Study Analyzes Ocular Abnormalities Among Patients with Nonsegmental Vitiligo

Mahmoud Rageh, MD

A recent study added more evidence that nonsegmental vitiligo is associated with a higher risk of ocular changes.

The case-control study included 40 nonsegmental vitiligo patients recruited from outpatient clinics of Al-Azhar University hospitals in Egypt and 40 healthy controls.

“Our research highlights the important fact that vitiligo is a systemic condition that is not only limited to the skin but can also affect ocular melanocytes within the retinal pigment epithelium and the uveal tract,” corresponding author Mahmoud Rageh, MD, of Al-Azhar University in Cairo, Egypt, told HCPLive.

The study was consistent with prior research showing a greater risk of ocular abnormalities, uveitis and subclinical inflammatory fundus dipigmentation among patients with vitiligo.

Study participants were aged 18-40 years old, with men representing 52.5% of the patient group and 40% of the control group. Among those in the patient group, 55% had acrofacial lesions and 45% had generalized lesions. Duration of the idiopathic systemic autoimmune disorder among study participants ranged from 1-13 years with a mean of 3.71.

“We found that duration of vitiligo did not show any significant impact on the ocular abnormalities encountered in our study,” Rageh said.

The study included dermatological and ocular examinations. Slit lamp fundus examinations revealed significant abnormalities in 57.5% of vitiligo patients compared with 6.3% of the controls. Abnormalities included retinal hypopigmentation, retinal hyperpigmentation, iris nevus, iris depigmentation, elevated disc, tigroid fundus and conjunctival nevus.

Differences also were noted in central macular thickness measured by optical coherence tomography, with the highest value among those in the control group. The highest error of refraction value was in the control group.

Melanocytes in the retinal pigment epithelium and uveal tract share common developmental origins, physiology and morphology with those in the skin and protect against ultraviolet light.

“Ocular problems may be closely connected to vitiligo as the depigmentation process in vitiligo patients can influence ocular melanocytes resulting in alterations in macular thickness, iris and retinal pigmentation,” Rageh said. “However, no impairment of vision was detected since ocular melanocytes aren't involved in the detection or transmission of visual pathway.”

The study called for routine ocular examination in vitiligo patients.

“We need to continue our research for defining the possible risks and optimal management plans for vitiligo and other dermatological diseases,” Rageh said.

Vitiligo, characterized by white lesions on the skin, affects about 1% of people worldwide, including 1 million to 2 million people in the United States. Nonsegmental vitiligo usually develops gradually in adulthood and makes up about 90% of vitiligo cases.

Conventional treatment includes phototherapy with topical corticosteroids, calcineurin inhibitors or vitamin-D analogue. The FDA approved the topical JAK inhibitor ruxolitinib in July as the first indicated treatment for the condition. Tofacitinib also has shown promise in clinical trials.

The study, “Ocular changes of non-segmental vitiligo: A case-control study,” was published online in Australasian Journal of Dermatology.