Vitiligo and disorders of the retinal pigment epithelium.

Abstract

SUMMARY The association of vitiligo with inflammation of the uveal tract is well established. The relationship between vitiligo and hypopigmentation and/or degeneration of the retinal pigment epithelium (RPE) not secondary to ocular inflammation has not been adequately investigated. Sixty (27%) of 223 consecutive patients with vitiligo were found to have some evidence of RPE hypopigmentation ranging from mild, focal areas of involvement in most cases to extensive RPE degeneration with a retinitis pigmentosa-like syndrome in one patient. Fifteen (25%) patients complained of night blindness. Only 6 (4%) of 148 patients in a control group had similar funduscopic findings (p<0-001). None of these patients were symptomatic. There have been isolated reports of vitiligo occurring with tapetoretinal degeneration. We report 2 patients with both vitiligo and retinitis pigmentosa.Vitiligo is defined as an 'idiopathic, probably autoimmune condition characterized by destruction of the melanocytes in small or large circumscribed areas of the skin, resulting in patches of depigmentation, often having a hyperpigmented border or often enlarging slowly'.' It affects approximately 0-38% to 1 0% of the population.23Depigmentation of the lids and poliosis of the brows and eyelashes are commonly seen in vitiligo. The association of vitiligo with inflammation of the uveal tract has long been recognised47 and is at present the subject of renewed interest.'-" There have also been isolated reports ofvitiligo occurring with tapetoretinal degenerations. [12][13][14][15][16][17] In the present report we consider the possible relationship between vitiligo and disorders of the retinal pigment epithelium (RPE). Materials and methodsThe common finding ofvitiligo and hypopigmentation and/or degeneration of the RPE was observed in patients drawn from 2 sources.Two hundred and twenty-three patients with previously documented cutaneous vitiligo were examined for ocular abnormalities. These The age range of the vitiligo patients was 2-82 years, with an average age of 43 years; 143 were female; 83 were male; there were 202 Caucasians and 21 blacks. The duration of the vitiligo ranged from 5 months to 66 years, with an average of 13 years. Most of the patients were on psoralen therapy for their disease.One hundred and forty-eight patients with psoriasis undergoing psoralen and ultraviolet light (PUVA) therapy were examined in an identical manner. This was an ideal control population because of a similar age range (5-77 years), average age (47 years), racial distribution (140 Caucasian, 6 black), and medication regimen (psoralen therapy) as a study group. Because of the nature of the skin changes in the vitiligo patients it was not possible to carry out a double-masked study.We examined 2 patients in whom both vitiligo and retinitis pigmentosa (RP) were present. 153 on 11 April 2019 by guest. Protected by copyright.

Evaluation of ocular findings in patients with vitiligo

“…Eye findings were investigated in patients with cutaneous vitiligo, but the results were limited. Posterior uveitis, sympathetic ophthalmia, and RPE atrophy were reported in vitiligo . Uveal inflammation related to those findings may suggest that inflammatory reaction may play a role in the etiopathogenesis of vitiligo.…”

Profile of vitiligo in the south of Tunisia

“…Antithyroid antibodies were detected in 13 patients (not all symptomatic for thyroid dysfunction). 28,29 As vitiligo affects all active melanocytes, auditory and ocular problems may result in patients with vitiligo. We believe that the significant number of vitiligo patients with atopic dermatitis in our study merely reflects the high prevalence of atopic dermatitis observed in the general population in Tunisia.…”

Cutaneous vitiligo associated with choroidal hypopigmentation

“…Large studies suggest that choroidal pigmentary changes occurring in the presence of vitiligo can be ascribed to uveitis in many cases, although in some no evidence of inflammation could be found. [1][2] Only a small number of cases have been reported with widespread hypopigmentation of both choroid and retinal pigment epithelium (RPE). [1][2][3] Our two patients with vitiligo had extensive choroidal hypopigmentation without signs or a previous history of ocular inflammation.…”

“…[1][2] Only a small number of cases have been reported with widespread hypopigmentation of both choroid and retinal pigment epithelium (RPE). [1][2][3] Our two patients with vitiligo had extensive choroidal hypopigmentation without signs or a previous history of ocular inflammation. They both had normal visual function, and additional fluorescein angiogram and electrodiagnostic tests in case 1 were normal.…”

“…Extensive choroidal involvement in vitiligo patients has rarely been reported, and is clearly uncommon. 2 However, it may not be detected since it may not always be evident clinically and it gives rise to no functional deficit. Owing to their Asian origin, the normal dark choroidal pigmentation could easily be distinguished from hypopigmented choroid.…”