitiligo spreads rapidly but is more stable than non-segmental. It is much less common than non-segmental. This type is only found in around 10% of patients diagnosed with vitiligo. This type of vitiligo tends to respond well to topical treatments.

What are the Signs and Symptoms of Vitiligo?

There are a number of symptoms seen in vitiligo, including:

  • White patches on hands, arms, face, arms, feet, and lips
  • Discoloration around the navel, rectum, genitals or armpits
  • Loss of color in the tissues that line the mouth and nose
  • Loss of color or change in the eyeball
  • Premature graying or whitening of the hair on the scalp, eyelashes, eyebrows or beard
  • Severe headache, dizziness or pain
  • Skin discoloration

Vitiligo may or may not spread to other parts of the body. Vitiligo is much more noticeable in people of color, though it does affect every race. For some people, vitiligo does not spread past the initial affected parts. Some people have more patches show up, but slowly over time. For others, vitiligo can spread very quickly and affect many parts of the body. Some experts theorize that chronic stress or physical trauma may trigger or worsen vitiligo.

What Causes Vitiligo?

There is no clear cut reason why the melanocytes die. Some of the reasons thought to cause vitiligo are:

  • An autoimmune attack, where the immune system inappropriately attacks and destroys the melanocytes in the skin
  • Imbalances in the body’s oxidative stress, that may be genetic
  • Viruses

A number of factors are considered trigger events for vitiligo, including:

  • Stressful events
  • Severe sunburn
  • Exposure to harsh chemicals

How is Vitiligo Diagnosed?

A doctor will diagnose vitiligo by evaluating your family and medical history, as well as a physical exam. Your doctor may order blood tests to evaluate your thyroid function, given the link between vitiligo and autoimmune thyroid disease.

Your doctor will typically ask questions, including:

  • Do you have other family members with vitiligo?
  • Do you have a family history of autoimmune diseases?
  • Did you have a serious rash or sunburn prior to the white patches showing up?
  • Are you under physical or mental stress?
  • Did your hair turn grey before age 35?
  • Are you sensitive to the sun?

How is Vitiligo Treated?

Most likely, you will need to see a dermatologist to properly diagnose vitiligo. The doctor can help you start a course of treatment. There is no cure for vitiligo, but there are many treatment options. The goal of any vitiligo treatment is to help restore the skin pigmentation, however, there are currently no treatments that will fully restore all lost pigmentation.

Treatment depends on your age, overall health, personal preferences, and the location of the vitiligo on your body. Some people choose not to treat their vitiligo.

The treatments for vitiligo include the following:

Two new options are also showing promise in treating vitiligo.

  • PC-KUS - PC-KUS is a topical treatment developed in Europe. In one study of almost 2,500 patients with vitiligo, Schallreuter and team analyzed 2,411 patients from several countries with vitiligo, and in treating them with PC-KUS, were able to restore pigmentation in their skin and hair in the majority of patients treated.
  • Tofacitinib - Tofacitinib, a drug typically used to treat moderate to severe rheumatoid arthritis, was found to stimulate nearly full repigmentation in a vitiligo patient. More extensive studies are needed to confirm that to confirm that the drug is both safe and effective in treating vitiligo.

More Information on Vitiligo

Source:
Jin, Ying M.D., Ph.D., et. al. "NALP1 in Vitiligo-Associated Multiple Autoimmune Disease," NEJM, Volume 356:1216-1225, March 22, 2007 Number 12

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