Comorbid autoimmune diseases in patients with vitiligo: A cross-sectional study

Evaluation of the clinical and sociodemographic features of patients with vitiligo from the central region of Romania

Background

In this study, we aimed to investigate and analyze the clinical and sociodemographic features and possible correlation with factors associated with the development of vitiligo in a cohort of patients suffering from this disease in the central region of Romania.

Methods

Patients diagnosed with vitiligo from private outpatient clinics in the region and from the outpatient clinic of the Dermatology Clinic in Târgu Mureş participated in the study. The study period was between March 2021 and March 2022. Both sets of patients adhered to the same specified inclusion and exclusion criteria. Included just patients who received a complete dermatological clinical examination. They were asked by experienced physicians about epidemiological and clinical data of the disease, using the questions about vitiligo from the validated questionnaire edited by the Vitiligo Research Foundation from the United States of America. The patients who were given incomplete responses were excluded. This questionnaire contains 30 questions with multiple answers, about the patients with vitiligo, divided into seven subgroups as follows: group 1. Origins (demographic data), 2. History of vitiligo, 3. Vitiligo description, 4. Vitiligo treatments, 5. Skin condition, 6. Other conditions (comorbidities), 7. Impact (cost of treatments). Our study consisted of 114 patients, all of whom were Caucasians with Fitzpatrick skin types ranging from I-III.

Results

We have analyzed the found data and compared the result with the data found in the literature. Most of the clinical and epidemiological characteristics of vitiligo in our patients were similar to those in other studies. A few of the characteristics linked to the possible appearance of the disease were present in higher percentages like the presence of the disease in the family, lighter color of the eyes, gray colored hair, the presence of the halo naevus, the predisposition to sunburn, the skin trauma as starting cause and the presence of increased level of thyroid disease.

Conclusion

Based on our results, we can conclude a profile of a potential patient who can develop vitiligo. To our knowledge, this study is the first of its kind from our country, however, our inferences remain limited by the single center, a relatively small sample size, recall bias, and a self-decided classification of some clinical aspects, which are potential limitations of this study.

Sirtuin1 Deficiency Could Exacerbate Melanocyte Apoptosis Under Endoplasmic Reticulum Stress

Vitiligo is a depigmentation disease caused by the targeted destruction of melanocytes, resulting in skin and hair depigmentation and significant psychological stress. However, the mechanisms underlying its onset and progression remain unclear. Endoplasmic reticulum (ER) stress, which is linked with oxidative stress and autoimmunity, is involved in the development of vitiligo, and prolonged ER stress induces apoptosis. Sirtuin 1 (Sirt1) might be a key regulator of ER stress. Thus, we explored how Sirt1 modulates ER stress-induced melanocyte apoptosis in vitro and in vivo. Our results showed that Sirt1 affected ER stress-induced apoptosis of melanocyte apoptosis when upon to ER stress in vitro. Sirt1 inhibition aggravated the vitiligo phenotype in mice; thereby protecting against the stress response, and abating the unfolded protein response. These results suggest that Sirt1 impairment could accelerate melanocyte apoptosis in vitiligo.

Neurological Mystery Post Travel: An Atypical Presentation and Partial Recovery With Immunotherapy

This case highlights the diagnostic challenges in atypical neurological presentations and the role of empirical immunotherapy despite the absence of a definitive diagnosis. We present a South Indian woman in her 40s who developed progressive lower limb weakness and respiratory compromise after recent international travel. Initially suspected to have Guillain-Barré syndrome (GBS), extensive investigations, including electromyography (EMG), nerve conduction studies (NCS), and cerebrospinal fluid (CSF) analysis, failed to confirm a clear diagnosis. Despite this uncertainty, empirical intravenous immunoglobulin (IVIG) therapy resulted in clinical improvement, supporting the likelihood of an immune-mediated process. Notably, the patient had been experiencing an ongoing flare-up of vitiligo, an autoimmune disease characterized by immune-mediated destruction of melanocytes, for approximately six months leading up to and during the onset of neurological symptoms, suggesting heightened autoimmune activity around the period of symptom onset. Additionally, the patient's South Indian ethnicity is relevant, as autoimmune disorders, including neurological conditions, may have distinct presentations and prevalence among South Asian populations due to genetic and environmental factors. The patient's prolonged ICU stay, need for mechanical ventilation, and complications such as stridor and vocal cord dysfunction underscore the complexity of managing undifferentiated neurological cases. This case serves as an important educational tool, demonstrating the limitations of standard diagnostic criteria in rare or evolving neurological syndromes, the importance of empirical immunotherapy in suspected immune-mediated conditions, and the need for a multidisciplinary approach with careful follow-up. By highlighting the intersection between neurology, immunology, and critical care, this case reinforces the importance of clinical judgment and individualized treatment strategies when conventional diagnostics fall short.

Prevalence of Thyrotropin Receptor Antibodies and Clinical Profile of Patients with Alopecia Areata: A Cross-Sectional Study

Introduction

Alopecia areata (AA) is associated with thyroid dysfunction and abnormal levels of thyroglobulin and thyroid peroxidase autoantibodies. One study detected high prevalence of thyrotropin receptor antibodies (TRAbs) in AA patients. Our aim was to investigate the prevalence of TRAb levels in AA patients and to assess their association with thyroid hormones, other thyroid antibodies, AA severity, and other epidemiological variables.

Methods

In this observational study, 139 patients (97 females, 42 males), aged 12 and above, with newly presenting, relapsing, or treatment-resistant AA were included. Medical histories were reviewed, alopecia severity was assessed using the Severity of Alopecia Tool (SALT), and blood tests measured thyroid hormones and autoantibodies.

Results

The prevalence of TRAb was significantly higher in AA patients (23.6%) compared to the general population (1-2%) (p < 0.001). Elevated TRAb titers did not correlate with diagnosed thyroid dysfunction or treatment, abnormal thyroid function tests and autoantibodies, AA severity, duration, and onset. Male patients exhibited a significantly higher prevalence of abnormal TRAb titers compared to females (75.0% vs. 21.3%, p = 0.002).

Conclusion

A significant proportion of AA patients presented with elevated TRAb levels, independent of thyroid hormone titers, other thyroid autoantibodies, or SALT score. Prevalence of abnormal TRAb levels was higher in males.

Burden of Vitiligo in Canada: Retrospective Analysis of a Canadian Public Claims Database

BACKGROUND

Vitiligo is an autoimmune disease resulting in skin depigmentation. Treatment options are limited.

OBJECTIVES

To examine disease burden and healthcare resource utilization (HCRU) among patients with vitiligo in Québec, Canada.

METHODS

In this retrospective study, data were obtained from the Régie de l'Assurance Maladie du Québec (RAMQ) databases for 125,000 random individuals from January 2010 to December 2019. The International Classification of Diseases, Ninth Revision (ICD-9) diagnostic code [709.x (other skin disorders)] with vitiligo-related treatment was used to identify patients with vitiligo. Patient characteristics and treatments, including treatment type, episodes (treatments used without discontinuation), and sequences (treatment episodes ≥30 days), were assessed. Annualized HCRU and costs (2021 adjusted) included all-cause hospitalization, emergency department visits, outpatient visits, and medications among patients with vitiligo (n = 113) and age- and sex-matched non-vitiligo controls (n = 339).

