A 25-year-old woman with type IV skin presents with well-defined, chalky-white patches on the dorsa of hands, neck, and perioral area. The patches show complete depigmentation on Wood's lamp with no residual pigment. She has a family history of thyroid disease. Which of the following investigations would be MOST appropriate to screen for associated systemic disease?
- A Serum cortisol and ACTH stimulation test
- B Serum B12 and peripheral blood smear
- C Thyroid function tests (TSH, T3, T4) and anti-thyroid peroxidase antibodies ✓
- D Anti-nuclear antibody (ANA) and anti-dsDNA
Explanation
Vitiligo is an acquired depigmentation disorder due to selective destruction of melanocytes, mediated by CD8+ cytotoxic T lymphocytes. It is strongly associated with other organ-specific autoimmune disorders, most commonly autoimmune thyroid disease (Hashimoto's thyroiditis and Graves' disease), followed by type 1 diabetes mellitus, Addison's disease, pernicious anaemia, and alopecia areata. Given the family history of thyroid disease, thyroid function tests and anti-TPO antibody screening are the single most important investigations. The association with thyroid disease is particularly common in female patients with vitiligo.
Reference: Neena Khanna Illustrated Synopsis of Dermatology & STD, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.