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 Table of Contents  
CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 50-52

Congenital vitiligo with positive paternal history − a rare case report


Acharya Shree Bhikshu Government Hospital, Moti Nagar, New Delhi, India

Date of Submission06-Feb-2020
Date of Decision06-Apr-2020
Date of Acceptance11-Apr-2020
Date of Web Publication10-Jul-2020

Correspondence Address:
Dr. Niharika Jha
A-51 Swasthya Vihar, Vikas Marg, New Delhi-110092
India
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Source of Support: None, Conflict of Interest: None


DOI: 0.4103/Pigmentinternational.Pigmentinternational_4

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  Abstract 


Vitiligo is considered to be an acquired skin disorder in which melanocytopenia occurs. It is characterized by development of achromic patches on skin. Most of the patients develop this disease in the second or third decade of life. We present a case of a 7 month old child who had depigmented patches on skin since birth, which questions the concept of acquired etiology of vitiligo.

Keywords: Achromic patches, congenital vitiligo, melanocytopenia, vitiligo


How to cite this article:
Jha N, Narayan V. Congenital vitiligo with positive paternal history − a rare case report. Pigment Int 2020;7:50-2

How to cite this URL:
Jha N, Narayan V. Congenital vitiligo with positive paternal history − a rare case report. Pigment Int [serial online] 2020 [cited 2020 Aug 10];7:50-2. Available from: http://www.pigmentinternational.com/text.asp?2020/7/1/50/289336




  Introduction Top


VItiligo is a pigmentary skin disoder characterized by achromic or depigmented macules on skin. It affects 1% of the total population and no sexual or racial predilection is associated with the disease.[1] The exact etiology of vitiligo is unknown and is considered to be multifactorial. Genetic factors, autoimmunity, toxic metabolites, neurologic factors and lack of melanocyte growth factors are common factors associated with vitiligo.[2] Most of the cases present in second and third decade of life.[3] Isolated cases of congenital vitiligo have been reported previously.[3],[4],[5],[6],[7] This is a rare case report of congenital vitiligo with a positive paternal history.

Case report

A 7-month old male child, born of a non-consanguineous marriage, was brought to our skin out-patient department by his mother with complaints of white colored lesions on the body. The mother informed that these patches were present since birth. According to the mother, few of these patches were increasing in size while few patches were gaining color spontaneously. The mother was not on any medications apart from the iron, folic acid and calcium tablets during her pregnancy. The pregnancy of the mother was uneventful and the baby was born by normal vaginal delivery. The other sibling did not have any similar complaints. The parents of the child did not seek any medical advice for the same prior to this. Similar white colored patches were also present in the father since his childhood. The lesions were initially smaller in size but later on coalesced to form a larger lesion. It was localized to the abdomen. Spontaneous re-pigmentation was noticed in the patch. Although, complete re-pigmentation never happened. Since, the lesions were on the covered part of the body so, he never took any medical treatment for the same. The disease was stable for the past 2 years at the time of the presentation. Patient’s father had no other co-morbidities. On examination, well-defined depigmented macules, of various shapes, were present on both legs (extending from lower thigh to upper one third of legs on both sides), abdomen and left forearm. The lesions were bilaterally symmetrical on legs. Leukotrichia was noted on careful examination. The largest lesion was present on right lower limb and measured 12 × 7 cm2. Spontaneous re-pigmentation was seen in the depigmented macules on both legs [Figure 1],[Figure 2],[Figure 3]. Patient did not have any associated white forelock or poliosis. Ophthalmological examination was within normal limits. On examining the father of baby, depigmented macule on abdomen with islands of re-pigmentation and leukotrichia was noted. A clinical diagnosis of congenital vitiligo with a positive paternal history was made. The parents of the baby did not agree for biopsy. Dermoscopy of the lesions showed absent pigmentary network with leukotrichia [Figure 4]. Patient was started on fluticasone propionate (0.05%) cream. The patient is still under follow up but has not shown much improvement with treatment. But, the lesions are not further increasing in size.
Figure 1 Depigmented, well-defined macules with spontaneous repigmentation on bilateral legs.