RESULTS

Of patients with vitiligo (mean age, 50.0 years; 68.1% female) identified using ICD-9 code 709.x with vitiligo-related treatment, 36.3% received ≥4 treatment episodes. Treatment patterns were heterogeneous, with 43 different sequences reported. Annualized mean outpatient visits (16.1 vs 5.5) and all-cause outpatient service costs per patient were significantly higher in the vitiligo versus the control group (CAN$1037 vs CAN$523; P < .01). Total all-cause services costs were higher for patients with vitiligo in the year after versus before diagnosis (CAN$3679 vs CAN$2085; P = .04).

CONCLUSIONS

Vitiligo is associated with significant burden and HCRU among patients in Québec, Canada, who were identified by ICD-9 code 709.x plus vitiligo-related treatment. Measurement of true vitiligo burden remains challenging.

Dietary Interventions, Supplements, and Plant-Derived Compounds for Adjunct Vitiligo Management: A Review of the Literature

Vitiligo is a chronic autoimmune pigmentation disorder shaped by a complex interplay of genetic predispositions and environmental triggers. While conventional therapies-phototherapy, corticosteroids, and immunosuppressants-can be effective, their benefits are often partial and temporary, with recurrence common once treatment stops. As such, there is increasing interest in exploring complementary approaches that may offer a more sustainable impact. Emerging evidence suggests that macronutrient and micronutrient-level changes could be beneficial for managing progression and, in some cases, facilitating repigmentation. Antioxidant-rich foods, such as apples, green tea, Indian gooseberry, onions, and peppers, may help mitigate oxidative stress, while inflammatory foods, such as gluten and high-phenol nuts and berries, may exacerbate the condition. Certain supplements, including high-dose vitamin D, vitamin C, vitamin E, and selenium, may enhance phototherapy outcomes. Omega-3 and other unsaturated fatty acids, in addition to prebiotics and probiotics, are under active investigation for their roles in gut health and immune regulation. Notably, plant-derived compounds, i.e., Ginkgo biloba, have demonstrated promise in promoting repigmentation and managing disease progression. However, it must be emphasized that these nutritional interventions remain exploratory, and more research is needed to establish their efficacy, safety, and optimal usage before they can be recommended as part of a standard treatment regimen.

A Canvas of Contemporary Insights into Clinical Vitiligo

Vitiligo is a chronic skin condition characterized by the loss of melanocytes, resulting in white patches on the skin. While its exact cause is unknown, it's believed to be an autoimmune disorder involving genetic, environmental, and immunologic factors. Various treatments, including topical drugs, phototherapy, and surgery, exist, but further research is needed for more targeted therapies. Standardization of treatment goals and outcome measures is crucial. Future directions involve personalized treatments based on genetic and immunologic profiles, along with advancements in melanocyte biology for more effective therapies. Collaborative research is the key to improving outcomes and quality of life for vitiligo patients.

Sjögren's Syndrome Is Associated With an Increased Risk of Vitiligo

OBJECTIVES

Limited studies reported the correlation between Sjögren's syndrome (SS) and vitiligo. This study explores the association between SS and the risk of developing vitiligo and assesses comorbidity profiles and medication impacts.

METHODS

We conducted a retrospective, population-based analysis using data from Taiwan's National Health Insurance Research Database, spanning 2008 to 2019. The primary outcome was the incidence of vitiligo, which was analyzed using Cox proportional hazards models, with additional subgroup and sensitivity analyses conducted.

RESULTS

The study incorporated 223 582 individuals with SS and 9 775 363 controls. A total of 208 942 pairs of the SS and controls were analyzed following propensity score matching. Non-matched and matched cohort analyses have consistent results. In matched analysis, individuals with SS had a 1.90-fold increased risk of developing vitiligo compared to those without SS after adjustment (95% confidence interval [Cl], 1.67-2.15; p < 0.001). Age-related risk was evident, particularly in those aged 40-59 years and 60-79 years. Males had a lower risk of vitiligo than females. Comorbidities such as hyperlipidemia, chronic liver disease, hyperthyroidism, and spondylarthritis further increase the risk. During the first year following diagnosis, individuals with SS exhibited a significantly elevated risk of developing vitiligo compared to those without SS (aHR, 2.15; 95% Cl, 1.54-3.00; p < 0.001). Over a decade of follow-up, the SS cohort showed a markedly higher cumulative risk of vitiligo than the non-SS cohort (log-rank p < 0.001). Subgroup analysis revealed that systemic corticosteroid administration significantly mitigated the risk of developing vitiligo in SS patients (aHR, 0.67; 95% CI, 0.53-0.86; p < 0.001) compared to patients who did not receive systemic corticosteroids.

CONCLUSION

SS is significantly associated with an increased risk of developing vitiligo. Further research is warranted to elucidate the underlying mechanisms.

Prevalence of co-existing autoimmune and autoinflammatory diseases in vitiligo: a survey-based study from Egypt

BACKGROUND

The exact cause of vitiligo is still unknown. Genetic factors, self-destruction of melanocytes, the autoimmune process, and oxidative stress all can contribute to the pathogenesis of vitiligo.

OBJECTIVES

The aim of this study was to figure out the frequency of coexisting autoimmune and autoinflammatory diseases (AIIDs) in Egyptian patients with vitiligo and identify the associated risk factors.

MATERIALS AND METHODS

Egyptian children and adults with vitiligo and their parents were asked to answer a web-based survey. The survey consisted of multiple questions centered around demographic, clinical, and therapeutic data. The vitiligo disease activity (VIDA) score was evaluated for all the patients. Patients were also asked about the presence of co-existing AIIDs.

RESULTS

There was a total of 294 participants, mostly females (54.8%), with a median age of 35 years and a median disease duration of 9 years. Nearly 27% had at least one AIID. The most common associated AIIDs were autoimmune thyroid disease (47 patients, 16%), followed by alopecia areata (14 patients,4.8%), then psoriasis and rheumatoid arthritis (11 patients, 3.7%). Univariate regression analysis revealed that age (OR 1.02, P = 0.036), female gender (OR 2.2, P = 0.004), disease duration (OR 1.04, P < 0.001), affected body surface area (OR 1.7, P = 0.048), and family history of AIIDs (OR 2.7, P < 0.001) were predictors for the presence of AIIDs in patients with vitiligo.

CONCLUSION

AIIDs are prevalent among vitiligo patients. Age, female gender, and family history of AIIDs are the main predictors of the presence of AIIDs in vitiligo patients.

Machine learning and artificial intelligence within pediatric autoimmune diseases: applications, challenges, future perspective

INTRODUCTION

Autoimmune disorders affect 4.5% to 9.4% of children, significantly reducing their quality of life. The diagnosis and prognosis of autoimmune diseases are uncertain because of the variety of onset and development. Machine learning can identify clinically relevant patterns from vast amounts of data. Hence, its introduction has been beneficial in the diagnosis and management of patients.

AREAS COVERED

This narrative review was conducted through searching various electronic databases, including PubMed, Scopus, and Web of Science. This study thoroughly explores the current knowledge and identifies the remaining gaps in the applications of machine learning specifically in the context of pediatric autoimmune and related diseases.

