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Koebnerization and generalized spread of vitiligo following radiotherapy

Indian Dermatology Online Journal
Medknow Publications
Publication Date
DOI: 10.4103/2229-5178.110594
  • Letters To The Editor
  • Chemistry
  • Medicine


Sir, Vitiligo is an acquired, idiopathic disorder characterized by circumscribed depigmented macules and patches with absence of melanocytes. It occurs worldwide with a prevalence of 0.12%.[1] Koebner phenomenon (KP) plays a very important role in the pathogenesis of vitiligo, with varying physical and chemical trigger factors. Herein we describe a case of vitiligo developing koebnerization and dissemination following radiotherapy for esophageal carcinoma. A 60-year-old male presented to our outpatient department with white colored patches over face, back, chest, both hands, and both thighs. Patient was a known case of vitiligo since childhood with small, stable lesions over the periorbital areas. He was diagnosed to have squamous cell carcinoma of middle one-third of esophagus six years ago that was treated with surgical resection followed by chemotherapy. Patient developed recurrence one year ago and was treated with paclitaxel and carboplatin followed by external beam radiotherapy (59.4 Gy in 33 cycles over a period of 43 days). Whilst on radiotherapy, the patient developed mild erythema over the exposure sites that subsided with hyperpigmentation. One month after completion of radiotherapy, the hyperpigmentation resolved and multiple depigmented macules developed over the areas of exposure. Similar macules also developed over both forearms and thighs. There was no subsequent improvement in these depigmented macules till presentation. On examination, multiple depigmented patches were present in a ‘L’ pattern over the back and chest, conforming to the area of radiotherapy exposure [Figures 1 and 2]. Multiple depigmented patches were also present in bilateral periorbital areas (present since childhood), dorsum of both hands, and thighs [Figure 2]. Wood's lamp examination of depigmented patches on back showed a milky white florescence. Figure 1 Depigmented patches on back conforming to the area of radiotherapy exposure Figure 2

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