from January 2012 to January 2013. We compared those having vitiligo alone (n = 119), versus those with both vitiligo and AIT (n = 75). The presence of AIT was defined as having at least one medium to high organspecific autoantibody titer ((anti-thyroglobulin (anti-TG), anti-thyroperoxidase (anti-TPO), anti-TSH receptor (antiTSHR)) and/or an autoimmune thyroid disease previously diagnosed by an endocrinologist. Medical assessment was performed by using a modified Vitiligo European Task Force (VETF) [1] form for each patient. The chi square test and the student’s t test were performed. Results were considered significant for p values ≤0.05. Logistic regression was performed, including six predictors as shown by figure 1B. Univariate analysis results are shown in figure 1A. The significant association of Koebner phenomenon with patients having both vitiligo and AIT differs from that previously reported by Arunachalam et al. [2] and we attribute this difference to the revised definition proposed by the VETF, in which Koebner phenomenon is considered positive on the basis of both clinical history and physical exam [3]. Acrofacial vitiligo was also found to be more frequent in patients with vitiligo and AIT. Similar to our finding, Van Geel et al. reported that the hands were more significantly associated with patients’ vitiligo and thyroid disease [4]. This datum differs from that referred by Gey et al. [5], who found that localization on the torso is significantly

8. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)-a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-6. 9. Augustin M, Kruger K, Radtke MA, Schwippl I, Reich K. Disease severity, quality of life and health care in plaque-type psoriasis: a multicenter cross-sectional study in Germany. Dermatology 2008; 216: 366-72. 10. Garzitto A1, Ricceri F, Tripo L, Pescitelli L, Prignano F. Possible reconsideration of the Nail Psoriasis Severity Index (NAPSI) score. J Am Acad Dermatol 2013; 69: 1053-4. doi:10.1684/ejd.2014.2399

Autoimmune thyroid disease in Italian patients with non-segmental vitiligo There are very few studies in the current literature that have analyzed vitiligo and autoimmune thyroid disease (AIT) using both univariate and multivariate analyses. Thus, we sought to investigate the practical/clinical implications in subjects with both vitiligo and AIT compared to those with vitiligo alone. Verification of data was done by using medical records from the patient’s family physician. We performed a prospective, case control study concerning 194 vitiligo patients, older than 18, seen in our clinic

A Patients with vitiligo and autoimmune thyroid disease (%)

Patients with vitiligo (%)


Localization: upper extremities 73.3


Localization: head and neck 83.14 33.3

Repigmentation after treatment




38.65 54.66

Koebner phenomenon

39.5 46.66

Family History: Thyroid Disease

26.05 81.94

Duration: > 5 years

54.62 22.66

Acrofacial Vitiligo


Figure 1A. Univariate analysis: significant variables in vitiligo versus vitiligo+AIT patients EJD, vol. 24, n◦ 5, September-October 2014


B OR [95% CI]

P value

Gender (female)

1.101 [-0.70-0.90]


Duration > 5 years

4.12 [0.62-2.21]


Repigmentation after treatment

2.292 [0.61-1.6]



4.070 [0.70-2.1]


Acrofacial vitiligo

0.992 [-0.53-0.51]


Koebner phenomenon

1.262 [-0.45-0.91]


Figure 1B. Multivariate analysis: significant variables in vitiligo versus vitiligo+AIT patients

associated with patients with both vitiligo and AIT. These differences might be due to ethnic differences. Considering that women tend to have more autoimmune diseases than men, multivariate analysis allowed us to evaluate clinical parameters and AIT independently of gender, a potentially confounding factor. Multivariable analysis results are shown in figure 1B. One of the best predictors of patients with both vitiligo and AIT was a specific stressful event correlated with the onset of vitiligo. The literature in fact suggests that stress increases the levels of neuroendocrine hormones, neuropeptides, and neurotransmitters in the central nervous system. The immune system, in particular, can be altered [6], thus facilitating the development and duration of AIT in vitiligo patients [7]. We also confirmed the association of vitiligo and AIT with a long duration of disease [5]. Lastly, we found that repigmentation after treatment was significantly greater in patients with both diseases. This suggests that the use of frequently used topical immunosuppressive therapies such as corticosteroids, calcineurin inhibitors and phototherapy is effective in inhibiting the immune system and therefore the autoimmune component of the disease. Similar to our results, another study also reported that patients with thyroid disease and vitiligo demonstrated a pronounced difference in repigmentation after treatment when compared with patients having vitiligo alone [4]. One possible limitation of this study concerns patients with negative AIT markers, which might have been positive previously. We believe that long disease duration and stressful life events should lead to thyroid screening in vitiligo patients. The authors have no conflict of interest to declare and there were no funding sources utilized for this work.  Disclosure. Financial support: none. Conflict of interest: none. Department of Surgery and Translational Medicine, Division of Dermatology Viale Michelangelo 41, 50100 Florence, Italy



1. Moretti S, Arunachalam M, Colucci R, et al. Autoimmune markers in vitiligo patients appear correlated with obsession and phobia. J Eur Acad Dermatol Venereol 2012; 26: 861-7. 2. Arunachalam M, Colucci R, Berti S, et al. Autoimmune signals in vitiligo patients are associated with distinct clinical parameters and toxic exposures. J Eur Acad Dermatol Venereol 2013; 27: 961-6. 3. Van Geel N, Speeckaert R, Taieb A, et al. Koebner’s phenomenon in vitiligo: European position paper. Pigment Cell Melanoma Res 2011; 24: 564-73. 4. Van Geel N, Speeckaert M, Brochez L, Lambert J, Speeckaert R. Clinical profile of generalized vitiligo patients with associated autoimmune/autoinflammatory diseases. J Eur Acad Dermatol Venereol 2014; 28: 741-6. 5. Gey A, Diallo A, Seneschal J, et al. Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricated pathomechanisms. Br J Dermatol 2013; 168: 756-61. 6. Stojanovich L, Marisavljevich D. Stress as a trigger of autoimmune disease. Autoimmun Rev 2008; 7: 209-13. 7. Effraimidis G, Tijssen JG, Brosschot JF, Wiersinga WM. Involvement of stress in the pathogenesis of autoimmune thyroid disease: a prospective study. Psychoneuroendocrinology 2012; 37: 1191-8. doi:10.1684/ejd.2014.2396

Early dermoscopic detection of lentigo maligna within a lesion of pigmented contact dermatitis It is often difficult to clinically diagnose lentigo maligna (LM) and lentigo maligna melanoma (LMM) in early or small lesions. Recent intensive studies have clearly indicated that dermoscopy greatly contributes to correct diagnoses of pigmented skin lesions and validation of criteria has been established [1, 2]. The Consensus Net Meeting on Dermoscopy (CNMD) has adopted 4 criteria for LM/LMM, “asymmetrical pigmented follicular structures”, “rhomboidal structures”, “annular-granular structures” and “gray pseudo-network”, for evaluations following Schiffner’s description [3, 4]. We here report a case of small lentigo maligna occurring within reticular pigmentation caused by contact dermatitis on the face and emphasize the importance of integration of dermoscopic and histopathological findings for a correct diagnosis. EJD, vol. 24, n◦ 5, September-October 2014

Autoimmune thyroid disease in Italian patients with non-segmental vitiligo.

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