Vitiligo is associated with mental heath conditions, other autoimmune diseases

People with vitiligo are more likely to have a variety of psychiatric and autoimmune conditions than those who don’t, according to research findings reported in the International Journal of Dermatology yesterday.

Identification of those associations are not novel, but lead and corresponding author Kritin K. Verma, MBA, a student at Texas Tech University Health Sciences Center School of Medicine, and his co-authors said their research helps fill out the picture with evidence from a large real-world population. To conduct their study, Verma and his colleagues used data from TriNetX, a private company that has assembled a vast database from electronic health records in the U.S. and elsewhere. The researchers identified 16,569 people with vitiligo in the database and a like-sized cohort of people who were matches on age and some other factors. They used standard statistical techniques to identify differences between the two groups in the likelihood of having psychiatric and autoimmune conditions.

Verma and his colleagues found that people with vitiligo were more likely to have depression than the matched cohort (15% vs. 13. 4%), anxiety (22.5% vs 20%), panic disorder (2.1% vs. 1.6%), insomnia (9.6% vs. 7.5%) and sexual dysfunction that can’t be explained by substance uses or physiologic problems (0.5% vs. 0.4%). Interestingly, attention deficit disorder was an exception to the pattern, being slightly less prevalent among patients with vitiligo than those without it (3.6% vs. 4%).

Many studies have shown that if someone has one autoimmune disease, they are more likely to have others. Vitiligo is commonly understood to be an autoimmune condition in which components of the immune system — innate immune cells, dendritic cells, T cells — attack melanocytes that are responsible for producing darkly pigmented melanin. Verma and his colleagues also found the typical clustering of autoimmune conditions. People with vitiligo were more likely to have alopecia areata than those without vitiligo (1.5% vs. 0.2%) in their study. The same is true of thyroid disorders (23.8% vs. 13.7%), Type 1 diabetes (2.4% vs. 0.9%), lupus (0.9% vs. 0.4%), rheumatoid arthritis (3.0% vs. 1.8%), systemic sclerosis (0.4% vs. 0.2%) and Sjögren syndrome (1.4% vs. 0.8%).

When the researchers also looked for differences in associations with substance abuse disorders, they no difference when it came to disorders involving alcohol, cannabis, opioids or cocaine. Nicotine dependence (4.6% vs. 5.1%) and cigarette-specific nicotine dependence (2.8% vs. 3.5%) were less common among those with vitiligo.

Verma and his co-authors say that one of the takeaways from their research, which was presented as a letter to the editor in the journal is the importance of mental health screening and multidisciplinary care for people with vitiligo.

The reasons for thesassociation with vitiligo are beyond the scope of Verma and his co-authors’ research, but they pointed to prior research suggesting that inflammatory pathways may explain the connection between vitiligo and mental health disorders. Many studies have shown that the origin stories of autoimmune diseases are rooted in similar immune system dysregulation. The association of vitiligo with some of the mental health conditions likely has social and cultural aspects. A review paper published earlier this year in the Journal of Cosmetic Dermatology about cultural beliefs about vitiligo found that stigmatization was a consistent pattern around the world and that it was particularly severe for women with the condition and those with darker skin types.

Corresponding author Isabella Tan, a student at Rutgers Robert Wood Johnson Medical School, and her co-authors found that quality of life of life impairment was greater in African, Middle Eastern, and South Asian populations compared with Western cohorts. Coping strategies includ concealment, spiritual reliance and use of complementary and alternative medicine. Tan and her colleague land on the suggestion that culturally tailored, multidisciplinary interventions — including education, psychological support, and community-based stigma reduction — are crucial to improving outcomes.