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Vitiligo associated with cutaneous amyloidosis
Department of Skin, 5TD and Leprosy, Sri Devaraj Sirs Medical College, Tamaka, Kolar - 563 101, Karnataka
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Rajkumar V, Okade R, Chakrabarty N, Yellappa K. Vitiligo associated with cutaneous amyloidosis. Indian J Dermatol Venereol Leprol 2001;67:263
AbstractVitiligo is known to be associated with a variety of dermatoses and systemic diseases. We describe a case of vitiligo developing in a patient having cutaneous amyloidosis. To our knowledge this is the first report of its kind in the literature.
Vitiligo is a specific, common, often heritable, acquired pigmentary disorder characterised by descrete, milky- white macules devoid of identifiable melanocytes. A number of disorders are associated with vitiligo. Cutaneous amyloidosis is an abnormality of protein metabolism with resultant deposition of amyloid protein in the skin. Cutaneous amyloidosis is reported to be associated with collagen vascular diseases, pachyonychia congenita and MEN Type 2a.
Here, we report a case of vitiligo associated with maculo papular amyloidosis in a 40-year-old woman.
A 40-year-old woman presented with asymptomatic, depigmented, discrete skin lesions over fingers, shin and elbows of three months duration. Examination revealed multiple, well circumscribed, depigmented macules and patches distributed over the abdomen and distal part of the extremities.
The patient also had reticulated pattern of hyperpigmented macules and papules distributed symmetrically over the shins. Depigmented macules were interspersed in this lesion. The hyperpigmented lesions were present since 8 to 10 years and were associated with mild itching. No family history of the disease was present. Physical and systemic examinations were normal.
Histopathological examination of the specimen from the lesion showed typical features of vitiligo with uniform deposition of eosinophilic material in the papillary dermis. Congo red staining of the specimen revealed typical green birefringence under the fluorescent microscope. Other laboratory investigations were within normal limits.
Though the exact etiology of vitiligo is not confirmed, it is thought to be mainly of autoimmune origin. It is known to be associated with a number of cutaneous as well as systemic diseases. But association with cutaneous amyloidosis has not been described.
In the development of primary cutaneous amyloidosis the exact etiology is not known. The close proximity of amyloid deposit to the lower epidermis strongly suggests that the epidermis plays a role in its pathogenesis. Further studies are needed to clarify whether this is a mere coincidence or an associated condition.
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