Background: Vitiligo has a complex etiopathogenesis. The role of nutritional factors (including Vitamin B₁₂and folic acid) has been recently proposed in its causation, which needs to be confirmed further. Aims: The study was conducted: (1) To estimate the serum levels of Vitamin B₁₂, folic acid, and homocysteine in patients of vitiligo and control group. (2) To determine the relationship between serum levels of Vitamin B₁₂, folic acid, homocysteine and the extent and activity of vitiligo. Methods: A cross-sectional, observational study consisting of 50 patients with vitiligo, and 35 age and sex matched controls was conducted. Serum homocysteine was estimated by Diazyme homocysteine enzymatic assay kit, and serum Vitamin B₁₂and folic acid levels were estimated by chemiluminescence using the Access Immunoassay System. Results: The mean serum Vitamin B₁₂and folate levels were found to be significantly lower in vitiligo patients than controls (157.18 ± 68.95 pg/mL vs. 306.6 ± 169.73 pg/mL and 4.18 ± 3.55 ng/mL vs. 7.3 ± 3.67 ng/mL, respectively), while serum homocysteine levels were significantly higher in cases (15.39 ± 7.2 μmol/L) as compared to controls (11.88 ± 4.81 μmol/L) (P < 0.05). There was a significant positive correlation of serum homocysteine levels with the duration of disease, Vitiligo Area Scoring Index (score), and type of vitiligo (higher levels in patients with universal vitiligo). Conclusions: Long standing vitiligo (especially universal and generalized variants) may show deranged serum homocysteine, Vitamin B₁₂, and folic acid levels. Supplementation with Vitamin B₁₂/folic acid may have a therapeutic role in improving the treatment outcome.

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Background: Several factors have been implicated in the etiology of melasma which include ultraviolet radiation, genetics, pregnancy, skin type, and drugs. However, there is a paucity of literature regarding the role of endocrine factors. Aim: To study the clinical and hormonal correlation in female patients with melasma. Methods: A total of 30 untreated female patients with melasma were included in the study. The control group included an equal number of age-matched females. Assays of free testosterone, total testosterone, dehydroepiandrosterone sulfate, 17-hydroxyprogesterone, luteinizing hormone (LH), follicle stimulating hormone, prolactin, 17β-estradiol (E2), progesterone, free triiodothyronine, free tetraiodothyronine, thyroid stimulating hormone were done on the 5^th or 6^th day of the menstrual cycle in the midfollicular phase. Results: The difference between means of free testosterone, total testosterone, LH, estradiol, progesterone, and free thyroxine of melasma cases and controls was found to be statistically significant. No correlation was found between the severity of melasma and the mean hormone levels. Conclusion: It can be inferred that these hormonal alterations may represent a subclinical evidence of a suppressed hypothalamic-gonadal axis and preclude the role of hormones in the pathogenesis of melasma.

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Background: Vitiligo is commonly associated with autoimmune and nonautoimmune disorders. However, there is a paucity of such data in the Indian context. Aims: We studied common disorders including autoimmune diseases associated with vitiligo. Methods: Clinical details and the results of serological studies comprising anti-TPO and anti-TG antibodies, antiparietal cell antibody, antinuclear antibodies, hepatitis B surface antibody, anti-hepatitis C virus immunoglobulin M antibody, rheumatoid factor, and immunoglobulin E (IgE) levels were analyzed in 200 consecutive vitiligo patients.Results: These 200 (male:female 96:104) patients were aged between 3 and 78 (median age 25) years having vitiligo for 15 days to 60 years. Nonsegmental vitiligo in 192 (96%) patients was the commonly reported pattern. Fifty-three (26.5%) patients had another affected a family member. Clinically, 37 (18.5%) patients had autoimmune disorders and 121 (60.5%) had serological evidence of autoimmunity. Autoimmune thyroid disorders in 85 (42.5%) patients were the most common. Others were rheumatoid arthritis 9 (4.5%), plaque psoriasis 5 (2.5%), alopecia areata 3 (1.5%), and limited cutaneous scleroderma 1 (0.5%). The presence of antithyroglobulin antibody in 53 (26.5%) and antithyroid peroxidase antibody in 44 (22%) patients, rheumatoid factor in 9 (4.5%) patients, and hyper IgE in 75 (37.5%) patients was significant observation. No patient had antiparietal cell antibodies or pernicious anemia. Conclusion: Clinical presentation of our patients conforms to established patterns of vitiligo. Subclinical autoimmune thyroiditis observed in the most cases is indicative of the potential benefit of screening these patients for concurrent thyroid disorders. The association of atopy remains poorly understood. Pernicious anemia and antiparietal cell antibodies do not appear a significant association in our patients.

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Nevus depigmentosus (ND) is a congenital leukoderma that is, stable in its size and distribution and may present as isolated, segmental or systematized form. Segmental ND sometimes can pose a diagnostic difficulty with segmental vitiligo. Likewise, segmental vitiligo overlaps with the clinical features of ND to a greater degree. A 15-year-old boy presented with two distinct asymptomatic pigmentary lesions involving the right thigh. Based on the clinical features, Wood's lamp examination and histological features a diagnosis of vitiligo arising within the confines of segmental ND was entertained. Though there are reports of vitiligo coexistent with ND in two different sites, and development of lentigines within ND, vitiligo developing within the preexisting ND makes this case an interesting presentation.

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Nevus refers to a maternal impression or birthmark. Various categories of nevi have been described in literature, with newer presentations being continuously reported. At times, gigantic presentations of melanocytic nevi may alarm patients to seek medical attention. Most often, though, these nevi are totally benign, the excision of which is indicated solely for cosmetic indications. We hereby report a case of corymbiform nevi, a morphologic rare subtype of lobulated intradermal nevi, which presented as a huge plaque, and is being reported because of its rarity, and the first of its kind from the Indian subcontinent.

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Background: Helicobacter pylori is a gastrointestinal infectious agent with worldwide distribution. A potential role of H. pylori infection in several extra-intestinal diseases including autoimmune and inflammatory skin diseases such as chronic urticaria, alopecia areata, psoriasis, and rosacea have been reported. Vitiligo is a common depigmenting skin disorder and autoimmunity has been suggested in the pathogenesis of vitiligo. There are few reports of association of H. pylori infection and vitiligo. Aims: The aim of our study is to evaluate the relationship between H. pylori infection and vitiligo. Methods: The study group included 40 patients with vitiligo, and the control group included 39 age- and gender-matched individuals. H. pylori stool antigen test was performed in the patient and control groups to detect the presence of H. pylori infection. Results: H. pylori stool antigen test was positive in 20 (50%) of the patients and 13 (33.3%) of the controls. No significant difference was found in H. pylori stool antigen test positivity between the patient and the control groups (P > 0.05). Also, no significant relationship was found between H. pylori stool antigen test positivity and the family history, type, duration, and activity of vitiligo. Conclusion: Our results indicate that H. pylori infection is not increased in vitiligo patients, and it is not necessary to screen vitiligo patients routinely for H. pylori infection.

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