Atopic dermatitis (AD) is a condition that causes loss of skin color in patches, usually permanently. Discolored areas often expand over time and can affect the skin, hair, and inside of the mouth. While there is no specific treatment for pigmentary changes in the skin, it is important to recognize and treat eczema in people of all skin types. A recent review and meta-analysis published online in December has found that AD is associated with vitiligo.
Prakash Acharya and Mahesh Mathur from the Faculty of Medical Sciences in Bharatpur, Nepal conducted a meta-analysis of observational studies to compare the prevalence and assess the risk of vitiligo in patients with AD. The independent variables were self-reported body surface area (BSA), duration of vitiligo, and itching or burning of the skin. The results showed that AD was associated with a BSA of at least 76% and itching or burning with atopic diseases. The association between eczema and vitiligo may be due to a pro-inflammatory state of AD which predisposes to the destruction of melanocytes, while scratching pruritic AD lesions may coebnerize vitiligo.
In some countries where leprosy is endemic, depigmented vitiligo spots can be confused with those seen in leprosy, leading to social stigmatization. It is important to note that if the spots are not really white, but hypopigmented and not depigmented (they are not improved by Wood's lamp), then they are NOT vitiligo and could be any number of different diseases and conditions. Anemic nevus is a common birthmark that looks lighter than the surrounding skin due to a lower blood supply to that area of the skin. People with tuberous sclerosis may have light areas of skin called ash leaf spots, but they also tend to have other, clearer signs of this condition.
Occasionally, darker skin from melasma may make normal skin appear lighter and may therefore look a little like vitiligo. About 25 to 50 percent of people with vitiligo have a relative with the condition, and about six percent have siblings with vitiligo. Eczema appears in small bumps or “papules” that itch on the skin, mainly on the trunk and forearms. Julie Van Onselen, NES Dermatology Nurse Advisor explains how problems arise with changes in skin pigmentation when normal skin color is altered due to eczema. Pityriasis alba is a low-grade eczema that is mainly seen in children or adolescents which can also cause paler patches on the skin. It is important to recognize eczema in people of all skin types as it can be associated with vitiligo.
It is an incredibly useful tool for a dermatologist and a vitiligo specialist, because very few other diseases turn the skin white in this way. The name means “fine scales” (pityriasis) and pale color (dawn), so eczema spots are hypopigmented, sometimes pink and dry.
