Familial coexistence of vitiligo and alopecia areata: successful treatment with intralesional corticosteroids

Abstract

Vitiligo and alopecia areata are autoimmune dermatological conditions that may coexist due to shared immunopathogenic mechanisms, although their occurrence within the same anatomical site is uncommon. We report the case of a 33-year-old Indian male with a familial history of autoimmune skin disease who presented with co-localized vitiligo and alopecia areata on the posterior scalp, with an additional vitiligo lesion on the left tibia. Vitiligo preceded the onset of alopecia areata within the same scalp lesion by approximately four months. Dermoscopic examination confirmed features of both conditions, including depigmentation with loss of pigment network and characteristic alopecia areata findings such as yellow dots, black dots, and exclamation mark hairs. The patient was treated with intralesional triamcinolone acetonide injections for the scalp lesion, along with topical corticosteroids, topical tacrolimus, minoxidil, and vitamin D supplementation. Marked hair regrowth and near-complete repigmentation of the scalp lesion were observed at follow-up. Notably, the vitiligo lesion on the tibia demonstrated significant repigmentation following intralesional corticosteroid therapy after limited response to topical treatment alone. This case highlights the rare co-localization of vitiligo and alopecia areata, supports a shared autoimmune pathogenesis, and suggests that intralesional corticosteroids may be an effective therapeutic option for selected localized vitiligo lesions, particularly when associated with alopecia areata.