Labial vitiligo associated with a factice disorder: a case report

Abstract

Introduction: Vitiligo is a non-contagious leukoderma. The loss of melanocytes result in a local hypopigmentation like white symmetrical plaques with sharp edges, most of the time surrounded by hyperpigmentation. It might be an auto immune disease with a genetic predisposition linked to psychological disorders. Oral mucosa vitiligo has rarely been described in the literature. Observation: A seventeen years old patient, native from North Africa, has consulted for a half left upper lip depigmentation appeared in October 2016. The dermatologist had made the diagnosis of vitiligo and prescribed vitamin C and folic acid, without any result. In July 2017, as the lesion has extended to the whole upper lip, the patient came to oral mucosa pathology consultation. Anamnesis revealed a chronic lips chewing. Clinical examination revealed a linear vermillion border depigmentation of the upper lip associated with peripheral pigment enhancement, as well as digital cutaneous involvement. The prescribed treatment was: tacrolimus 0.1% twice daily in local application, stopping practice disorder and sun protection. Comment: Diagnosis of vitiligo is based on clinical examination that can differentiate a segmental vitiligo (localized on at least one dermatomes) of a non-segmental vitiligo (acrofacial, generalized, universalis). Vitiligo of the oral mucosa is rare. It has mainly been described in India. Oral mucosa involvement would affect 55% of patient and the lip would be affected in almost one in two cases in this population. Conclusion: Oral mucosa vitiligo must be known by oral surgeon who has to master the diagnosis and treatments in association with dermatologist, given the concomitant skin involvement that is almost mandatory.

Keywords

• labial vitiligo
• factice disorder
• tacrolimus