EXPERT OPINION

Machine learning algorithms have the potential to completely change how pediatric autoimmune disorders are identified, treated, and managed. Machine learning can assist physicians in making more precise and fast judgments, identifying new biomarkers and therapeutic targets, and personalizing treatment strategies for each patient by utilizing massive datasets and powerful analytics.

Updates on the Association Between Vitiligo and Thyroid Diseases: A Systematic Review

The main objective of this study is to estimate the prevalence of thyroid diseases in patients with vitiligo and investigate the potential shared autoimmune mechanisms underlying the co-occurrence of vitiligo and thyroid diseases. To locate research that met the inclusion criteria, a thorough computerized search of relevant databases was carried out. A comprehensive search was carried out on PubMed, SCOPUS, Science Direct, and Web of Science to locate relevant material. Our data included 13 trials with 82,230 participants, and 40,116 (48.8%) of them were males. The prevalence of thyroid disorders ranged from 3.2% to 32.1%, with a total prevalence of 2,906 (3.5%). Vitiligo patients are more likely to have a number of immunological comorbidities, underscoring the serious effects of the illness on overall health, especially thyroid disorders. The correlation between vitiligo and positive thyroid peroxidase antibodies, hypothyroidism, and autoimmune thyroiditis is notably high. We found a strong association between vitiligo and the incidence of thyroid disorders, particularly autoimmune thyroid disorders. The findings emphasize the necessity of identifying and treating thyroid dysfunction in vitiligo patients, as it might affect the clinical course of the skin condition and overall patient health. Future research is required to standardize study methodology, investigate underlying mechanisms, and create integrated therapy and screening regimens.

Co-regulatory mechanisms and potential markers of oxidative stress-related genes in vitiligo and alopecia areata

BACKGROUND

The specific role of oxidative stress (OS) in vitiligo and alopecia areata (AA) remains unclear. The aim of this study was to analyze and identify the key markers of OS in vitiligo and AA by bioinformatics.

METHODS

We obtained vitiligo and AA datasets from gene expression omnibus (GEO) database. The difference-expressed genes of vitiligo and AA were identified by differential analysis, and the functions of difference-expressed genes were identified by gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and Gene Set Enrichment Analysis (GSEA) enrichment analysis. Subsequently, Veen package was used to obtain the intersection genes of OS-related genes with vitiligo and AA. Finally, we used CIBERSORT to assess the infiltration of immune cells in vitiligo and AA.

RESULTS

Through enrichment analysis, we found that vitiligo and AA were mainly enriched in cell cycle and cell adhesion molecular channels. We identified KLB and EIF3C as key genes in OS regulation of vitiligo and AA, and found that KLB and EIF3C participate in disease progression by regulating T cells and neutrophils.

CONCLUSIONS

According to our findings, KLB and EIF3C play a crucial role in the progression and development of vitiligo and AA, which have been identified as biomarkers and target for early diagnosis of patients.

Association between vitiligo and risk of retinal detachment: a population-based cohort study in Taiwan

BACKGROUND

Vitiligo is reportedly associated with several ocular abnormalities. However, the relationship between vitiligo and retinal detachment (RD) remains unclear.

OBJECTIVES

To examine the risk of RD in patients with vitiligo.

METHODS

A nationwide population-based cohort study was conducted using data from the Taiwan National Health Insurance Database from 2007 to 2018. A total of 21 132 patients with vitiligo were matched in a 1 : 4 ratio with people without vitiligo by age, sex and comorbidity propensity score. Cumulative incidence and Cox proportional hazard models were used to investigate the risk of RD in patients with vitiligo. Subgroup analysis was performed.

RESULTS

The cohort with vitiligo had a significantly higher rate of RD than the cohort without vitiligo [adjusted hazard ratio (aHR) 1.44, 95% confidence interval (CI) 1.20-1.72; P < 0.001]. Patients with vitiligo who required treatments such as phototherapy, systemic corticosteroids or immunosuppressants exhibited an even greater risk of RD (aHR 1.57, 95% CI 1.16-2.14; P = 0.004).

CONCLUSIONS

Our study revealed a 1.44-fold increased risk of RD in patients with vitiligo, with an even higher risk in patients receiving phototherapy, systemic corticosteroids or immunosuppressants. The risk remained consistently higher over a 10-year follow-up period.

Exosome-derived microRNAs: emerging players in vitiligo

Exosome-derived microRNAs (miRNAs) are biomacromolecules and nanoscale extracellular vesicles originating from intracellular compartments that are secreted by most cells into the extracellular space. This review examines the formation and function of exosomal miRNAs in biological information transfer, explores the pathogenesis of vitiligo, and highlights the relationship between exosomal miRNAs and vitiligo. The aim is to deepen the understanding of how exosomal miRNAs influence immune imbalance, oxidative stress damage, melanocyte-keratinocyte interactions, and melanogenesis disorders in the development of vitiligo. This enhanced understanding may contribute to the development of potential diagnostic and therapeutic options for vitiligo.

Prevalence of Multiple Sclerosis in Vitiligo Patients and Their First-Degree Relatives: Two Diseases with Similarities in Pathogenesis and Treatment

INTRODUCTION

Vitiligo is a common pigmentation disorder manifested by white macules and patches. It is accompanied by some autoimmune and neurological diseases. Recently, it has been suggested that multiple sclerosis (MS) is more common in vitiligo patients and that they have a higher risk of developing MS during their lifetime.

OBJECTIVES

In this study, we aimed to determine the prevalence of MS in patients with vitiligo and their first-degree relatives and compare it with the prevalence in the population.

METHODS

In this cross-sectional study, data were consecutively collected from patients referred to Razi Hospital from March 2020 to December 2021.

RESULTS

Seven hundred and nine patients with vitiligo participated in this study, and 15 reported a history of MS (2.12%, 95% confidence interval [CI] 1.06%-3.17%). This rate was significantly higher than the prevalence of MS in the average population of Tehran (P < 0.001). Of the 2886 first-degree relatives of the patients, 10 had MS (0.35%, 95%CI 0.13&-0.56%), which was higher than the prevalence of MS, yet not statistically significant.

CONCLUSIONS

A significant association between vitiligo and MS was observed, which should be of clinical and therapeutic importance. However, the prevalence of MS in first-degree relatives of vitiligo patients was higher than the average rate, yet not statistically significant.

Epidemiology and Treatment Patterns of Patients with Vitiligo: A Real-World Analysis

INTRODUCTION

Vitiligo, a chronic autoimmune skin depigmentation disease with an unpredictable course, has been associated with several comorbid autoimmune and psychological conditions. Our current understanding of vitiligo burden and management in the real world is limited. This real-world analysis presents data on vitiligo epidemiology, comorbidities, and treatment of patients in Israel.

METHODS

This retrospective study analyzed data from the Maccabi Health Services database. Prevalent patients with vitiligo in 2021 were matched to patients in the general population on the basis of age group, gender, and socioeconomic status. Patient demographics, vitiligo incidence and prevalence, comorbidities, and treatment patterns are reported. Data are presented as percentages, mean, median, P values, and standard mean differences (SMD).

