Hints from the skin beneath: Vitiligo in Vogt–Koyanagi–Harada disease

Vogt–Koyanagi–Harada disease (VKHD) is a major vision-threatening autoimmune disease. One of its associated features is vitiligo. Little study has been done on the association between vitiligo and the disease activity of VKHD. The authors searched available literature on the relationship between vitiligo and ophthalmic disease activity in VKHD in terms of pathogenesis, clinical presentations, risk factors as well as disease activity. Among the findings is that early treatment of VKHD may be associated with full recovery. The reversal of poliosis and vitiligo is associated with the remission of uveitis, but the reverse does not hold true, whereby the worsening of vitiligo may not reflect the worsening of uveitis. It is also found that there may be an association between immunotherapy and Vogt–Koyanagi–Harada-like disease. In summary, vitiligo is an immune-mediated cutaneous manifestation which may contribute to diagnostic and treatment strategies in VKHD. Future research on genetic differences in vitiligo is still needed and may contribute to specific monitoring and therapeutic approach in this disease.