HIV-Associated Vitiligo Totalis with Minimal Repigmentation and Alopecia Areata Diffusa During Immune-Reconstitution

Cutaneous findings in the setting of HIV infection encompass a broad spectrum of diseases. Only few cases of vitiligo or alopecia areata have been described in HIV/AIDS patients and it remains unclear whether there is a causal relationship between HIV/AIDS and these two conditions.

Our patient initially presented with diffuse generalized pruritic hypo- and depigmented macules and patches. She was diagnosed with advanced HIV/AIDS at that time. There was progression to vitiligo totalis followed by partial repigmentation and generalized alopecia areata diffusa with immune-reconstitution.

This is, to our knowledge, the first case of rapidly progressing vitiligo totalis in a patient with advanced HIV/AIDS. We conclude that this, together with the observation of repigmentation during immune-reconstitution, suggests a causal relation between vitiligo and HIV/AIDS. The different time course of the also observed alopecia areata diffusa, with first manifestation during immune-reconstitution, may be due to differences in the immune-pathogenesis between vitiligo and alopecia areata.