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Year : 2013  |  Volume : 4  |  Issue : 2  |  Page : 127-129

Vitiligo, childhood asthma and chronic urticaria in a 9-year-old African child: A case report


Department of Paediatrics, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria

Date of Web Publication16-Sep-2013

Correspondence Address:
Ibrahim Aliyu
Department of Paediatrics, Aminu Kano Teaching Hospital/Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0975-9727.118247

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  Abstract 

Vitiligo affects all ages but it is most common in the second and third decades of life. Although its exact cause is not completely understood, autoimmunity and viral skin infection have been implicated in the etiology of vitiligo, but its association with urticaria and childhood asthma at an early age in a child without an established autoimmunity disorder is a rare event.

Keywords: Asthma, autoimmunity, idiopathic, urticaria, vitiligo


How to cite this article:
Aliyu I. Vitiligo, childhood asthma and chronic urticaria in a 9-year-old African child: A case report. Muller J Med Sci Res 2013;4:127-9

How to cite this URL:
Aliyu I. Vitiligo, childhood asthma and chronic urticaria in a 9-year-old African child: A case report. Muller J Med Sci Res [serial online] 2013 [cited 2020 Nov 24];4:127-9. Available from: https://www.mjmsr.net/text.asp?2013/4/2/127/118247


  Introduction Top


Chronic urticaria is the presence of evanescent wheals persisting for more than 6 weeks. [1],[2] Chronic urticaria may last for several months, even up to 1 year in 50% of the cases. However, 20% of the cases have reported chronic urticaria lasting for up to 20 years. [3]

Vitiligo is characterized by depigmentation of the skin, hair and or mucous membrane. It occurs in all ages but is most common among adults. It results from selective destruction of melanocytes which produce the skin pigment called melanin. The cause of vitiligo is not completely known but research suggests that it may arise from autoimmune, genetic, oxidative stress, neural or viral causes. [4] The incidence worldwide is less than 1%, [5] but it is most noticeable in blacks; however its prevalence among Nigerians is not known. It is classified as segmental and non-segmental (which may be generalized or focal) vitiligo. Non-segmental vitiligo is the most common among Caucasians, and it appears as symmetric patches sometimes over large areas of the body. Furthermore, vitiligo may be sporadic or familial. Autoimmune disorders like rheumatoid arthritis, chronic urticaria, alopecia areata and Psoriasis; diabetes mellitus and asthma have been associated with generalized familial vitiligo and in members of their first-degree relatives; [6] however, a case of a 9-year-old boy with sporadic vitiligo, chronic urticaria and asthma is reported.


  Case Report Top


A 9-year-old boy developed skin depigmentation since the age of 2-years which occurred spontaneously and had progressingly involving the right thigh and buttocks with few scattered patches on the left thigh. These white patches were non-itchy with no surrounding area of redness. Because of this lesion, he had been to several dermatology centers and was placed on medication without significant improvement. His parents then stopped all forms of treatment for close to 3 years. There was no history of a similar problem in the family. Two years before presentation, the mother noticed spontaneous change in the lesion with areas of repigmentation [Figure 1], which had been increasing with areas of almost complete repigmentation [Figure 2]. However, at the age of 7 years, the patient developed recurrent episodic difficulties with breathing, which were associated with wheezing and cough mostly at night and following exercise. He was diagnosed with childhood asthma, which was confirmed by deranged peak expiratory flow rate and spirometry test results. He had been symptom-free following environmental manipulation. About 8 weeks to presentation, the mother noticed hyperpigmented swellings (wheals) on the trunk involving the right axillary area almost coalescing to form a common swelling [Figure 3] that were itchy but not tender. That was his first experience of the disease and there was no history of drug or unfamiliar food consumed prior to its onset. A review of other systems was not remarkable. On examination, the lesion had a mosaic outlook with areas of depigmented and repigmenting patches extended from the right groin involving the anterio-lateral aspect of the thigh to the knee almost describing a dermatomal pattern, also involving the gluteal region, while that on the left thigh were few re-pigmenting patches. There was no loss of sensation on these patches; similarly the limbs and digits were normal while the wheals on the trunk were hyperpigmented and slightly raised. These swellings (wheals) resolved 3 weeks into treatment with topical hydrocortisone, ranitidine and lorantidine [Figure 4]. He was then diagnosed to have a combination of vitiligo, asthma and chronic urticaria. Although a Wood's lamp examination was not done on the patches because the skin lesions were obvious, the full blood count, erythrocyte sedimentation rate, thyroid function test and antinuclear antibody were normal.
Figure 1: Showing extensive areas of white patches mixed with areas of re-pigmentation on the right thigh

