Some patients with vitiligo have an underlying autoimmune disease.


Autoimmune diseases associated with vitiligo:

(1) autoimmune polyendocrinopathy, especially when Addison's disease and/or Grave's disease are present

(2) rheumatoid arthritis

(3) psoriasis

(4) systemic lupus erythematosus

(5) pernicious anemia


Proposed mechanism: autoantibody targeting melanocytes.


Patients with autoimmune Addision's disease may have autoantibodies against aromatic L-amino acid decarboxylase or tryptophan hydroxylase.


Some affected families have a defect in the NALP1 gene on 17p13.


A skin biopsy may show a loss of dermal melanocytes in affected areas.


Differential diagnosis:

(1) depigmenting chemical exposures

(2) depigmentation due an underlying skin disease


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