Vitiligo Differential Diagnoses

Updated: Jul 25, 2017
  • Author: Krista Roncone; Chief Editor: Dirk M Elston, MD  more...
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DDx

Diagnostic ConsiderationsVitiligo and ocular diseaseVitiligo and autoimmune disordersVitiligo and auditory abnormalitiesVitiligo and melanoma

The uveal tract and retinal pigment epithelium contain pigment cells. Uveitis is the most significant ocular abnormality associated with vitiligo. The most severe form of uveitis is seen in the Vogt-Koyanagi-Harada syndrome. This syndrome is characterized by vitiligo, uveitis, aseptic meningitis, dysacusis, tinnitus, poliosis, and alopecia.

Alezzandrini syndrome includes facial vitiligo, poliosis, deafness, and unilateral visual changes. The affected eye has decreased visual acuity and an atrophic iris. [1]

Vitiligo is frequently associated with disorders of autoimmune origin, with thyroid abnormalities being the most common. Vitiligo usually precedes the onset of thyroid dysfunction. A significant incidence of thyroid dysfunction has been found in pediatric patients with nonsegmental vitiligo, suggesting that it may be prudent to screen thyroid function and antibody levels in pediatric patients with vitiligo. [22]

Vitiligo can be found in patients with autoimmune polyendocrinopathy candidiasis-ectodermal dystrophy. In this genetic syndrome, autoantibodies cause destruction of endocrine cells. [23]

Moreover, studies suggest that an association exists between a positive family history of vitiligo, autoimmune/endocrine diseases, leukotrichia, and an increased incidence of vitiligo in children. [24]

Melanin may play a significant role in the establishment and/or maintenance of the structure and function of the auditory system and may modulate the transduction of the auditory stimuli by the inner ear. [25, 26] Because vitiligo affects all melanocytes, auditory disturbances may result, albeit rarely. Several studies have described familial vitiligo to be associated with hearing abnormalities and hypoacusis. [26]

Vitiligolike depigmentation can occur in patients with malignant melanoma, [4, 27] and this is believed to result from a T-cell–mediated reaction to antigenic melanoma cells and cross-reactivity to healthy melanocytes. Most patients with melanoma or with vitiligo develop antibodies to similar antigens that are present both on melanocytes and on melanoma cells. These findings support the hypothesis that the clinical link between the two diseases results from immune responses to antigens shared by normal and malignant pigment cells. Studies have demonstrated that a halo nevus, hypopigmentation, or depigmentation may occur in patients with melanoma. The depigmentation or hypopigmentation spreads centrifugally from the trunk to other parts of the body. It is believed that active vitiligo in patients with melanoma may indicate a better prognosis, as melanoma patients with vitiligo have been shown to have longer survival than otherwise expected. [28]

Differential Diagnoses