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Figure 2: Re-pigmenting patches on the left thigh

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Figure 3: Confluent wheals on the right side of the trunk

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Figure 4: Wheals completely resolved after treatment with steroid and anti-histamines

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  Discussion Top


Chronic urticaria is idiopathic in about 12-30% [7] of the cases; however autoimmune disorders have been implicated in these cases. The exact relationship among vitiligo, urticaria and asthma in this case is not clear. Although vitiligo may complicate chronic urticaria, in our case, this lacked an association because the vitiligo occurred long before the first episode of urticaria. Furthermore, most cases of vitiligo following other primary skin damages occur at the site of damage, but in this case, the site of urticaria was different from the vitiligo. Again, the urticaria resolved following topical steroid application and anti-histamines. Autoimmunity may be a plausible explanation in this case because it has been Implicated in the three disorders, although this has been reported mostly in those with generalized vitiligo and a family history of vitiligo in their first-degree relatives, [8],[9] which was absent in this case. Furthermore, the thyroid function test was normal and he lacked any other clinical feature suggestive of connective tissue disease or endocrine disorder, which highlights the uniqueness of this case. The absence of these may not completely rule out that possibility because some of these endocrine disorders may manifest late during the course of illness. [10] Furthermore, the distribution of the vitiligo in this case closely described a dermatomal pattern (segmental), which is more common among teenagers but not usually associated with autoimmune disorder. [10]

Treatment of this lesion was challenging. The antihistamines reduced the pruritus and the urticaria improved remarkably, but the treatment outcome of vitiligo was not very remarkable, more so when most of the treatment options such as psoralen and UVA (PUVA) were not readily available in our setting. Topical steroid did little in slowing the progression and stabilization of the vitiligo and parents stopped applying any medication for over 5 years. But spontaneously over the years repigmentation of the skin occurred which is a rare event in vitiligo; again, his asthma symptoms never warranted any long-term medication.


  Conclusion Top


The occurrence of vitiligo, urticaria and asthma is a rare event whose exact cause is not clear. The outcome of vitiligo was often poor, but the case of a 9-year-old boy whose lesion was re-pigmenting spontaneously after 6 years of onset is amazing.

 
  References Top

1.James WD, Berger GT, Elston MD. Andrews' diseases of the skin: Clinical dermatology. 11 th ed. Philadelphia: Saunders; 2011. p. 138.  Back to cited text no. 1
    
2.Rapini RP, Bolognia JL, Jorizzo JL. Dermatology. Vol. 2. Set. St. Louis: Mosby; 2007. p. 265.  Back to cited text no. 2
    
3.Champion RH, Roberts SO, Carpenter RG, Hadinger N. Urticaria and angio-oedema. A review of 554 patients. Br J Dermatol 1969;81:588-97.  Back to cited text no. 3
    
4.Halder RM, Chappell JL. Vitiligo update. Semin Cutan Med Surg 2009;28:86-92.   Back to cited text no. 4
[PUBMED]    
5.Nath SK, Majumder PP, Nordlund JJ. Genetic epidemiology of vitiligo: Multilocus recessivity cross-validated. Am J Hum Genet 1994;55:981-90.   Back to cited text no. 5
[PUBMED]    
6.Zhang Z, Xu SX, Zhang FY, Yin XY, Yang S, Xiao FL. The analysis of genetics and associated autoimmune diseases in Chinese vitiligo patients. Arch Dermatol Res 2009;301:167-3.  Back to cited text no. 6
    
7.Najib U, Bajwa ZH, Ostro MG, Sheikh J. A retrospective review of clinical presentation, thyroid autoimmunity, laboratory characteristics, and therapies used in patients with chronic idiopathic urticaria. Ann Allergy Asthma Immunol 2009;103:496-501.  Back to cited text no. 7
[PUBMED]    
8.Spritz RA. The genetics of generalized vitiligo and associated autoimmune diseases. Pigment Cell Res 2007;20:271-8.  Back to cited text no. 8
[PUBMED]    
9.Laberge G, Mailloux CM, Gowan K, Holland P, Bennett DC, Fain PR, et al. Early disease onset and increased risk of other autoimmune diseases in familial generalized vitiligo. Pigment Cell Res 2005;18:300-5.  Back to cited text no. 9
[PUBMED]    
10.Taïeb A, Picardo M. Clinical practice. Vitiligo. N Engl J Med 2009;360:160-9.  Back to cited text no. 10
    


    Figures

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



 

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