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Figure 2 Depigmented macule on abdomen.

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Figure 3 Depigmented macules in father and son.

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Figure 4 Dermoscopic image showing loss of pigment network and leukotrichia.

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  Discussion Top


Vitiligo is an acquired disease with a variable course and very rarely occurs congenitally. It is characterized by depigmented macules which are thought to occur secondary to melanocyte loss or dysfunction.[8] Not much is known about its etiopathogenesis. The first case of congenital vitiligo was reported by Lerner and Norlund in the year 1978.[4] The first case from India was reported by Chandra et al 1992.[5]

Achromic patches at birth can be seen in other diseases like tuberous sclerosis, nevus depigmentosus, piebaldism, oculocutaneous albinism and hypomelanosis of Ito apart from congenital vitiligo.[7] Absence of koenen’s tumor, ash leaf macules, angiofibromas; non- serrated and irregular margins; absence of white forelock and poliosis; normal eyes and hair; spontaneous repigmentation of lesions ruled out the possibility of above mentioned differential diagnoses.[9] Arrangement of lesions was not along Blaschko’s lines, which ruled out the possibility of hypomelanosis of Ito.[10]

In other reported cases of congenital vitiligo, minimal or no change in lesions were noticed in due course of time. But in our case, spontaneous repigmentation was seen in a few patches. Occasional cases of congenital vitiligo with a positive maternal history have been reported previously.[6] Our patient had a positive paternal history. Vitiligo has a 7 to 10 fold increased risk of occurrence in first degree relatives.[11]Our case adds to the evidence that vitiligo is not always acquired and can occur congenitally. It also signifies the importance of differentiating between various diseases presenting with hypopigmented or achromic macules at birth, since they have different prognosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Esfandiarpour I, Farajzadeh S. Clinical characteristics of late-onset vitiligo in an Iranian population. Dermatol Sin 2012;30:43-6.  Back to cited text no. 1
    
2.
Rashighi M, Harris JE. Vitiligo Pathogenesis and Emerging Treatments. Dermatol Clin 2017;35:257-65.  Back to cited text no. 2
    
3.
Casey C, Stephen SE. Insight into natural history of congenital vitiligo: a case report of a 23-year-old with stable congenital vitiligo. Case Rep Dermatol Med 2017 5172140.  Back to cited text no. 3
    
4.
Lerner AB, Nordlund JJ. Vitiligo. What is it-? Is important? JAMA 1978;239:1183-7.  Back to cited text no. 4
    
5.
Chandra S, Kumar A, Singh KK, Mohan L. Congenital vitiligo. Indian J Dermatol Venereol Leprol 1992;58:339.  Back to cited text no. 5
  [Full text]  
6.
Chandan KS, Patni G, Murugesh SB. Congenital vitiligo: time to think beyond the concept of acquired etiology. Indian J Pediatr Dermatol 2016;17:328-30.  Back to cited text no. 6
    
7.
Barro M, Diallo JW, Ouattara ABI, Nacro B. Congenital vitiligo: a case observed in the cohort of HIV-exposed infants in Bobo-Dioulasso, Burkina Faso. Pediatr Rep 2017;6;9:7300.  Back to cited text no. 7
    
8.
Dillon AB, Sideris A, Hadi A, Elbuluk N. Advances in vitiligo: an update on medical and surgical treatments. J Clin Aesthet Dermatol 2017;10:15-28.  Back to cited text no. 8
    
9.
Oiso N, Fukai K, Kawada A, Suzuki T. Piebaldism. J Dermatol 2013;40:330-5.  Back to cited text no. 9
    
10.
Tey HL. A practical classification of childhood hypopigmentation disorders. Acta Derm-Venereol 2010;90:6-11.  Back to cited text no. 10
    
11.
Kakourou T. Vitiligo in children. World Journal of Pediatrics 2009;5:265-8. doi: 10.1007/s12519-009- 0050-1.  Back to cited text no. 11
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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