Vitiligo: ocular and electrophysiological findings.

AIM: The aim of this study was to analyze the involvement of the retinal pigment epithelium (RPE) and optic nerve in patients with vitiligo (N.=40, 12 males and 28 females, age 12-82 years; average 45.8). METHODS: The dermatological and ophthalmological examinations have been followed by electro-oculography (EOG) and pattern visual evoked potential (VEP) tests. RESULTS: The results of the fundus examination were normal, showing no characteristics that might be considered typical of vitiligo. Sixteen patients had an altered VEP (9 with amplitude reduction, 7 with amplitude reduction and increased latency); 4 patients showed only an Arden Index (AI) > or =180; and 4 patients showed both an altered VEP and AI < or =180. EOG detected 1 pathological case (AI < or =160); 7 subnormal patients (AI 160-180); and 32 normal patients (AI > or =180). The mean AI was 249 in the vitiligo patients compared to 277.2 in the normal controls. Patients with both an altered VEP and an abnormal EOG had higher than average skin involvement and a longer disease duration, and the alterations in VEP (amplitude and latency) were much more marked than in the other patients. CONCLUSION: These results confirm that the simultaneous presence of abnormal VEP and EOG is characteristic of severe disease. Patients with only a pathological VEP (N.=12) had a noticeably longer mean disease duration, while those only with AI < or =180 showed a slightly higher degree of skin involvement. It may be concluded that patients with more extensive skin involvement and a longer disease duration will also exhibit more markedly negative ocular electro-physiologic findings. Pattern VEP and EOG offer useful tools to evaluate the evolution of vitiligo, because they can detect subclinical involvement of the optic nerve and RPE. The results of these two tests are correlated with the disease duration and extent of cutaneous involvement.

Pattern VEP alterations in psoriatic patients may indicate a sub clinic optic neuritis.

We examined 44 subject (Group A) of both sexes (27 males and 17 females) aging between 16 and 80 (average: 45+/-16.6), divided into age bands, affected by mild-medium psoriasis with PASI (psoriasis area and severity index) between 1.2 and 48.6 (average: 11.2+/-9.7) without any other disease and we performed pattern transient VEP (Visual Evoked Potential) at the frequencies usually used in clinical experience (73', 36', 18' check size). For a good statistic comparison we choose 55 healthy subjects (group B) divided into age bands on which we performed the same test. Comparison of VEP parameters between psoriatic and healthy subjects, showed in group A 10 normal (22.7%) and 34 pathological (77.3%). In the latter group there are 16 subjects who show only a P100 reduced amplitude (36.3%), 3 with only increased latency (6.8%), 15 with alterations of both values (34%). The achieved data show that more than 3/4 of group A subjects have VEP alterations as index of the presence of a sub clinic optic neuritis with a probably toxic autoimmune origin due to the action of TNFalpha, of IgG, of ECP or of other cytokines (IL6, IL7, etc) that are increased in the blood of this patients. The electro physiologic monitoring of optic nerve seems to represent a good routine test to evaluate the global conditions of psoriatic patients.