World Vitiligo day (June 25)
Eminent Author, Medical Biochemist and Scientist, Technical Education consultant.
AGD Biomedicals (Pvt) LTD. Andheri East, Mumbai.
Vitiligo is the most common skin pigment disorder, with a reported prevalence of 0.1–4% worldwide(1-5). Patients with vitiligo are likely to experience significant psychological trauma due to the visible white discoloration patches on the body, mainly on face and with the associated social stigma(1). About 89 percent of Indian vitiligo patients reported moderate to severe symptoms of depression. Vitiligo can lead to lowered self-esteem, anxiety, depression, and even thoughts of self-harm(1,3). The fear of judgment and rejection can also lead to social withdrawal and relationship difficulties. World vitiligo day is observed on June 25th each year to raise awareness about the skin condition and its impact on the affected individuals and communities. Latest fifth generation IVD clinical laboratory tests are extremely useful for individuals suspected of having vitiligo, mainly to rule out other autoimmune conditions that may be associated with vitiligo. These tests could help to assess overall health and guide treatment decisions(6,7).
Note
(A) Melanocyte cells in the uppermost layer of the skin (epidermis) produce melanin pigment, that protects from harmful effects of UV light of sun and also imparts dark colour to the skin. In vitiligo, antibodies produced against melanocytes, destroy these cells leading to the white discoloration patches on the skin.
(B) Blood test results should always be interpreted within the context of a patient’s overall clinical picture, including their medical history, physical examination findings, and other diagnostic tests.
Q1. What is the difference between vitiligo and leukoderma?
ANS: Leukoderma term is used to describe any clinical condition that leads to loss of skin pigmentation. These clinical conditions include vitiligo and other factors such as chemical exposure, burns, trauma, or certain infections.
Q2. What is the difference between vitiligo and psoriasis?
ANS: In vitiligo specific antibodies act against melanocyte cells present in the skin epidermis and destroy these cells, leading to discoloration of the skin of various parts of the body. While in psoriasis keratinocytes present in the epidermis become hyperactive due to immunological disorder, that leads to high levels of specific cytokines resulting in thick, scaly patches on the various parts of the body.
Q3. What is albinism?
ANS: Albinism is discoloration of the skin caused due to a genetic defect that leads to deficiency of the enzyme tyrosinase, that converts tyrosine to melanin. Due to genetic deficiency of the enzyme, although melanocytes are present, these are not able to produce melanin pigment, leading to skin discoloration. Individuals with albinism often have pale white skin, light hair (white, blonde or reddish), and light-coloured eyes (gray, pink, blue). Albinism may be associated with vision problems such as sensitivity to light, refractive errors, involuntary eye movements etc.
Note :
25th June was chosen as the world vitiligo day to remember the passing of past famous American singer, song writer, singer and philanthropist, Michael Jackson. He openly discussed his struggles with vitiligo. This day serves as an opportunity to break down stigmas and promote understanding and acceptance of vitiligo.
CASE STUDY 1
A 15- year-old girl suffered from discoloration of skin on face and also on other parts of the body. Skin specialist advised the following complete body profile laboratory tests, before starting any specific treatment:
COMPLETE HEMOGRAM
| TEST | RESULT | REFERENCE RANGE |
| Hemoglobin | 9.8 g/dl | 12.5–15.5 g/dl |
| Total erythrocyte count | 3.13 X 1012/l | 4.5.0 ± 0.5 X 1012 /l |
| Total leukocyte count | 5.7 X 109/l | 7.0 ± 3.0 X 109/l |
| Differential leukocyte count | ||
| Neutrophils | 68% | 40–75% |
| Lymphocytes | 26% | 20–45 % |
| Eosinophils | 4% | 1–4 % |
| Monocytes | 2% | 2–8% |
| Stained peripheral blood smear – Microscopic observations | ||
| Hypochromia | + | Normal cells |
| Macrocytosis | ++ | Normal cells |
| PCV | 31% | 36–48% |
| MCV | 101 fL | 82–92 fL |
| MCH | 37 pg | 27–32 pg |
| MCHC | 32 % | 32–36 % |
| RDW- CV | 12.8 | 12–14 |
| Platelet count | 260 X 109/l | 150–400 X 109/l |
Interpretation of Complete hemogram report
Very low values of blood hemoglobin, high MCV, MCH, normal MCHC and presence of macrocytes indicate Normochromic macrocytic anemia (Examples: Macrocytic anemia, Pernicious anemia).
Note:
(A) Folic acid and/or vitamin B12 deficiency leads to macrocytic anemia (Presence of abnormally large size of RBCs). If vitamin B12 deficiency is due to autoimmune antibodies that destroy gastric cells, which secret intrinsic factor, pernicious anemia is diagnosed.
(B) Skin biopsy test may be advised to diagnose loss of melanocyte cells, due to autoimmune antibodies.