RESULTS

In this analysis, 11,412 patients with vitiligo were matched to patients from the general population. Incidence and prevalence rates increased over time from 2005 to 2021. Compared to the general population, patients with vitiligo were more likely to have an immune-mediated comorbidity (29.7% vs 18.4% [P < 0.001; SMD 0.27]) or psychological comorbidity (18.7% vs 15.9% [P < 0.001; SMD 0.07]). Comorbidities included atopic dermatitis (patients with vitiligo vs general population 12.5% vs 8.4%), psoriasis (5.8% vs 3.6%), Hashimoto's thyroiditis (2.9% vs 1.1%), alopecia areata (2.2% vs 0.9%), depression (10.8% vs 9.5%), and sleep disorder/insomnia (5.9% vs 4.4%). Only 74.8% of all patients with vitiligo had ever received treatment, with topical corticosteroids (51.5%) and calcineurin inhibitors (36.5%) most commonly prescribed. At the end of 2021, 83.7% of patients were untreated.

CONCLUSION

Patients with vitiligo are more likely to have various immune-related and psychological comorbidities, highlighting the significant impact of the condition on well-being. Nearly a quarter of patients had never received treatment, with many receiving only topical treatments, and medication persistence was low. This highlights the lack of adequate treatment in this population and the need for more effective management options.

Identifying the genetic association between common rheumatic diseases and vitiligo

BACKGROUND

Although observational studies have suggested a correlation between vitiligo and rheumatic diseases, conclusive evidence supporting a causal relationship is still lacking. Therefore, this study aims to explore the potential causal relationship between vitiligo and rheumatic diseases.

METHODS

Using genome-wide association studies, we performed a two-sample Mendelian randomization (MR) analysis. In our analysis, the random-effects inverse variance weighted (IVW) method was predominantly employed, followed by several sensitivity analyses, which include heterogeneity, horizontal pleiotropy, outliers, and "leave-one-out" analyses.

RESULTS

The genetically predicted vitiligo was associated with an increased risk of rheumatoid arthritis (RA) (OR, 1.47; 95% confidence interval [CI], 1.29-1.68; p < 0.001), and systemic lupus erythematosus (SLE) (OR, 1.22; 95% CI, 1.06-1.39; p = 0.005). The causal associations were supported by sensitivity analyses. In Sjögren's syndrome and ankylosing spondylitis, no causal relationship with vitiligo was found in the study.

CONCLUSION

Our MR results support the causal effect that vitiligo leads to a higher risk of RA and SLE. Individuals with vitiligo should be vigilant for the potential development of RA and SLE. Managing and addressing this potential requires regular monitoring.

Disseminated Hypertrophic Discoid Lupus Erythematosus in a Patient with Vitiligo: A Case Report and Literature Review

Vitiligo has been reported to occur in association with lupus erythematosus (LE) and other autoimmune diseases. However, it remains unclear whether this association occurs because of shared immunopathogenesis. We hereby describe a case of discoid lupus erythematosus (DLE) in a 51-year-old man with a 3 years history of skin lesions on his face, arms, and the V zone of the neck, and with the coexistence of vitiligo for 12 years, who developed from DLE to hypertrophic discoid lupus erythematosus (HDLE) after 10 months. We reviewed the previously reported cases to summarize the clinical characteristics of these patients and hope it may provide a reference for dermatologists.

The causal relationship between vitiligo and autoimmune thyroid diseases: A bidirectional two-sample Mendelian randomization analysis

BACKGROUND

Vitiligo is an acquired autoimmune depigmented disorder characterized by the presence of white and well-defined patches on the skin, mucous membrane, or both. It is associated with a significant disease burden and has a profoundly impacts patients' quality of life. Autoimmune thyroid diseases (AITDs) result from an autoimmune system dysregulation, leading to an erroneous immune attack on the thyroid gland. Previous observational and epidemiological studies have suggested the association between vitiligo and AITDs. However, the bidirectional cause-effect relationship between vitiligo and AITDs has not been formally assessed.

METHOD

Two-sample bidirectional Mendelian randomization (MR) analysis was conducted to explore potential causal relationships between genetically increased risk of vitiligo and AITDs, using summary statistics from genome-wide association studies in European populations. Causal effects were primarily estimated using the inverse variance weighted method, and additional quality control was performed using the MR-Egger, weighted median, simple mode, and weight mode methods. Sensitivity analysis was conducted to assess the robustness of the results.

RESULTS

The forward MR analysis showed a positive causal relationship between vitiligo and autoimmune thyroiditis (AIT), autoimmune hyperthyroidism (AIH), and Graves' disease (GD). The odds ratio (OR) were 1.17 (95% CI, 1.01-1.35; p = 0.04), 1.12 (95% CI, 1.03-1.22; p = 0.01), and 1.13 (95% CI, 1.06-1.20; p < 0.01), respectively. In the reverse MR analysis, a positive causal relationship was found between AIT and vitiligo, with an OR of 1.10 (95% CI, 1.01-1.35; p = 0.04). However, no causal relationship was observed between AIH (p = 0.10) or GD (p = 0.61) and vitiligo. Sensitivity analysis revealed no evidence of horizontal pleiotropy or heterogeneity.

CONCLUSIONS

The genetic-level investigation provides evidence of a genetic causal association between susceptibility to vitiligo and an increased risk of AITDs. Additionally, the results demonstrate a genetic causal association between susceptibility to AIT and an increased risk of vitiligo, while not indicating a similar association with susceptibility to AIH or GD.

Clinico-Epidemiological Profile of Vitiligo Among Patients Attending a Tertiary Care Centre of North-East India

Objectives Vitiligo is a widespread cutaneous disorder. The present study aims to evaluate the epidemiologic profile of vitiligo and investigate its different clinical forms, disease activity, hereditary associations, triggering factors, and probable association with other diseases. Methods This prospective observational study was conducted over one year, from 2019 to 2020, and included 120 cases demonstrating definite clinical evidence of vitiligo. All selected patients underwent a detailed medical history interview. Specific enquiries were made regarding precipitating factors, clinical features of the disease, histories of other autoimmune diseases, and family histories. Thorough clinical, laboratory, and cutaneous examinations were performed on all patients. Descriptive statistical methods and diagrams were used to summarise the data. Results The age at presentation (31 patients, 25.8%) and the onset of the disease (32 patients, 26.6%) was predominantly in the second decade of life. The condition was usually progressive, with vitiligo vulgaris being the most prevalent type (56 cases, 46.7%). Disease onset (37 individuals, 30.8%) and the prevalence of lesions were higher in the lower leg. Body surface area involvement was ≤1% in 72 (60.0%) patients. Itching and trauma were the typical initiating factors. Leukotrichia in 38 (31.7%) cases, Koebner's phenomena in 23 (19.1%) cases, and a positive family history in 26 (21.7%) cases were observed. Thyroid dysfunction, hypertension, and various skin conditions are associated with the disease. Conclusion Vitiligo is more common in the young population. The condition is often progressive, with vitiligo vulgaris being the most common type. Itching and trauma are frequent initiating factors. Monitoring patients for associated diseases may be crucial for diagnosis and treatment outcomes.

Identification of Shared Biomarkers and Immune Infiltration Signatures between Vitiligo and Hashimoto's Thyroiditis

Background

Vitiligo and Hashimoto's thyroiditis (HT) are concomitant autoimmune diseases characterized by the destruction of melanocytes or thyrocytes. We aimed to explore the immunological mechanism of this comorbidity and screen their potential biomarkers.

