Abstract
Background: The precise pathogenesis remains not fully understood. However, it is thought to involve an autoimmune process directed against melanocytes. Thyroid disorders and autoimmune thyroid diseases have been shown in some reports to be associated with vitiligo. Additionally, there is limited and conflicting data examining the association of antinuclear antibodies (ANA) with vitiligo. Methods: We conducted a cross-sectional study among 50 vitiligo patients diagnosed according to established clinical criteria at King Khalid University Hospital, Riyadh from January 2008 through December 2010. Blood samples were obtained from the study participants and were tested for antinuclear antibodies (ANA), thyroid stimulating hormone (TSH) and free thyroxin hormone (T4). Results: Males represented 62% and the mean age was 28.2±11.0 years. A total of 20 (41.7%) had positive ANA values (titer ≥1:40). The mean TSH level was 2.69±2.17 µIU/mL. The mean free T4 level was 16.40±2.74 pmol/L and all patients were in the normal range (10.3-25.8 pmol/L). There were no statistically significant associations between ANA and age, gender, extent of skin lesion, face inclusion, and free thyroxin levels. On the other hand, positive ANA level had significant association with TSH level (p≤0.041). With exception of ANA, TSH level had no statistically significant associations with the above variables. Conclusions: The results of the current study showed higher prevalence of ANA in vitiligo patients, probably suggesting autoimmune process. The current finding may need to be confirmed in a larger prospective multicentric study before recommending periodic screening of patients with vitiligo for thyroid function and antithyroid antibodies.
Keywords: Vitiligo · autoimmune · thyroid disease · antinuclear antibodies
References
- 1.Alikhan A, Felsten LM, Daly M, Petronic-Rosic V. Vitiligo: a comprehensive overview Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. Journal of the American Academy of Dermatology 2011; 65(3): 473-91.
- 2.Taieb A, Picardo M. The definition and assessment of vitiligo: a consensus report of the Vitiligo European Task Force. Pigment cell research / sponsored by the European Society for Pigment Cell Research and the International Pigment Cell Society 2007; 20(1): 27-35.
- 3.Kruger C, Schallreuter KU. A review of the worldwide prevalence of vitiligo in children/ adolescents and adults. International journal of dermatology 2012; 51(10): 1206-12.
- 4.Dwivedi M, Laddha NC, Shajil EM, Shah BJ, Begum R. The ACE gene I/ D polymorphism is not associated with generalized vitiligo susceptibility in Gujarat population. Pigment Cell Melanoma Res 2008; 21(3): 407-8.
- 5.Kyriakis KP, Palamaras I, Tsele E, Michailides C, Terzoudi S. Case detection rates of vitiligo by gender and age. International journal of dermatology 2009; 48(3): 328-9.
- 6.Handa S, Dogra S. Epidemiology of childhood vitiligo: a study of 625 patients from north India. Pediatr Dermatol 2003; 20(3): 207-10.
- 7.Zhang Z, Xu SX, Zhang FY, et al. The analysis of genetics and associated autoimmune diseases in Chinese vitiligo patients. Arch Dermatol Res 2009; 301(2): 167-73.
- 8.Halder RM, Taliaferro SJ. Vitiligo. In: Wolff K, Goldsmith L, Katz S, Gilchrest B, Paller A, Lefell D, editors. Fitzpatrick’s dermatology in general medicine. New York: McGraw-Hill; 2008. p. 72.
- 9.Grimes PE. New insights and new therapies in vitiligo. JAMA 2005; 293(6): 730-5.
- 10.Sandoval-Cruz M, Garcia-Carrasco M, SanchezPorras R, et al. Immunopathogenesis of vitiligo. Autoimmun Rev 2011; 10(12): 762-5.
- 11.Spritz RA. The genetics of generalized vitiligo and associated autoimmune diseases. Pigment Cell Res 2007; 20(4): 271-8.
- 12.Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigment Cell Res 2003; 16(3): 20814.
- 13.Gopal KV, Rama Rao GR, Kumar YH, Appa Rao MV, Vasudev P. Vitiligo: a part of a systemic autoimmune process. Indian J Dermatol Venereol Leprol 2007; 73(3): 162-5.
- 14.Amerio P, Di Rollo D, Carbone A, et al. Polyglandular autoimmune diseases in a dermatological clinical setting: vitiligo-associated autoimmune diseases. Eur J Dermatol 2010; 20(3): 354-8.
- 15.Jin Y, Birlea SA, Fain PR, et al. Variant of TYR and autoimmunity susceptibility loci in generalized vitiligo. N Engl J Med 2010; 362(18): 1686-97.