(C) Skin discoloration in vitiligo may be caused due to a combination of genetic, autoimmune, and environmental factors(1-5). Autoimmune factors attack and destroy the melanocytes. Similarly, hyper-or hypothyroidism caused due to specific antibodies, presence of alopecia areas and pernicious anaemia might also trigger vitiligo(6). Corticosteroid treatment, emotional trauma, typhoid fever, prolonged antibiotic treatments and recurrent jaundice may trigger vitiligo in certain persons(1).
Routine urine examination: All normal values
Routine feces examination: All normal values
Significant values of Liver profile tests, Cardiac profile tests, Lipid profile tests, Thyroid panel tests, Electrolyte profile and other tests were as follows:
| TEST | RESULT | REFERENCE RANGE |
| Blood sugar (Fasting) | 86 mg/dl | 70-110 mg/dl |
| HbA1C | 5.6 | Below 5.8 |
| Serum cholesterol | 158 mg/dl | Less than 200 mg/dl |
| LDL cholesterol | 85 mg/dl | Less than 100 mg/dl |
| SGPT | 30 IU | 5-35 IU |
| SGOT | 35 IU | 8-40 |
| High sensitivity CRP | 0.8 mg | Less than 1.0 mg/L |
Interpretation
All above test values were normal .
THYROID FUNCTION TESTS
| TEST | RESULT | REFERENCE RANGE |
| T3 | 77 ng/dl | 86-187 ng/dl |
| T4 | 3.7 µg/dl | 4.5-12.5 µg/dl |
| TSH | 9.6 µIU/ ml | 0.3- 5.0 µIU/ ml |
Interpretation
Patient was suffering from Hypothyroidism. It is necessary to test serum for the presence of antibodies to thyroid tissue.
VITAMIN TESTS
| TEST | RESULT | REFERENCE RANGE |
| Serum vitamin B12 | 110 ng/L | 206-678 ng/L |
| Serum vitamin D3 | 15 ng/ml | > 30 ng/ml |
Interpretation
Patient was suffering from vitamin D and vitamin B12 deficiencies.
Note:
(A) Blood tests can provide valuable information about the overall health of the patient, including blood levels of vitamins and minerals, which could be important to provide supportive treatment for vitiligo.
(B) Main factors considered to understand the discoloration of skin problem: The medical history of the patient, the appearance of white spots or patches on the skin, recent events of injury, or trauma that could contribute to the white patch.
(C) Presently there is no drug that can prevent or cure vitiligo. Even after curing vitamin deficiencies and thyroid diseases, vitiligo may persist, due to heterogeneous nature of the specific antibodies. Some drugs in combination with light therapy, could be helpful to restore some original colour of the skin.
(D) In autoimmune diseases, the immunosuppressive treatments based on steroids and/or anti-mitotic agents used so far are now in the process of replacement with more immune selective drugs. These new therapies are in the form of antagonist and cytotoxic antibodies.
References
(1) James WD, Elston D, Treat JR, Rosenbach MA, Neuhaus I (2020). “36. Disturbances of pigmentation”. Andrews’ Diseases of the Skin: Clinical Dermatology (13th ed.). Edinburgh: Elsevier. pp. 871–874. ISBN 978-0-323-54753-6.
(2) Ezzedine K, Eleftheriadou V, Whitton M, van Geel N (July 2015). “Vitiligo”. Lancet. 386 (9988): 74–84. doi:10.1016/s0140-6736(14)60763-7. PMID 25596811. S2CID 208791128.
(3) “Questions and Answers about Vitiligo”. NIAMS. June 2014. Archived from the original on 21 August 2016. Retrieved 11 August 2016.
(4) Zhang Y, Cai Y, Shi M, Jiang S, Cui S (2016). “The Prevalence of Vitiligo: A Meta-Analysis”. PLOS ONE. 11 (9): e0163806. Bibcode:2016PLoSO..1163806Z. doi:10.1371/journal.pone.0163806.
(5) “Vitiligo–Symptoms and causes”. Mayo Clinic. Retrieved 5 May 2023.
(6) Diane Giovannini, Aude Belbezier, Athan Baillet, Laurence Bouillet, Mitsuhiro Kawano, Chantal Dumestre-Perard, Giovanna Clavarino, Johan Noble, Jacques-Olivier Pers, Nathalie Sturm and Bertrand Huard. When are laboratory tests indicated in patients. Dermato-Endocrinology 4:1, 58–62; January/February/March 2012; G 2012 Landes.
(7) Godkar PB, Godkar DP. Text book of Medical laboratory technology (4th edition, 2024), Bhlani Publishers, Mumbai. India.
(8) Boehncke WH, Schön MP (September 2015). “Psoriasis”. Lancet. 386 (9997): 983–94. doi:10.1016/S0140-6736(14)61909-7. PMID 26025581. S2CID 208793879.