Methods

We downloaded the microarray datasets from the GEO database. Differentially expressed genes (DEGs) and immune-related genes (IRGs) were selected. The immune-related differentially expressed genes (IRDEGs) were obtained by taking the intersection. Candidate biomarkers were elected by Cytoscape software. CIBERSORT was used to depict immune cell infiltration prospects. Correlation analysis was conducted between infiltrating cells and several indicators. The results were validated by real-time quantitative PCR (RT-qPCR).

Results

Three datasets and 60 IRDEGs were obtained in total. Pathway enrichment analysis showed that the T cell receptor signaling pathway, IL-17 signaling pathway, receptor-ligand activity, and signaling receptor activator activity were significantly enriched. We screened out four hub genes, including IFNG, STAT1, IL1B, and CXCL10. The ROC curve indicated the highest diagnostic value of CXCL10 in both vitiligo and HT. Immuno-infiltration analysis revealed significant changes in T cell subsets and macrophage subtypes, which were correlated with four hub genes, melanocyte markers, and thyroid-specific antigens. qPCR validated the hub genes in peripheral blood mononuclear cells from patients with comorbidity.

Conclusion

IFNG, STAT1, IL1B, and CXCL10, were the key IRDEGs to vitiligo and HT. These genes may participate in the comorbidity by remodeling the immune cell infiltration pattern, and cross-expressed antigens may mediate the common damage of melanocytes and thyroid tissues.

Ocular findings in vitiligo and recommendations for dermatologists

Since extracutaneous melanocytes in the eye may also be affected in vitiligo, a systematic review was conducted to explore the ocular manifestations of vitiligo. Studies point to a higher risk of ocular findings in periorbital vitiligo. Dry eye disease is the most reported ocular abnormality in vitiligo. Additionally, several small studies have found potential links to uveitis and glaucoma. Various other chorioretinal pigmentary changes are also reported, but without accompanying functional consequences or changes in vision. Although there is a need for larger studies to further elucidate these associations, dermatologists should be aware of potential ocular comorbidities in vitiligo and refer to ophthalmology accordingly.

Single-cell transcriptomics reveals peripheral immune responses in non-segmental vitiligo

Background

Vitiligo is a common autoimmune depigmented dermatology due to destruction of melanocytes. Much evidence suggests that vitiligo is associated with systemic immune activation. Previous studies have focused on immune cell infiltration in and around lesion areas, but few studies have investigated the cell types and function of circulating immune cells in peripheral blood. Here, single cell RNA-sequencing (scRNA-seq) was used to investigate the mechanisms of peripheral immune responses in vitiligo patients.

Methods

Peripheral blood was collected from five patients with progressive non-segmental vitiligo and three healthy controls. Peripheral blood mononuclear cells (PBMCs) were obtained by Ficoll-Paque density gradient centrifugation, and scRNA-seq was performed on isolated cell populations to obtain single cell transcriptomes and characterize important genes and intracellular signaling pathways. The key findings were validated with qPCR and flow cytometry assays.

Results

We identified 10 major cell types by scRNA-seq. Among these cell types, neutrophils were specifically observed in our scRNA-seq data from PBMCs. Peripheral blood effector CD8+ T cells from vitiligo patients did not show significant differences at the transcriptome level compared with healthy controls, whereas regulatory T cells showed pro-inflammatory TH1-like properties. Innate immune cells, including natural killer cells and dendritic cells, showed increased antigen processing and presentation as well as upregulated interferon responses. B cells, monocytes, and neutrophils all showed activation. B cells, especially memory B cells, had upregulated expression of genes related to humoral immunity. Monocytes showed production of proinflammatory cytokines and chemokines. Neutrophils showed strong chemokine ligand-receptor (L-R) pair (CXCR8-CXCR2) autocrine signaling pathway.

Conclusion

This study revealed the genetic profile and signaling pathway characteristics of peripheral blood immune cells in vitiligo patients, providing new insights into its pathogenesis, which may facilitate identification of potential therapeutic targets.

Association of vitiligo with multiple cutaneous and extra-cutaneous autoimmune diseases: a nationwide cross-sectional study

Previous studies found conflicting results about associations of vitiligo with different autoimmune diseases. To evaluate associations of vitiligo with multiple autoimmune diseases. A cross-sectional study representative of 612,084,148 US patients from the Nationwide Emergency Department Sample (NEDS) 2015-2019 was performed. Vitiligo and autoimmune diseases were identified using International Classification of Diseases-10 codes. The most frequent autoimmune disorders in patients with vitiligo were type 1 diabetes, rheumatoid arthritis, systemic lupus erythematosus (SLE), autoimmune thyroiditis, Addison's disease, and systemic sclerosis (SSc). Vitiligo was associated with any autoimmune disorder (adjusted odds ratio [95% confidence interval] 1.45 [1.32-1.58]). Cutaneous disorders with largest effect-sizes were alopecia areata (186.22 [115.31-300.72]) and SSc (32.13 [25.28-40.82]). Non-cutaneous comorbidities with largest effect-sizes were primary sclerosing cholangitis (43.12 [18.98-97.99]), pernicious anemia (41.26 [31.66-53.78]), Addison's disease (33.85 [26.68-42.9]), and autoimmune thyroiditis (31.65 [26.34-38.02]). Vitiligo is associated with multiple cutaneous and non-cutaneous autoimmune diseases, especially in females and older age.

Comorbidity Burden Among Patients with Vitiligo in the United States: A Large-Scale Retrospective Claims Database Analysis

INTRODUCTION

Vitiligo is often associated with comorbid conditions that may increase economic burden and affect patients' health-related quality of life. No large-scale study has been published to date using claims databases to evaluate the burden of comorbidities among patients with vitiligo. Herein, we evaluate the comorbidity burden among patients diagnosed with vitiligo from the US.

METHODS

This retrospective cohort analysis used the Merative MarketScan Commercial Database. Eligible patients were diagnosed with vitiligo between January 2008 and December 2020 and matched 1:4 (vitiligo:control) with control subjects with no diagnosis of vitiligo between January 2007 and December 2021. Study outcomes were the incidence of comorbidities after matching, adjusted hazard ratios of comorbidity incidence among patients with vitiligo relative to matched control subjects, and time to comorbidity diagnosis or incidence.

RESULTS

Baseline demographics were well balanced between matched vitiligo (n = 13,687) and control cohorts (n = 54,748). Incidence rates of comorbidities were higher among patients compared with control subjects (psychiatric, 28.4% vs 22.8%; autoimmune, 13.4% vs 5.1%; and non-autoimmune, 10.0% vs 7.0%). The most common psychiatric and autoimmune comorbidities in patients with vitiligo compared with control subjects included anxiety (14.3% vs 11.0%, respectively), sleep disturbance (9.1% vs 7.1%), depression (8.0% vs 6.3%), atopic dermatitis (3.1% vs 1.1%), psoriasis (2.7% vs 0.6%), and linear morphea (1.5% vs 0.1%). The risk of developing any psychiatric (hazard ratio 1.31; P < 0.01), autoimmune (hazard ratio 2.77; P < 0.01), or non-autoimmune (hazard ratio 1.45; P < 0.01) comorbidity was significantly higher among patients with vitiligo. Time to diagnosis of most vitiligo comorbidities was 1-3 years, although linear morphea was diagnosed at < 1 year.

