Scleroderma has a similar presentation to vitiligo in patients with skin of colour

Dr. Andrew F. Alexis discusses the similarities and differences between the two skin conditions (764 words, 3 min)

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Vitiligo is not the only cause of hypopigmentation in patients with skin of colour, said Dr. Andrew F. Alexis in a presentation at Skin Spectrum Summit in Vancouver. 

“When there is a striking contrast of normal and involved skin, and it has that sort of milk-white appearance, it is usually vitiligo. However, not all depigmented patches on the skin are vitiligo. We have to keep an open mind and consider other diagnoses,” he said. 

“Light patches, loss of pigment on the face, [are] a pretty common scenario when treating patients with skin of colour,” noted Dr. Alexis. “While vitiligo can certainly affect the periorificial areas of the face, ... you have to look at the whole patient,” not just the affected areas. 

During his presentation, Dr. Alexis described the case of a patient who was referred to him with a diagnosis of vitiligo; however, further evaluation revealed that she actually had scleroderma. 

The patient, an African-American woman, had patches of hypopigmentation on her face and trunk, but, most importantly, she had taut, bound-down skin and tapering of her digits. 

“When scleroderma presents in darker skin, it often presents with an associated pigment change, which might be the first thing the patient notices, and the thing that would drive the patient to a physician or, specifically, a dermatologist,” noted Dr. Alexis.

Systemic sclerosis has a higher prevalence rate in women of African-Ameri- can ancestry, usually with a worse prognosis than other groups, said Dr. Alexis. 

Dr. Alexis provided another example of a patient diagnosed with vitiligo before seeing him, but clinical examination, biopsies and a serological workup were consistent with scleroderma. 

After looking at the whole patient, he saw “areas with some hyperpigmentation and hypopigmentation.... In the area with the loss of pigmentation, there is some follicular sparing, creating a salt-and-pepper appearance,” said Dr. Alexis. According to Dr. Alexis, “this salt-and-pepper appearance, especially involving the trunk, is a very striking and common presentation of scleroderma in darker-skin patients.” 

The takeaway: Dr. Alexis also stressed palpating the skin. “Don’t forget the importance of palpation. Don’t just stand at the edge of the bedside or doorway when diagnosing what seems to be a pigmentary concern.” 

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FROM THE LITERATURE ON SCLERODERMA

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

  • According to a recent study, Black patients and Asian patients show faster and earlier onset of scleroderma than White patients. Also, Black patients had a higher rate of skin involvement, according to the study of 9,684 patients.

From "Rheumatology"

Targeting CD38-dependent NAD+ metabolism to mitigate multiple organ fibrosis

  • Using human patient samples and preclinical mouse models, authors of a recent study looked into skin scarring causes caused by scleroderma. They found that scleroderma-related inflammation causes a spike of the enzyme CD38, which breaks down the metabolic nutrient NAD+, according to the researchers. A reduction of NAD+ leads to a higher likelihood of chronic tissue injury. 

    From “iScience”

Increased Mortality in Asians With Systemic Sclerosis in Northern California

  • Asian patients face an increased mortality rate due to scleroderma compared to White patients, according to a recent study. Also, the study found that Black patients had a greater prevalence of diffuse skin disease.

    From “ACR Open Rheumatol.”

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