Examining Comorbidities in Vitiligo

Vitiligo is known to be associated with several autoimmune and systemic conditions, but new research sheds light on the evidence surrounding the most frequently-occurring comorbidities associated with the pigment disorder.

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In a recent review,¹ researchers sought to evaluate prior studies and review the evidence for the comorbidities that are the most-frequently found in patients with vitiligo, citing advancements in understanding the disease’s implications, such as associations with autoimmune and systemic diagnoses.

In fact, researchers cited a cross-sectional survey that found that patients with vitiligo are 2.6 times more likely to have either an autoimmune or autoinflammatory comorbidity when compared to individuals without vitiligo.

Upon review, researchers cited several comorbidities that frequently occur in patients with vitiligo. These include thyroid disease, alopecia areata, diabetes mellitus, and metabolic syndrome.

Autoimmune thyroid diseases (AITD), including Hashimoto thyroiditis and Grave’s disease, have strong, demonstrable linkages to vitiligo, with researchers reporting a prevalence of 14.3% among patients with vitiligo. 77 of 79 patients with vitiligo assessed in the review were found to have a presence of anti-thyroid hormone antibodies.

In older patients with non-segmental vitiligo, researchers noted that there is a 2.5-fold risk of developing AITD, with prior research suggesting that this risk may increase over time.

Patients with alopecia areata experience a reported 3% to 8% chance of also having vitiligo simultaneously, with research finding that the 2 conditions share similarities in pathogenesis.

Furthermore, patients with vitiligo may also experience rates of someautoimmune diseases at a prevalence higher than the general population. Researchers examined and compared rates of rheumatoid arthritis, dermatomyositis, systemic lupus erythematosus, scleroderma, insulin-dependent diabetes mellitus, alopecia areata, and thyroiditis.

Of these, patients with vitiligo had a higher prevalence of dermatomyositis, systemic lupus erythematosus, scleroderma, alopecia areata, and thyroiditis when compared to the general population. Researchers noted a significantly lower prevalence of rheumatoid arthritis in patients with vitiligo than the general population and found that prevalence of diabetes mellitus was almost exactly equal between both groups.

Additionally, researchers assessed the prevalence of systemic conditions among patients with vitiligo. They compared rates of sarcadosis, folate deficiency anemia, B12 deficiency anemia, Turner’s syndrome, anemia, psoriasis, and atopic dermatitis.

They found that patients with vitiligo had a higher prevalence of every single above condition when compared to the general population.

“Every case of vitiligo is unique, and the evidence to date supports an alignment of a multitude of comorbidities with vitiligo,” review authors wrote. “Of importance, it is critical that healthcare professionals be aware of the possible autoimmune and systemic diseases that may concurringly ensue with vitiligo to provideoptimal management and treatment; its chronicity and ease of relapsing warrants a necessary call to action to establish cornerstone screening assessment guidelines for early recognition and intervention.” 

Reference

1. Desai S, McCormick E, Sodha P, Friedman A. Shining a light on vitiligo and associated comorbidities: what is the evidence? Jour Drugs in Dermatol. 2023; 22(4). doi:10.36849/JDD.2023.NVRN0423