Vitiligo is an autoimmune, depigmenting skin disease affecting 0.1–1.6% of adults in the USA. Despite observed correlations between vitiligo and other autoimmune conditions in global patient populations, a focused review of comorbidities in US patients with vitiligo is lacking. This systematic literature review and meta-analysis evaluated the prevalence of autoimmune comorbidities in adult patients with vitiligo in the USA.
A systematic literature search of the PubMed and Embase electronic databases (January 1, 2012–November 30, 2022) selected observational studies reporting data on prevalence of autoimmune diseases in US patients with vitiligo. The Grading of Recommendations, Assessment, Development, and Evaluation approach for prognosis was applied to assess certainty of evidence.
Eight studies were eligible for inclusion, encompassing 10,246 patients with vitiligo. Thyroid diseases (14.2%), psoriasis (5.1%), rheumatoid arthritis (3.2%), and alopecia areata (2.7%) were among the most common comorbidities by pooled prevalence rates, with the highest certainty of evidence for associations with thyroid disease and alopecia areata. In addition, there was high or moderate certainty of evidence that greater vitiligo extent is associated with increasing prevalence of thyroid disease, type 1 diabetes, rheumatoid arthritis, and pernicious anemia.
There is clear evidence of correlations between vitiligo and select autoimmune comorbidities in US adults despite the limitations of this study, including the small number of available high-quality studies. The findings presented here demonstrate the importance of future longitudinal studies to identify causal links between vitiligo and comorbidities, and to evaluate potential benefits of screening and early management for thyroid disease, rheumatoid arthritis, and other autoimmune comorbidities.
Vitiligo is a skin disease in which the body’s immune system attacks the cells that provide skin color. This causes people to develop white patches of skin. People with vitiligo also often develop other immune system diseases (also known as autoimmune diseases). To better understand the types of autoimmune diseases people with vitiligo tend to have, this analysis performed a careful and detailed search of published studies. The authors looked for articles with information on adults with vitiligo in the USA that were published between 2012 and 2022. The search found eight studies that met all requirements, and the data from these studies were combined using an approach called a meta-analysis. To focus on the highest-quality data, the authors also used standard approaches to grade the articles by potential bias and overall quality. The authors found that several autoimmune diseases occurred more often in people with vitiligo than the general US adult population, most notably thyroid disease and a type of hair loss called alopecia areata. Furthermore, people with white skin patches covering more of their body were the most likely to have other autoimmune diseases. These include thyroid disease, type 1 diabetes, rheumatoid arthritis, and anemia. On the basis of this study’s findings, vitiligo should be viewed as an autoimmune medical condition, and healthcare professionals should be aware of the potential need to screen patients with vitiligo for other autoimmune diseases.
Vitiligo is a chronic autoimmune skin disease affecting 0.1–1.6% of US adults, regardless of ethnicity, sex, or skin type. The disease presents with progressively depigmenting skin lesions that form as a result of autoimmune targeting and destruction of melanocytes. Patients with vitiligo may experience significant quality-of-life impairment and are at increased risk for various comorbidities that can further increase the burden of the disease. In particular, patients with vitiligo are at risk for psychiatric (including depression and anxiety) and other autoimmune diseases, with a recent systematic literature review and meta-analysis of global patient populations identifying thyroid diseases, alopecia areata, rheumatoid arthritis, and pernicious anemia among the most common and of highest risk for patients with vitiligo. However, although studies have reported correlations between vitiligo and autoimmune conditions in global patient populations, a contemporary and comprehensive systematic review of comorbidities in US patients with vitiligo is lacking. This report summarizes findings from a systematic literature review and meta-analysis of observational studies to determine prevalence of autoimmune diseases in US adults with vitiligo and characterize associations between vitiligo and autoimmune comorbidities.
This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors.
A systematic literature search of PubMed and Embase was conducted for articles published between January 1, 2012 and November 30, 2022. Relevant studies were identified with a combination of National Library of Medicine’s medical subject headings and other keywords specific to the comorbidities of interest. Searches were limited to articles published in the English language. Complete search strings for PubMed and Embase are available in Supplementary Table. To supplement the PubMed and Embase literature searches, bibliographic hand searching of systematic reviews that assessed vitiligo comorbidities was also performed. The study design and analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.
Observational studies (including cohort, cross-sectional, and case–control studies) providing data on the incidence or prevalence of autoimmune diseases in US adults (≥ 18 years old) with vitiligo of any extent were included. Comparative studies were eligible for inclusion, with acceptable comparators including the general population, healthy controls, and adults without vitiligo.
The extraction of data from all included studies was done using structured data tables. Data extraction was initially performed by an independent methodologist, with subsequent quality control performed by additional independent reviewers. Discrepancies were resolved through discussion between the original data extractor and the independent reviewer.
The included studies were assessed for bias using the Newcastle–Ottawa Scale (NOS; cohort and case–control studies) or a modified Newcastle–Ottawa Scale (mNOS; cross-sectional studies). The risk of bias assessment was completed by an independent methodologist, with subsequent quality control by independent reviewers. The NOS and mNOS assess individual studies across three broad categories and award stars per the scoring system: selection (maximum score, 4 stars for NOS and 5 for mNOS), comparability (maximum score, 2 stars for NOS and mNOS), and exposure (maximum score, 3 stars for NOS) or outcomes (maximum score, 3 stars for mNOS). A total score of 7 to 9 indicates a low risk of bias (i.e., high quality), a score of 4 to 6 indicates a high risk of bias, and a score of 1 to 3 indicates a very high risk of bias (i.e., low quality). Use of the NOS and mNOS, considered the industry standard for assessing risk of bias in systematic literature reviews (SLRs), allowed a consistent set of assessment criteria and a common scoring interpretation to be applied to the cohort and cross-sectional studies identified in this review.
Meta-analysis was conducted using Open Meta-Analyst software (Brown University, Providence, RI, USA). Crude prevalence data were pooled from studies that listed the number of patients with vitiligo and the number with vitiligo and a comorbid autoimmune disease. In addition, comparator studies were required to re
