High prevalence of vitiligo in lepromatous leprosy

Background Leprosy and vitiligo are common affections in the West Indies. V itiligo frequently occurs in lepromatous patients, an observation rarely re ported in the literature. Methods We studied the prevalence of vitiligo in patients affected by lepro sy by performing a retrospective study between 1978 and 1999 in the French West Indies (Martinique). Results Eleven patients presented with vitiligo among 101 with lepromatous (multibacillary) leprosy. None presented with vitiligo among the 364 with t he tuberculoid (paucibacillary) form. The mean age of the vitiligo patients was 55.4 years at vitiligo onset. The sex ratio was 0.8. Vitiligo occurred 19 years after the diagnosis of leprosy, with a range from 3 to 42 years. The prevalence of vitiligo in lepromatous patients was 10.9%, compared to 0 % in tuberculoid patients. Such an increase in prevalence compared with tha t in the general population (0.34%) was shown to be highly significant (P < 0.0001). Conclusions Our data confirmed that the association of vitiligo and leprosy was not fortuitous. The physiopathology leading to this high rate of vitil igo in lepromatous leprosy is unclear, despite the fact that autoimmunity p lays a major role in both diseases.