Dialysis Unexpectedly Spurred Skin Repigmentation in Patient with Rare Form of Vitiligo

A 25-year-old woman with vitiligo universalis, a severe form of vitiligo that causes nearly complete loss of skin color across the body, experienced significant repigmentation after starting dialysis, according to a new case report published in Clinical, Cosmetic and Investigational Dermatology.

The patient, who had lost pigmentation in 95% of her body surface area for 15 years, began showing new areas of skin color within weeks of starting dialysis (also called hemodialysis), a treatment that filters waste and excess fluid from the blood when kidneys can no longer perform this function. She required the treatment three times weekly for kidney inflammation caused by lupus. After 11 months of treatment, color returned to more than 70% of her body surface area, including her face, arms, thighs, abdomen and back.

The case represents only the third documented instance of hemodialysis-induced repigmentation in patients with this severe form of vitiligo, according to the researchers led by Abdulaziz A. Alnoshan, M.D., of Security Forces Hospital in Riyadh, Saudi Arabia. The findings suggest hemodialysis may help restore the function of melanocytes, the cells responsible for producing skin pigment or color.

While vitiligo affects up to 1.8% of the population, cases this severe rarely show improvement. The researchers note that this unexpected return of skin color could provide new insights into potential therapeutic approaches, though more research is needed to better understand the mechanism behind how it happens.

The two previous case reports documenting similar skin color restoration in vitiligo patients undergoing hemodialysis include one involving a 60-year-old African American woman and another involving a 45-year-old woman – while similar repigmentation has also been observed in patients receiving chemotherapy and corticosteroid therapy.

The researchers suggest two ways that hemodialysis might help restore skin color: First, the treatment removes certain substances from the blood that normally suppress the immune system. Second, hemodialysis improves blood circulation, which may help pigment-producing cells move to areas where they're needed and multiply.

“The phenomenon of repigmentation in vitiligo universalis is exceptionally rare,” the study authors wrote. “To our knowledge, this case represents one of the very few instances documented in the literature, providing a unique opportunity to explore potential mechanisms and contribute to the understanding of this rare occurrence.”