- 16.Quan C, Ren YQ, Xiang LH, et al. Genomewide association study for vitiligo identifies susceptibility loci at 6q27 and the MHC. Nat Genet 2010; 42(7): 614-8.
- 17.Spritz RA. Shared genetic relationships underlying generalized vitiligo and autoimmune thyroid disease. Thyroid 2010; 20(7): 745-54.
- 18.Daneshpazhooh M, Mostofizadeh GM, Behjati J, Akhyani M, Robati RM. Anti-thyroid peroxidase Indicators of Autoimmune Illness & Thyroid Disease among Vitiligo Patients, Al Shahrani N 39 Original Article MAJMAAH JOURNAL OF HEALTH SCIENCE, Vol 2, Issue 1, 2014 antibody and vitiligo: a controlled study. BMC Dermatol 2006; 6: 3.
- 19.Gey A, Diallo A, Seneschal J, et al. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms. The British journal of dermatology 2013; 168(4): 756-61.
- 20.Zettinig G, Tanew A, Fischer G, Mayr W, Dudczak R, Weissel M. Autoimmune diseases in vitiligo: do anti-nuclear antibodies decrease thyroid volume? Clin Exp Immunol 2003; 131(2): 347-54.
- 21.Kroon MW, Joore IC, Wind BS, et al. Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo. The British journal of dermatology 2012; 166(3): 532-8.
- 22.Kakourou T, Kanaka-Gantenbein C, Papadopoulou A, Kaloumenou E, Chrousos GP. Increased prevalence of chronic autoimmune (Hashimoto's) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol 2005; 53(2): 220-3.
- 23.Paravar T, Lee DJ. Vitiligo in an urban academic setting. Int J Dermatol 2010; 49(1): 39-43.
- 24.Prcic S, Duran V, Poljacki M, Petrovic L, Jakovljevic A, Jokic M. [Autoantibodies in children with vitiligo]. Med Pregl 2004; 57(7-8): 386-90.
- 25.Marin GG, Cardiel MH, Cornejo H, Viveros ME. Prevalence of antinuclear antibodies in 3 groups of healthy individuals: blood donors, hospital personnel, and relatives of patients with autoimmune diseases. J Clin Rheumatol 2009; 15(7): 325-9.
- 26.Tan EM, Feltkamp TE, Smolen JS, et al. Range of antinuclear antibodies in "healthy" individuals. Arthritis Rheum 1997; 40(9): 1601-11.
- 27.Farrokhi S, Hojjat-Farsangi M, Noohpisheh MK, Tahmasbi R, Rezaei N. Assessment of the immune system in 55 Iranian patients with vitiligo. J Eur Acad Dermatol Venereol 2005; 19(6): 706-11.
- 28.Chow S, Rizzo C, Ravitskiy L, Sinha AA. The role of T cells in cutaneous autoimmune disease. Autoimmunity 2005; 38(4): 303-17.
- 29.Prcic S, Duran V, Poljacki M, Petrovic L, Jakovljevic A, Jokic M. [Autoantibodies in children with vitiligo]. Medicinski pregled 2004; 57(7-8): 38690.
- 30.Nunes DH, Esser LM. Vitiligo epidemiological profile and the association with thyroid disease. An Bras Dermatol 2011; 86(2): 241-8.
- 31.Karelson M, Silm H, Salum T, Koks S, Kingo K. Differences between familial and sporadic cases of vitiligo. J Eur Acad Dermatol Venereol 2011.
- 32.Boelaert K, Newby PR, Simmonds MJ, et al. Prevalence and relative risk of other autoimmune diseases in subjects with autoimmune thyroid disease. The American journal of medicine 2010; 123(2): 183 e1-9.
- 33.Ingordo V, Gentile C, Iannazzone SS, Cusano F, Naldi L. Vitiligo and autoimmunity: an epidemiological study in a representative sample of young Italian males. J Eur Acad Dermatol Venereol 2011; 25(1): 105-9.
- 34.Artantas S, Gul U, Kilic A, Guler S. Skin findings in thyroid diseases. Eur J Intern Med 2009; 20(2): 158-61.
- 35.Vrijman C, Kroon MW, Limpens J, et al. The prevalence of thyroid disease in patients with vitiligo: a systematic review. The British journal of dermatology 2012; 167(6): 1224-35.
- 36.Dittmar M, Kahaly GJ. Polyglandular autoimmune syndromes: immunogenetics and long-term follow-up. The Journal of clinical endocrinology and metabolism 2003; 88(7): 2983-92. Indicators of Autoimmune Illness & Thyroid Disease among Vitiligo Patients, Al Shahrani N 40