CONCLUSION

Results of this retrospective analysis demonstrated that patients were much more likely to be diagnosed with autoimmune or psychiatric comorbidities following a vitiligo diagnosis, which likely contributed to increased economic burden and lower quality of life.

An extensive review of vitiligo-associated conditions

Vitiligo is an autoimmune disorder caused by the destruction of melanocytes in various body regions. Numerous diseases may accompany vitiligo. The prevalence of vitiligo varies among geographical regions and shows no relation to sex or age. However, vitiligo most commonly affects people aged 10 to 30 years. The clinical symptoms of vitiligo include irregular patches on the skin and various diseases associated with this disorder. The present review focuses on the clinical effects and risk factors of vitiligo-associated conditions and the current therapeutics for treating vitiligo. This systematic review was performed based on the PRISMA guidelines and articles published from 2000 to 2023 in several electronic databases (Web of Science, PubMed, PsycINFO, and others). The most clinically significant diseases associated with vitiligo are alopecia areata, autoimmune thyroid disease, Addison's disease, and type 1 diabetes mellitus. No targeted population is specifically prone to vitiligo; it does not affect any particular race or sex. Hence, awareness of the diseases associated with vitiligo is necessary to control them through various medical and surgical treatments with the proper facilities.

Clinical features of myasthenia gravis with neurological and systemic autoimmune diseases

Multiple reports on the co-existence of autoimmune diseases and myasthenia gravis (MG) have raised considerable concern. Therefore, we reviewed autoimmune diseases in MG to explore their clinical presentations and determine whether the presence of autoimmune diseases affects the disease severity and treatment strategies for MG. We reviewed all the major immune-mediated coexisting autoimmune conditions associated with MG. PubMed, Embase and Web of Science were searched for relevant studies from their inception to January 2023. There is a higher frequency of concomitant autoimmune diseases in patients with MG than in the general population with a marked risk in women. Most autoimmune comorbidities are linked to AChR-MG; however, there are few reports of MuSK-MG. Thyroid disorders, systemic lupus erythematosus, and vitiligo are the most common system autoimmune diseases associated with MG. In addition, MG can coexist with neurological autoimmune diseases, such as neuromyelitis optica (NMO), inflammatory myopathy (IM), multiple sclerosis (MS), and autoimmune encephalitis (AE), with NMO being the most common. Autoimmune diseases appear to develop more often in early-onset MG (EOMG). MS coexists more commonly with EOMG, while IM coexists with LOMG. In addition, MG complicated by autoimmune diseases tends to have mild clinical manifestations, and the coexistence of autoimmune diseases does not influence the clinical course of MG. The clinical course of neurological autoimmune diseases is typically severe. Autoimmune diseases occur most often after MG or as a combined abnormality; therefore, timely thymectomy followed by immunotherapy could be effective. In addition, thymoma-associated AChR MG is associated with an increased risk of AE and IM, whereas NMO and MS are associated with thymic hyperplasia. The co-occurrence of MG and autoimmune diseases could be attributed to similar immunological mechanisms with different targets and common genetic factor predisposition. This review provides evidence of the association between MG and several comorbid autoimmune diseases.

Incidence and Prevalence of Diagnosed Vitiligo According to Race and Ethnicity, Age, and Sex in the US

Importance

Vitiligo has substantial psychosocial consequences. Yet its burden is poorly established.

Objective

To estimate incidence and prevalence of diagnosed vitiligo across age, sex, and racial and ethnic subgroups in the US.

Design, Setting, and Participants

This analysis comprising a cohort study and cross-sectional study included electronic health records for health care-seeking children, adolescents, and adults across 4 US census regions. Data for the incidence analysis were obtained from January 1, 2015, through December 31, 2019, and data for the prevalence analysis were obtained from January 1 through December 31, 2019. Data were analyzed from December 13, 2022, to June 8, 2023.

Main Outcomes and Measures

The main outcomes were incidence (per 100 000 person-years [PY]) and prevalence of diagnosed vitiligo overall and by age, race and ethnicity, and sex.

Results

A total of 2 980 778 patients with vitiligo were included in the incidence analysis (mean [SD] age, 41.5 [24.0] years; 57.0% female; 1.4% Asian American; 12.9% Black; 1.5% Hispanic/Latino; 77.3% White; 6.9% other or multiracial) and 1 057 534 in the prevalence analysis (mean [SD] age, 43.4 [24.7] years; 57.5% female; 1.7% Asian American, 14.7% Black, 1.4% Hispanic/Latino; 75.7% White; 6.6% other or multiracial). Age- and sex-adjusted overall incidence rate (IR) of diagnosed vitiligo was 22.6 per 100 000 PY (95% CI, 21.5-23.8 per 100 000 PY), and prevalence was 0.16% (95% CI, 0.15%-0.17%). Sex-adjusted IR was highest among patients aged 60 to 69 years (25.3 per 100 000 PY; 95% CI, 22.2-28.6 per 100 000 PY), and prevalence was highest among patients aged 70 years or older (0.21%; 95% CI, 0.19%-0.23%). The highest age-adjusted IR was observed among Asian American patients (41.2 per 100 000 PY; 95% CI, 28.2-58.2 per 100 000 PY), followed by Hispanic/Latino patients (37.3 per 100 000 PY; 95% CI, 25.7-52.4 per 100 000 PY), patients reporting other or multiple races (31.1 per 100 000 PY; 95% CI, 25.9-37.1 per 100 000 PY), Black patients (29.6 per 100 000 PY; 95% CI, 26.0-33.6 per 100 000 PY), and White patients (18.7 per 100 000 PY; 95% CI, 17.5-20.0 per 100 000 PY). The highest age-adjusted prevalence was observed among Hispanic/Latino patients (0.29%; 95% CI, 0.20%-0.39%), followed by Asian American patients (0.27%; 95% CI, 0.19%-0.35%), patients reporting other or multiple races (0.24%; 95% CI, 0.20%-0.28%), Black patients (0.22%; 95% CI, 0.19%-0.24%), and White patients (0.13%; 95% CI, 0.12%-0.14%).

Conclusions and Relevance

This cross-sectional study found that vitiligo diagnosis was more common in older patients, Hispanic/Latino patients, and Asian American patients.

Automated Mass Screening for Comorbidities of Vitiligo Using the National Health Insurance Database

Although the study design for identifying specific disease associations using a health insurance database has been well-established, few studies explore unknown comorbidities. We conducted a series of automated case-control studies for all International Classification of Disease, Tenth Revision, Clinical Modification diagnostic codes (A01-Z99) using the Korean National Health Insurance database from 2007 to 2017 to reveal undiscovered disease associations of vitiligo. A total of 90,297 patients with vitiligo and 90,297 age- and sex-matched controls without vitiligo were included, and disease associations for 1,265 relevant diagnostic codes were screened. A meta-analysis of the individual ORs for each International Classification of Disease, Tenth Revision code was performed to identify the possibility of selection bias. Finally, the association with vitiligo was significantly increased in 45 diseases and decreased in 6 diseases. We not only reaffirmed the positive correlation between vitiligo and other autoimmune diseases but also observed associations with obsessive-compulsive disorder and melanoma. In contrast, femur fracture showed a negative correlation. In this study, we attempted an automated mass screening and suggested a possible selection bias. In the era of large-scale databases, a systematic and comprehensive approach might be needed.

