Psoriasis associated with vitiligo universalis and photosensitive rash

A 35-year-old-female presented with itchy, reddish, and scaly lesions over the body for the past 5 months, she also gave history of whitish lesions all over the body for the past 25 years. Cutaneous examination revealed multiple, well-defined, erythematous, and indurated plaques with silvery scales over extensor aspects of bilateral upper and lower limbs, trunk, and scalp (body surface area ~8%) [Figure 1a and b]. Depigmentation all over the body with eyebrows and frontal hair involvement and discrete hyperpigmented skin macules on the face was also noted [Figure 1c]. There was photosensitive rash on the face, extending on to the V area of neck and upper back [Figure 1b and c]. Ophthalmology reference was sought and ocular albinism was ruled out.

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Figure 1:

(a). Erythematous indurated plaques with silvery scales on a background of depigmented lesions on the extensor aspects of bilateral lower limbs (b). Erythematous indurated plaques with silvery scales on a background of depigmented lesions on the back and photosensitive rash on the upper back (c). Discrete hyperpigmented skin macules and photosensitive rash on the face.

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A diagnosis of plaque psoriasis with vitiligo universalis and photosensitive rash was arrived at. The patient was advised photoprotection; and for psoriasis, she was given oral antihistamines, combined clobetasol 0.05% and salicylic acid 6% ointment once daily and emollients for cutaneous lesions on body; combined halobetasol 0.05% and salicylic acid 3% lotion, and ketoconazole 2% shampoo for scalp lesions. She did not want treatment for vitiligo. Although various studies reported association of vitiligo with psoriasis,^[1] we hereby report a case of psoriasis in pre-existing vitiligo universalis with photosensitive rash.