Is Vitiligo Just Skin Deep? A Review of Associated Comorbidities

🔍 Key Finding Vitiligo, a common depigmentation disorder, is associated with various comorbidities, including ocular and auditory abnormalities, autoimmune disorders, other dermatological diseases, metabolic syndrome, and psychological diseases, highlighting the need for a multidisciplinary approach to patient management. These associations suggest that vitiligo involves systemic alterations beyond the skin and may share underlying pathophysiological mechanisms with these comorbidities.

🔬 Methodology Overview

• Design: Narrative review.
• Data Sources: PubMed, Web of Science, Embase, and Cochrane Library (inception to April 30, 2022).
• Selection Criteria: Case-control, cross-sectional, and cohort studies, systematic reviews, and meta-analyses related to vitiligo and associated comorbidities.
• Search Terms: “vitiligo,” “eye diseases,” “ear diseases,” “autoimmune diseases,” “metabolic syndrome,” and “mental disorders.”
• Analysis Approach: Qualitative synthesis of findings from selected studies.
• Scope: Overview of comorbidities associated with vitiligo and their potential pathogeneses.

📊 Results

• Ocular abnormalities: Patients with vitiligo had significantly higher prevalence of ocular abnormalities, including hypopigmented trabecular meshwork, pigment clumps, uveitis, and RPE atrophy. Periorbital depigmentation was associated with eye abnormalities. Dry eye symptoms were more prevalent in vitiligo patients, with reduced tear production and shorter tear film break-up time.
• Auditory abnormalities: Patients with vitiligo had a 6.02-fold increased risk of developing sensorineural hearing loss. Elevated pure-tone thresholds were observed at high frequencies (2,000, 4,000, and 8,000 Hz).
• Autoimmune diseases: Comorbid autoimmune conditions occur in approximately 23% of vitiligo patients. These include thyroid disease (15.7% prevalence), rheumatoid arthritis (2.9%), inflammatory bowel disease (2.3%), systemic lupus erythematosus (2.2% in US population, 0.3% in another US study), and type 1 diabetes mellitus.
• Other dermatological diseases: Alopecia areata was observed in 3.8% of vitiligo patients in one study and 5.3% in another. Psoriasis prevalence varied across studies (3%, 7.79%, and 16.9% past/present history). Atopic dermatitis was 7.82 times more frequent in vitiligo patients.
• Metabolic syndrome (MetS): Vitiligo patients had a 1.648-fold increased risk of MetS. Component risks were also elevated: 3.30-fold increased risk for diabetes mellitus, 2.08-fold increased risk for obesity, and 19.0% prevalence of hypertension.
• Psychological diseases: Vitiligo patients experience impaired quality of life. Depression symptoms were present in 33% and clinical depression in 8%. General anxiety incidence was 35.8%, higher in females. Stigmatization, sleep disturbance, and sexual dysfunction were also reported.

💡 Clinical Impact Vitiligo is associated with numerous comorbidities, including ocular and auditory abnormalities, autoimmune disorders, other dermatological diseases, metabolic syndrome, and psychological diseases. These associations highlight the importance of a multidisciplinary approach and routine screening for these conditions in managing vitiligo patients.

🤔 Limitations

• Small sample sizes
• Heterogeneous definitions
• Conflicting results between studies
• Heterogenous definition of hearing loss between included studies
• Most published studies on the association of vitiligo with neurological disease are case series or small sample studies.

✨ What It Means For You Doctors should be aware of the increased risk of various comorbidities in patients with vitiligo, including ocular and auditory abnormalities, autoimmune disorders, metabolic syndrome, and psychological diseases, and screen for them accordingly. This necessitates a multidisciplinary approach to vitiligo management, involving referrals to specialists like endocrinologists, ophthalmologists, audiologists, and psychiatrists/psychologists as needed.

Reference Hu Z, Wang T. Beyond skin white spots: Vitiligo and associated comorbidities. Front Med. 2023;10:1072837. https://doi.org/10.3389/fmed.2023.1072837