Validation of medical service insurance claims as a surrogate for ascertaining vitiligo cases

The epidemiology of vitiligo, especially its disease burden on the healthcare system, can be assessed indirectly by analyzing health insurance claims data. Validating this approach is integral to ensuring accurate case identification and cohort characterization. The primary aim of this study was to develop and validate an indirect measure of vitiligo ascertainment using health insurance claims data. These data were used secondarily to identify demographic characteristics, body site involvement, vitiligo subtypes, disease associations, and treatments. This study assessed the validity of identifying vitiligo from billing claims within a Canadian provincial universal health insurance program, versus vitiligo cases accrued from direct medical chart reviews. Claims-based algorithms combining ICD-9-CM diagnostic code 709 with treatment-specific data were derived and tested to identify vitiligo patients. This was compared against cases arising from the manual review of medical records of 606 patient with a diagnostic code for "dyschromia" (ICD-9-CM diagnostic code 709) from January 1 to December 31, 2016. Based on the chart reviews, 204 (33.7%) patients were confirmed to have vitiligo. 42 separate claims-based algorithms combining ICD-9-CM diagnostic code 709 with treatment data specific to vitiligo were modeled and individually tested to evaluate their accuracy for vitiligo ascertainment. One algorithm achieved a sensitivity, specificity, PPV and NPV of 86.8% (95% CI 82.1-91.4), 92.5% (95% CI 90.0-95.1), 85.5% (95% CI 80.7-90.3), and 93.2% (95% CI 90.8-95.7), respectively. There was a 2.2 female-to-male ratio. The most common medical treatments were tacrolimus (74.5%) and topical corticosteroids (54.3%). Hypertension (24.2%) and hypothyroidism (19.6%) were the predominant co-morbidities associated with vitiligo. Health insurance claims data can be used to indirectly ascertain vitiligo for epidemiologic purposes with relatively high diagnostic performance between 85.5 and 93.2%.

Ocular manifestations of vitiligo: a systematic review

Vitiligo is a disorder characterized by loss of epidermal melanocytes, resulting in depigmented macules and patches. While the relationship between ocular pathology and vitiligo has been demonstrated in conditions such as Vogt-Koyanagi-Harada and Alezzandrini syndromes, the ocular associations of non-syndromic vitiligo are incompletely understood. We conducted a systematic review to comprehensively describe the structural and functional changes seen in the eyes of patients with vitiligo, to identify patients at heightened risk for ocular disease, and to provide an approach to management of ocular manifestations of vitiligo. Overall, the strongest link between vitiligo and ocular pathology seems to lie with dry eye disease and pigmentary abnormalities of various ocular structures, especially the retinal pigment epithelium. Normal-tension glaucoma may also be more prevalent in the vitiligo population. The available literature did not provide conclusive evidence for increased risk of cataracts or uveitis. Aside from the impact of symptomatic dry eye disease, it seems unlikely that there are significant functional consequences of these ocular manifestations such as impaired visual acuity or visual fields.

Experimental approaches to assess melanocytes mosaicism in segmental vitiligo

Vitiligo is an autoimmune disease of the skin that results in localized or disseminated white macules. One common feature of several existing classification protocols is the distribution of the disease into two main subtypes, non-segmental vitiligo (NSV) and segmental vitiligo (SV). SV is characterized by depigmentation spreading within one or more skin segments while NSV is widespread. Several clinical-epidemiological observations suggest that SV has distinct autoimmune pathophysiology compared to NSV. Furthermore, the clinical distribution pattern of SV lesions closely resembles other melanocyte mosaicism diseases. These observations led us to hypothesize that SV is caused by a localized autoimmune reaction targeting epidermal mosaicism melanocytes. Here, we proposed examples of experimental approaches to assess mosaicism in SV patients.

Primary Neurologic Symptoms: Have You Considered Pernicious Anemia?

BACKGROUND

Vitamin B12, or cobalamin, is a nutrient that is vital for metabolic function. Absorption of ingested B12 is dependent on intrinsic factor, which is secreted by parietal cells within the stomach. Pernicious anemia is caused by an intrinsic factor deficiency or autoantibodies against intrinsic factor. The presence of parietal cell antibodies can destroy parietal cells, which can also lead to a deficiency in intrinsic factor. Both lead to megaloblastic anemia caused by vitamin B12 deficiency. The typical presentation of pernicious anemia includes fatigue, pale appearance, tingling sensation, depression, alterations to vision and smell, urinary incontinence, psychotic episodes, and weakness. The most effective treatment for pernicious anemia is intramuscular B12.

CASE REPORT

A 27-year-old woman with a history of vitiligo presented to the emergency department (ED) with bilateral lower extremity weakness, clumsiness, numbness, and tingling. Physical examination revealed ataxia, no sensation below her umbilicus, decreased strength, and hyperreflexia in both lower extremities. Complete blood count in the ED revealed low hemoglobin and hematocrit and elevated mean corpuscular volume, concerning for pernicious anemia. Further laboratory testing upon inpatient admission revealed a low vitamin B12 level and parietal cell antibodies in the blood. The patient's pernicious anemia was treated with intramuscular vitamin B12 injections, which led to near complete resolution of her symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Early suspicion and detection of pernicious anemia in the ED can prevent serious and permanent hematologic and neurologic damage and the development of other autoimmune disorders.

Beyond skin white spots: Vitiligo and associated comorbidities

Vitiligo is a common depigmentation disorder of an unknown origin characterized by the selective loss of melanocytes, resulting in typical white macules and patches. However, vitiligo is now recognized as more than just a skin disease, what a dermatologist observes as a white spot of skin is just the "tip of the iceberg" of the condition. We attempt to clarify the classification of comorbidities associated with vitiligo from various reviews and reports, and describe their possible pathogenesis. In conclusion, the literature provides evidence of an association between vitiligo and ocular and auditory abnormalities, autoimmune disorders, other dermatological diseases, metabolic syndrome and related disorders, and psychological diseases. These associations highlight the importance of a multidisciplinary approach in managing vitiligo patients.

Predicting the risk of autoimmune thyroid disease in patients with vitiligo: Development and assessment of a new predictive nomogram

BACKGROUND

This study aimed to develop an autoimmune thyroid disease (AITD) risk prediction model for patients with vitiligo based on readily available characteristics.

METHODS

A retrospective analysis was conducted on the clinical characteristics, demographics, skin lesions, and laboratory test results of patients with vitiligo. To develop a model to predict the risk of AITD, the Least Absolute Shrinkage and Selection Operator (LASSO) method was used to optimize feature selection, and logistic regression analysis was used to select further features. The C-index, Hosmer-Lemeshow test, and decision curve analysis were used to evaluate the calibration, discrimination ability and clinical utility of the model. Internally, the model was verified using bootstrapping; externally, two independent cohorts were used to confirm model accuracy.

RESULTS

Sex, vitiligo type, family history of AITD, family history of other autoimmune disease, thyroid nodules or tumors, negative emotions, skin involvement exceeding 5% of body surface area, and positive immune serology (IgA, IgG, IgM, C3, and C4) were predictors of AITD in the prediction nomogram. The model showed good calibration and discrimination (C-index: 0.746; 95% confidence interval: 0.701-0.792). The accuracy of this predictive model was 74.6%.In both internal validation (a C-index of 1000 times) and external validation, the C-index outperformed (0.732, 0.869, and 0.777). The decision curve showed that the AITD nomogram had a good guiding role in clinical practice.

