Dermatology: Practical and Conceptual


Image Letter | Dermatol Pract Concept. 2022;12(1):e2022007 1

Vitiligo Co-Localized Over a Patch of Alopecia 
Areata in Two Patients: More Than a Coincidence?

Rashi Pangti1, Iftekhar Khan1, Somesh Gupta1

1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India

Citation: Pangti R, Khan I, Gupta S. Vitiligo co-localized over a patch of alopecia areata in two patients: more than a coincidence? 
Dermatol Pract Concept. 2022;12(1):e2022007. DOI: https://doi.org/10.5826/dpc.1201a07

Accepted: April 25, 2021; Published: January 2022

Copyright: ©2022 Pangti et al. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use, 
distribution, and reproduction in any medium, provided the original authors and source are credited.

Funding: None.

Competing interests: None.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Somesh Gupta, Professor, Department of Dermatology & Venereology, All India Institute of Medical Sciences, 
New Delhi, India. E-mail: someshgupta@hotmail.com

Case Presentation

A 17-year-old boy and an 8-year-old boy presented to us 

with discrete patches of smooth, non-scarring alopecia co- 

localized with depigmentation over the scalp (Figure 1, A 

and B). In the first case, alopecia areata followed vitiligo, 

while it was the opposite in the second case. On dermoscopy 

of the alopecic patches, black dots, broken hairs, and vel-

lus hairs were appreciated. We made a diagnosis of alopecia 

areata co-localized with vitiligo based on clinical and dermo-

scopic findings.

Teaching Point

There are few previous reports of co-localization of alope-

cia areata and vitiligo [1,2]. They seem to share common 

pathogenesis; however, it has also been argued that this 

might be just a coincidence. An interferon (IFN)-γ-driven im-

mune response is proposed in both diseases whereby IFN-γ is 
required for the recruitment of CD8+ cytotoxic lymphocytes 

to the sites of inflammation [2]. Class II human leukocyte 

antigen (HLA) and other non-HLA genes have also been im-

plicated in both diseases [1]. In alopecia areata, the initial 

targets for autoimmunity are hair follicle melanocytes (along 

with keratinocytes, and dermal papilla cells) while in vitil-

igo the initial target is epidermal melanocytes [1]. When this 

compartmentalization is blurred, both epidermal and hair 

follicle melanocytes are destroyed by autoimmunity, leading 

to co-localization.



2 Image Letter | Dermatol Pract Concept. 2022;12(1):e2022007

References

1. Krishnaram A S, Saigal A, Adityan B. Alopecia areata - Vitiligo 

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6323.113100. PMID: 23760330.

Figure 1. (A) Patient 1: Development of vitiligo over 1 out of the 3 patches of alopecia areata. (B) Patient 2: Development of alopecia areata 

over both patches of vitiligo. Inset shows the patches individually.

2. Rork JF, Rashighi M, Harris JE. Understanding autoimmunity 

of vitiligo and alopecia areata. Curr Opin Pediatr. 2016;28(4): 

463-469. DOI: 10.1097/MOP.0000000000000375. PMID: 

27191524. PMCID: PMC4957563.