Unstable Vitiligo in the Setting of Diffuse Hypermelanosis: A Peculiar Presentation of Schmidt’s Syndrome

Abstract

Vitiligo is an acquired prevalent pigmentary disorder characterized by its chronicity, refractoriness and significant psychosocial burden. Concerning its pathogenesis, several genetic, environmental, oxidative stress mechanisms and immune disturbances combine in an intricate, complex way. Diverse immunemediated comorbidities do occur in a variable yet significant manner, so as to fully justify the careful approach and follow-up of these patients. polyglandular autoimmune syndrome type II – Schmidt`s syndrome – is defined by the association of Addison`s disease with immunemediated thyroid disease and/or type 1 diabetes mellitus. The case of a 64year old Caucasian female patient with a long lasting history of several immunemediated disorders (namely Hashimoto thyroiditis and hypothyroidism, atrophic gastritis, lichen planus and stable acrofacial vitiligo) is reported. who For the last 3 months her vitiligo had suffered significant extension and morphologic changes – confettilike lesions, trichromic vitiligo and Koebner`s phenomenon – along with discrete and subtle generalized hypermelanosis. Laboratory work up disclosed a state of hypocortisolism –further confirmed by functional, immunological and image studies: autoimmune Addison`s disease in the context of Schmidt`s syndrome. An effective endocrine insufficiency correction prompted for a quick patient`s recovery as far as hydroelectrolytic and metabolic metabolism, with a concomitant reversion of the hypermelanosis and a stabilization of the vitiligo. In this case it is noteworthy the rapid expansion of a previous stable vitiligo along with the acquisition of peculiar new morphologic features, in the context of a subtle diffuse hypermelanosis in a patient with a past history of several immunemediated disorders. We underline the need to acknowledge the possible association of vitiligo with immunemediated comorbidities, particularly whenever atypical semiological or evolutive features are present.