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Vitiligo: More Than Skin Deep

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Vitiligo affects the skin, but this condition can be detrimental to patients’ emotional health, and a recent study indicates that it also may have implications for their physical health. According to research presented at the American Academy of Dermatology’s (AAD) 73rd Annual Meeting in San Francisco, certain autoimmune diseases, including thyroid disease and alopecia areata, may be more prevalent among vitiligo patients.

AAD expert

Information is provided by Iltefat Hamzavi, MD, FAAD, senior staff physician, dermatology, Henry Ford Hospital, Detroit. Liza Gill and Allison Zarbo also made contributions toward this research.

 

What is vitiligo?

  • Vitiligo is a condition that causes color loss. It most commonly affects the skin, resulting in light-colored or white patches, but it also may develop in the hair, in the eyes or inside the mouth. The amount of color loss varies from patient to patient.
     
  • Millions of people around the world have vitiligo. It occurs in individuals of all skin colors, and it affects men and women fairly equally. About half of vitiligo patients are diagnosed before age 21, and most patients who get the disease will have it for the rest of their lives.
     
  • The majority of vitiligo patients do not have any physical symptoms other than skin lightening, although some report that the affected skin itches or feels painful. For many patients, however, vitiligo can contribute to emotional problems like low self-esteem or depression.

Associated psychological conditions

Knowing that vitiligo is associated with certain psychological conditions, Hamzavi and researchers at Henry Ford Hospital decided to investigate its association with other physical conditions. After evaluating 10 years of patient data, they found that nearly 20% of the 1,098 vitiligo patients studied had at least one additional autoimmune disease, also known as a comorbid condition.

Vitiligo has previously been associated with thyroid disease and alopecia areata, Hamzavi says, so researchers were not surprised to see that those diseases were the most prevalent among the vitiligo patients studied. Thyroid disease was 15 times more common in these patients than in the general United States population, while alopecia areata was 31 times more common.

Some relatively rare conditions occurred in only a few of the patients studied, but they were more prevalent in the vitiligo population than researchers expected. These conditions included:

  • Linear morphea, a disorder that causes hardening or thickening of the skin, which occurred 182 times more frequently than expected;
  • Guilllain-Barré syndrome, a condition in which the immune system attacks the nervous system, which occurred 137 times more frequently than expected; and
  • Myasthenia gravis, a disorder characterized by muscle weakness, which occurred 36 times more frequently than expected.

Other conditions with increased prevalence in the vitiligo patients studied included lupus, inflammatory bowel disease, and Sjögren’s syndrome, which results in dry eyes and a dry mouth.

Awareness of potential implications

Hamzavi says it’s important for vitiligo patients and their physicianss to be aware of the potential for comorbid conditions. Patients should pay attention to any symptoms they experience and report them to their physician, and physicians should then screen those patients for any diseases associated with those symptoms. Additionally, he says, everyone with vitiligo should be screened for thyroid disorders once a year.

According to Hamzavi, the next step in vitiligo research is determining whether the condition is caused by a specific molecular target. If scientists can identify such a pathway and develop a therapy to target it, doctors may be able to treat vitiligo in the same way they are now treating psoriasis.

AAD advice

“Vitiligo is often perceived to be ‘only a cosmetic condition,’ but it’s not just a disease of the skin,” Hamzavi says. “While the skin is a primary target, other organs are also at risk, and the emotional effects on patients can be devastating.”

For more information, visit www.aad.org.

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