Hypopigmented skin lesions associated with atopic dermatitis in asthma

The association of vitiligo and other skin pigmentary disorders has been well shown with autoimmune diseases, i.e., systemic lupus erythematosus, rheumatoid arthritis. Furthermore, in certain diseases such as diabetes mellitus and adrenal insufficiency the incidence of pigmentation disorders is higher than in the general population. A total of 53 male and 46 female patients with a diagnosis of asthma, based on clinical findings and pulmonary function tests (PFT), were thoroughly examined for the presence of hypopigmented skin lesions and compared with 100 nonasthmatic controls with a similar demographic distribution. The patients were questioned regarding the history of steroid treatment in the past and present and subdivided into five groups based on the duration of therapy. Adrenal gland function was tested by 8:00 A.M. serum cortisol concentration in the group of patients with a history of steroid use as well as in some patients without this history. These patients were also tested for absolute lymphocyte and eosinophil count. Hypopigmented lesions were noted in 36.4% of asthmatic patients and in 11% nonasthmatic controls (p-value < 0.01). There were no differences in the location, but the size of lesions per patient was larger in the asthmatic than the control group. Twenty of 55 patients who had a history of steroid treatment in the past had hypopigmented skin lesions as compared to 16 of 42 patients who had no history of steroid treatment. We conclude that there is a higher coincidence of hypopigmented skin lesions, mainly vitiligo-type in asthmatic patients, compared to the general population, which is not related to a history of steroid treatment or incidence of adrenal insufficiency in these patients.