Shining a Light on Vitiligo and Associated Comorbidities: What Is the Evidence?

April 2023 | Volume 22 | Issue 4 | 428 | Copyright © April 2023


Published online March 27, 2023

Sapana Desai MD, Erika McCormick BS, Pooja Sodha MD, Adam Friedman MD FAAD

George Washington University Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC

Diabetes Mellitus
Many studies have explored potential ties between vitiligo and diabetes mellitus (DM) identifying 1 to 7% of vitiligo patients have concomitant DM.2,20,21 T1DM is an autoimmune disease characterized by destruction of insulin-producing pancreatic beta cells, and coexistence of the two diagnoses provides further insight that vitiligo, too, is a T-cell mediated disease. A meta-analysis comparing 14 studies reported that the prevalence of vitiligo among T1DM patients ranged from 0.5 to 23.3%, with a mean incidence of 2.4% vs 0.4% in the general population. In other studies, estimated prevalence of vitiligo in T1DM patients was higher, 4.3% vs 1.4%, compared to studies that failed to perform active vitiligo screening.11 Similarly, vitiligo was observed in 12% of cases, and 6% in the age and sex-matched controls amidst one study examining 600  T2DM patients.2,12,13  Recent studies likewise determined a 4.9% prevalence of vitiligo in T2DM individuals contrasting with 0.6% in the general population.14

Metabolic Syndrome
Metabolic syndrome is defined as the co-occurrence of metabolic risk factors for cardiovascular disease and T2DM. Surprisingly, proinflammatory cytokines IL-6, IL-1, and TNF-a associated with insulin resistance and atherosclerosis, have also been recognized as influential cytokines affecting vitiligo pathogenesis, thus accentuating a likely correlation between the two as well as parallels between the syndrome and activity and duration of vitiligo.15,16 One prospective cross-sectional study showed a significantly higher incidence of metabolic syndrome in vitiligo patients, especially those with a higher Vitiligo Area Severity Index (VASI). In all vitiligo individuals evaluated, fasting glucose, LDL cholesterol, and blood pressure levels were appreciably higher than controls after the exclusion of those affected by comorbidities including obesity, diabetes, and AITD; criteria for metabolic syndrome were met amidst 37.4% of studied vitiligo patients.15

Conclusion

Every case of vitiligo is unique, and the evidence to date supports an alignment of a multitude of comorbidities with vitiligo. Of importance, it is critical that healthcare professionals be aware of the possible autoimmune and systemic diseases that may concurringly ensue with vitiligo to provide optimal 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. 

Disclosure

The authors declare no conflicts of interest.

REFERENCES

  1. Damsky W, King B. JAK inhibitors in dermatology: the promise of a new drug class. J Am Acad Dermatol. 2017;76(4):736-744. doi: 10.1016/j. jaad.2016.12.005
  2. Dahir AM, Thomsen SF. Comorbidities in vitiligo: Comprehensive review. Int J Dermatol. 2018;57(10):1157-1164.
  3. Gill L, Zarbo A, Isedeh P, et al. Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study. J Am Acad Dermatol. 2016;74(2):295- 302.
  4. Ongenae K, Van Geel N, Naeyaert JM. Evidence for an autoimmune pathogenesis of vitiligo. Pigment Cell Res. 2003;16(2):90-100. 
  5. Bergqvist C, Ezzedine K. Vitiligo: A review. Dermatology. 2020;236(6):571- 592.
  6. Baldini E, Odorisio T, Sorrenti S, et al. Vitiligo and autoimmune thyroid disorders. Front Endocrinol (Lausanne). 2017;8:290. 
  7. Sandru F, Carsote M, Albu SE, et al. Vitiligo and chronic autoimmune thyroiditis. J Med Life. 2021;14(2):127-130.
  8. Chivu AM, Bălășescu E, Pandia LD, et al. Vitiligo-thyroid disease association: when, in whom, and why should it be suspected? A systematic review. J Pers Med. 2022;12(12):2048.
  9. Rork JF, Rashighi M, Harris JE. Understanding autoimmunity of vitiligo and alopecia areata. Curr Opin Pediatr. 2016;28(4):463-469.
  10. Tomaszewska KA, Kozłowska M, Kaszuba A, et al. Increased serum levels of interleukin-17 in patients with alopecia areata and non-segmental vitiligo. Postepy Dermatol Alergol. 2022;39(1):195-199.
  11. Nederstigt C, Uitbeijerse BS, Janssen LGM, et al. Associated autoimmune disease in type 1 diabetes patients: a systematic review and meta-analysis. Eur J Endocrinol. 2019;180(2):135-144.
  12. Chang HC, Lin MH, Huang YC, Hou TY. The association between vitiligo and diabetes mellitus: A systematic review and meta-analysis. J Am Acad Dermatol. 2019;81(6):1442-1445. 
  13. Raveendra L, Hemavathi RN, Rajgopal S. A study of vitiligo in type 2 diabetic patients. Indian J Dermatol. 2017;62(2):168-170. 
  14. Afkhami-Ardekani M, Ghadiri-Anari A, Ebrahimzadeh-Ardakani M, et al. Prevalence of vitiligo among type 2 diabetic patients in an Iranian population. Int J Dermatol. 2014;53(8):956-958.
  15. D'Arino A, Picardo M, Truglio M, et al. Metabolic comorbidities in vitiligo: A brief review and report of new data from a single-center experience. Int J Mol Sci. 2021;22(16):8820.
  16. Ibrahim S, El-Tahlawi S, Mogawer RM, et al. Different vitiligo characteristics as predictors of increased risk of metabolic syndrome and insulin resistance: A case-control study. J Cosmet Dermatol. 2022;21(12):7170- 7177.
  17. Eleryan M, Friedman, A. The Full Spectrum of Dermatology: A Diverse and Inclusive Atlas! Available at: https://jddonline.com/project-atlas/. Accessed October 11, 2022.
  18. Hercogova J, Lotti T. Vitiligo: Problems and Solutions. New York, London: Marcel Dekker; Taylor & Francis. 2004.
  19. Lotti T, D’Erme AM. Vitiligo as a systemic disease. Clin Dermatol. 2014; 32(3):430-434.
  20. Gopal KV, Rao GR, Kumar YH. Increased prevalence of thyroid dysfunction and diabetes mellitus in Indian vitiligo patients: A case-control study. Indian Dermatol Online J. 2014;5(4):456-460.
  21. Zhang Z, Xu SX, Zhang FY, et al. The analysis of genetics and associated autoimmune diseases in Chinese vitiligo patients. Arch Dermatol Res. 2009;301(2):167-173.
  22. Lensing M, Jabbari A. An overview of JAK/STAT pathways and JAK inhibition in alopecia areata. Front Immunol. 2022;13:955035. 
  23. Howell MD, Kuo FI, Smith PA. Targeting the janus kinase family in autoimmune skin diseases. Front Immunol. 2019;10:2342. 
  24. Abdel Motaleb AA, Tawfik YM, El-Mokhtar MA, et al. Cutaneous JAK expression in vitiligo. J Cutan Med Surg. 2021;25(2):157-162.
  25. Ezzedine K, Anastasspoulos K, Gandhi K, et al. A survey study of selfreported comorbidities among adults with vitiligo in the United States. JEADV Clin Pract. 2023;1-6

AUTHOR CORRESPONDENCE

Adam Friedman MD FAAD ajfriedman@mfa.gwu.edu
Close Menu