Annual Meeting of the North American Society for Pediatric Gastroenterology and Nutrition; Toronto, October 30 - November 2, 1997
Inflammatory bowel disease (IBD), particularly ulcerative colitis (UC) is associated with autoimmune disorders such as cholangitis, thyroiditis, alopecia areata and vitiligo. Vitiligo was reported in 1.1% of adult patients with UC and 0.5% with Crohn's disease (CD) compared to 0.3% in a control population.1 The association of vitiligo and CD has been described in a single case report2 in childhood and we report four cases seen over eight years. Table
Four boys (2 East Indian & 2 Caucasian) were diagnosed to have CD, confirmed by endoscopy and histology. Family history was positive for IBD in two and for vitiligo in none. All had segmental vitiligo patches. The response to therapy was variable but patient no. 3 showed a good response to psoralen and ultraviolet A (PUVA). The course of CD was not unusual and all responded to standard therapy eg. steroids, 5-ASA, elemental diet. After a mean follow-up of 2.5 years (0.5 to 6 years), all are in remission.
The incidence of vitiligo in our CD clinic (4 of 240) is 1.67%. This is much higher than the reported incidence of 0.5% under 20 years and 0.25% in children below 8 years of age in the general population (equal sex distribution). Interestingly, all our patients were male (as was the previously reported case2), had a segmental vitiligo involving a dermatome and the onset of vitiligo preceded the symptoms of CD. It is possible that these two conditions have a common genetic basis but the exact genetic markers have yet to be identified.
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Monroe EW. Arch Dermatol 1976;112:833-4