Volume 2 • Issue 1 • 1000154 Pigmentary Disorders ISSN: 2376-0427 JPD, hybrid open access journal Journal of Pigmentary Disorders Attwa et al., Pigmentary Disorders 2014, 2:1 http://dx.doi.org/10.4172/2376-0427.1000154 Research Article Hybrid Open Access Vitiligo and Associated Autoimmune Diseases in Zagazig University Hospitals, Sharkia Governate, Egypt Enayat Attwa 1 , Ahmad Nofal 1 , Mohamed H Khater 1 , Khaled Gharib 1* and Nglaa Khalifa 2 1 Department of Dermatology and Venereology, Faculty of Medicine, Zagazig University, Egypt 2 Department of Clinical Pathology, Faculty of Medicine, Zagazig University, Egypt *Corresponding author: Khaled Gharib, Dermatology Department, Faculty of Medicine, Zagazig, Egypt, Tel: 00201001658084; E-mail: kh_gharib@hotmail.com Received October 31, 2014; Accepted November 03, 2014; Published November 05, 2014 Citation: Attwa E, Nofal A, Khater MH, Gharib K, Khalifa N (2014) Vitiligo and Associated Autoimmune Diseases in Zagazig University Hospitals, Sharkia Governate, Egypt. Pigmentary Disorders 2: 154. doi:10.4172/2376-0427.1000154 Copyright: © 2014 Attwa E et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keywords: Vitiligo; Autoimmune diseases; Anti–thyroidperoxides; Anti–thyroglobulins Introduction Vitiligo is an acquired depigmenting disorder. Vitiligo may be associated with other autoimmune diseases, especially thyroid disease and diabetes mellitus. Other associated autoimmune diseases include pernicious anemia, Addison disease, and alopecia areata [1]. Diferent theories regarding its pathogenesis have been put forward, autoimmunity being the most popular one. he latter is based mainly on the association of vitiligo with known autoimmune diseases and the presence of organ speciic antibodies in afected patients [2]. Another common inding in support of this hypothesis is that vitiligo oten responds to immuno-suppressive treatments. he mechanisms of immunity are humoral (antibody-mediated), cell-mediated, or mediated by cytokines. Auto- antibodies and their respective target cells are also relevant to the pathogenesis of vitiligo [3]. hyroid functional disorders and autoimmune thyroid diseases (ATD) have been reported in association with vitiligo, and it seems that the incidence of clinical and subclinical thyroid involvement is more common in vitiligo patients than healthy subjects [4]. Hashimoto thyrioditis and Graves’ disease are the most important autoimmune thyroid diseases that characterized by elevated serum antibodies directed against thyroid-speciic antigens like thyroperoxidase (TPO) and thyroglobulin (TG). Patients with non- segmental vitiligo display an increased presence of elevated anti-TPO antibodies and show a high prevalence of ATD. herefore, the presence of elevated anti-TPO antibodies may serve as a useful clinical tool in euthyroid subjects with vitiligo to identify patients at risk for thyroid disease [5]. Vitiligo oten precedes the clinical manifestations of thyroid gland dysfunction [6,7]. hus, screening of patients with vitiligo for thyroid function and anti-thyroid antibodies to diagnose early changes in the function of this gland becomes relevant and necessary [8]. Both the lichen planus and psoriasis occurred on lesions of the preceding vitiligo vulgaris. he potential mechanisms for association of these three dermatoses, may consider the Koebner phenomenon Abstract Although the pathogenesis of vitiligo is not yet fully understood, the autoimmune hypothesis is the most commonly accepted. The aim of this study was to study the frequency of autoimmune diseases in a group of Egyptian patients with vitiligo compared with control. This study involved 50 Egyptian patients with vitiligo and 50 healthy subjects as control group. Patients should be made aware of signs and symptoms that suggest the onset of thyroid dysfunction, diabetes, or other autoimmune disease. If signs or symptoms occur, appropriate tests were performed. Screenings for thyroid disease were through evaluation of thyroid antibodies (anti-thyroidperoxidase, anti-thyroglobulin antibody), serum thyrotropin (TSH), free tri-iodothyronine (T3) and free thyroxine (T4). Screening for diabetes was done with fasting blood glucose or glycosylated hemoglobin testing. A complete blood count with indices helped rule out anemia. Antinuclear antibody screening was also done. Screening for celiac disease, IgA anti-glutaminase antibody was measured. The frequencies of autoimmune disorders were signiicantly elevated in vitiligo patients: vitiligo itself, autoimmune thyroid disease (particularly hypothyroidism), alopecia areata, pernicious anaemia, adult-onset type 1 diabetes mellitus, psoriasis and probably inlammatory bowel disease. These associations indicate that vitiligo shares common genetic aetiologic links with these other autoimmune disorders. related to the photo damage causing initiation of lichen planus and psoriasis over vitiliginous skin which supports their pathogenic relationship [1,9]. here may be a relationship between celiac disease and vitiligo. his may indicate a common basic autoimmune mechanism that is an explanation for few case reports that gluten free diets were efective in the treatment of vitiligo patients [10]. Coexistence of systemic lupus erythematosus and vitiligo has been infrequently reported. However, cases of vitiligo coexisting with discoid lupus erythematosus (DLE) have been much rarer [11]. here have been rare published cases of DLE with other autoimmune cutaneous and systemic disorders. Sharma et al. [12] described a 36 years old female patient with DLE lesions on the face and hands with coexistence of lip-tip vitiligo and hypothyroidism which supported their autoimmune pathogenic relationship. he aim of this study was to study the frequency of autoimmune diseases in a group of Egyptian patients with vitiligo compared with control. Patients and Methods his study was conducted in the Dermatology, Venereology and Clinical Pathology Departments, Faculty of Medicine, Zagazig University Hospitals, in the period from December 2013 to August 2014. he research protocol was approved by local ethics committee and all subjects provided written informed consent.