Autoimmune Comorbidities Prevalent in Patients With Vitiligo

This content was produced independently by The American Journal of Managed Care^® and is not endorsed by the American Academy of Dermatology.

Two posters presented at the 2024 American Academy of Dermatology Annual Meeting show that many patients with vitiligo had various autoimmune comorbidities, demonstrating the need for earlier screenings and updated guidelines.

The first poster¹ described a cross-sectional analysis of the associations between vitiligo and other autoimmune diseases among a US population. Although several studies have alluded to the coexistence of autoimmune diseases in patients with vitiligo, the researchers explained that there is a lack of studies on the role of income and education in such associations. Consequently, they aimed to learn more about these areas.

More specifically, their 3 main objectives were to investigate the association between vitiligo and other autoimmune diseases, to identify demographic factors that may influence the associations, and to determine the specific autoimmune comorbidities most strongly associated with vitiligo.

To accomplish these, they used the All of Us database, a National Institutes of Health research initiative that recruits patients historically underrepresented in biomedical research. The researchers identified patients with vitiligo within the database by using Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED) code 56727007.

Woman with vitiligo | Image Credit: oneinchpunch - stock.adobe.com

Through their analysis, the researchers found a significant increase in the risk of autoimmune conditions in patients with vitiligo. The most prevalent comorbidities included alopecia areata (OR, 8.81; 95% CI, 4.64-17.64; P < .001), Hashimoto thyroiditis (OR, 5.43; 95% CI, 3.32-8.99; P < .001), and psoriatic arthritis (OR, 4.06; 95% CI, 2.26-7.30; P < .001). Conversely, the researchers noted that Graves disease, multiple sclerosis, and myasthenia gravis did not show significant associations with vitiligo.

The researchers explained that their findings suggest a potential shared pathophysiological mechanism, which could be rooted in genetic predisposition and immune system dysregulation. Their findings also suggest the need for vigilant screening for various autoimmune diseases in patients with vitiligo; they noted that doing so could facilitate early diagnosis and management, potentially improving patient outcomes.

The second poster² featured a systematic review that aimed to examine autoimmune conditions among patients with vitiligo on a global scale. Although previous studies frequently associated vitiligo with other autoimmune diseases, the researchers noted that specific attempts to provide prevalence estimates at a global scale have not been made, so they set out to do so.

On August 6, 2023, the researchers searched the electronic databases PubMed, EMBASE, and CINAHL for observational studies with a primary focus on reporting autoimmune disease in patients with vitiligo. Their search yielded 615 eligible studies (203 from PubMed, 357 from EMBASE, and 55 from CINAHL). Of these studies, they selected 23 for analysis; these studies originated from 16 countries.

Their combined population across all studies included 231,791 patients with vitiligo. Of these patients, 57.4% were female, and the mean (SD) age was 36.6 (11.4) years.

The most prevalent autoimmune diseases based on reported cases were atopic dermatitis (7.95%; n/N = 1235/15,541), type 1 diabetes (2.81%; n/N = 1957/69,623), and psoriasis (2.29%; n/N = 694/30,370). However, the least prevalent autoimmune comorbidities were Sjögren syndrome (0.29%; n/N = 423/143,988), primary biliary cholangitis (0.15%; n/N = 59/39,173), and autoimmune uveitis (0.09%; n/N =1/1098).

The researchers explained that these findings should be validated as more data become available and incorporated into clinical guidelines to ensure patients with vitiligo are aware of and treated for such comorbidities.

References

1. Abdi P, Haq Z, Diaz MJ, Mirza FN, Yumeen S, Joshipura D. Autoimmune co-morbidities associated with vitiligo: a United States population-based case control analysis using the All of Us research program. Presented at American Academy of Dermatology Annual Meeting; March 8-12, 2024; San Diego, CA. Poster 54311.

2. Diaz M, Lakshmipathy D, Aflatooni S, et al. Global prevalence of autoimmune diseases in patients with vitiligo: a systematic review. Presented at American Academy of Dermatology Annual Meeting; March 8-12, 2024; San Diego, CA. Poster 54790.