CONCLUSION

The novel AITD nomogram effectively evaluated the risk of AITD in patients with vitiligo.

Hashimoto's thyroiditis, vitiligo, anemia, pituitary hyperplasia, and lupus nephritis-A case report of autoimmune polyglandular syndrome type III C + D and literature review

Objective

This study aims to summarize the clinical characteristics of one teenager with autoimmune polyglandular syndrome (APS) type III C + D to improve the understanding of APS III C + D and its effect of thyroid function.

Methods

This article reported the clinical manifestations, laboratory examinations, treatment methods, and outcomes of an adolescent with anemia admitted to the Pediatrics Department of Tianjin Medical University General Hospital in July 2020 and reviewed the literature.

Results

A girl, aged 13 years and 1 month, was admitted to the hospital due to anemia for more than 4 years and episodic abdominal pain for 1 week. Four years ago, the girl went to a local hospital for "vitiligo", and a routine blood test revealed anemia. The lowest hemoglobin (HGB) was 61 g/L, and the blood test revealed iron deficiency anemia. She had no menstrual cramps for 2 months. Urine routine showed protein 3+∼4+ and 258 red blood cells (RBCs)/high-power field. Urine protein was 3,380 mg/24 h. Free thyroxine was low, thyroid-stimulating hormone was >100 uIU/ml, thyroid peroxidase antibody was >1,000 IU/ml, and thyroglobulin antibody and thyrotropin receptor antibody were negative. Pituitary magnetic resonance imaging showed a mass in the sellar region with a uniform signal and a maximum height of about 15.8 mm. The result of the antinuclear antibody was 1:80 homogeneous type, and anti-dsDNA and anticardiolipin antibodies IgA and IgM were slightly higher. Thyroxine and iron were given for 1 month, menstruation resumed, and urine protein and RBC count decreased. After 5 months of treatment, free thyroid function, HGB, RBCs in urine, and pituitary returned to normal. Later, a renal biopsy showed changes in focal proliferative glomerulonephritis, and the girl was diagnosed with lupus glomerulonephritis type III. After 3 days of shock therapy with methylprednisolone, prednisone, mycophenolate mofetil, and other treatments were administrated for 1 year. At the time of writing, urine protein was 280 mg/24 h.

Conclusion

Co-occurrence of Hashimoto's thyroiditis, vitiligo, anemia, pituitary hyperplasia, and lupus nephritis is rare. It is very important to pay attention to the screening of thyroid function.

Vitiligo-Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review

In most dermatological pathologies, the phenomena observed on the skin are a reflection of internal disorders. In patients with associated acral involvement on the dorsal sides of the hands, this "vitiligo phenotype" may lead to the investigation of certain associated pathologies that sometimes have no obvious clinical impact. To assess the link between skin depigmentation and autoimmune pathologies, we conducted a systematic review involving article selection from the PubMed database. Patients with coexisting thyroid pathologies were found to have a predisposition for developing acral vitiligo and depigmentation of the wrists, and autoimmune thyroid pathologies appeared to be the only coexisting autoimmune or inflammatory diseases in vitiligo patients to show a pattern of distribution. The association of concomitant thyroid dysfunction with depigmentation of the hands was found to be so strong that the absence of depigmented macules on the hands may exclude the coexistence of an autoimmune thyroid pathology. Although the frequency of acral involvement in patients with vitiligo and autoimmune pathologies is higher, the mechanism by which thyroid dysfunction influences this distribution pattern remains incompletely elucidated and requires future studies.

Different vitiligo characteristics as predictors of increased risk of metabolic syndrome and insulin resistance: A case-control study

BACKGROUND

Autoimmune and metabolic disturbances have been reported in association with vitiligo, highlighting possible systemic associations that should be considered.

AIMS

To assess the possible association of metabolic syndrome (MetS) as well as insulin resistance (IR) with vitiligo in different age groups.

METHODS

This case-control study included 142 patients with vitiligo aging ≥ 6 years and 142 age- and sex-matched controls. Participants were assessed for MetS using the International Diabetes Federation (IDF) criteria in addition to IR via homeostasis model assessment of IR (HOMA-IR). The study was registered at Clinical Trials.gov, Identifier: NCT03622320, on August 9, 2018.

RESULTS

As per the IDF criteria, patients with vitiligo showed significantly more frequent association with high fasting plasma glucose levels, high blood pressure readings, central obesity, dyslipidemia, and MetS than controls (p = 0.020, p = 0.034, p = 0.014, p < 0.001, and p = 0.002, respectively). Moreover, patients with vitiligo have significantly higher levels of fasting insulin and HOMA-IR (p ≤ 0.001). Results obtained from patients with vitiligo and controls with coexistent MetS/IR demonstrated vitiligo as a risk factor for both MetS and IR. Univariate and multivariate logistic regression highlighted that older age was the significant independent predictor for MetS and IR.

CONCLUSION

Patients with vitiligo showed a significantly higher incidence of MetS than controls. Vitiligo per se can be considered a risk factor for MetS and IR. Therefore, regular follow-up and early metabolic derangement diagnoses are mandatory.

Comorbidities in Patients with Vitiligo: A Systematic Review and Meta-Analysis

Vitiligo has been reported to be associated with a variety of diseases, but it has not been systematically reviewed. Therefore, we aimed to identify prevalent diseases in patients with vitiligo and quantify their associations compared with those in healthy controls. A comprehensive search of MEDLINE and EMBASE from the inception to June 2022 was conducted. Observational studies on prevalent diseases in patients with vitiligo compared with those in healthy controls were included, whereas studies limited to pediatrics or providing only laboratory results were excluded. A total of 78 studies were eligible for analyses. Patients with vitiligo showed higher risks of having comorbid autoimmune and connective tissue diseases, including alopecia areata (OR = 2.63, 95% confidence interval [CI] = 2.50‒2.78), discoid lupus erythematosus (OR = 2.54, 95% CI = 1.74‒3.72), Sjogren's syndrome (OR = 2.50, 95% CI = 1.98‒3.16), myasthenia gravis (OR = 2.30, 95% CI = 1.74‒3.02), systemic lupus erythematosus (OR = 1.96, 95% CI = 1.52‒2.52), and rheumatoid arthritis (OR = 1.82, 95% CI = 1.55‒2.15). Thyroid diseases, diabetes mellitus, metabolic syndrome, sensorineural hypoacusis, and ophthalmic abnormalities were also more prevalent in patients with vitiligo. In conclusion, vitiligo is associated with various systemic diseases. Physicians should evaluate and manage potential comorbid conditions in patients with vitiligo.

Inflammatory bowel disease and immune-mediated inflammatory diseases: looking at the less frequent associations

Patients with inflammatory bowel disease (IBD) often have other immune-mediated inflammatory diseases (IMIDs), and the prevalence of any IMID is higher in IBD patients than in the general population. IBD and other IMIDs involve alterations in innate and adaptive immune responses. Their co-occurrence depends on shared immune and inflammatory processes, pathogenic mechanisms, and genetic and environmental risk factors, including drugs, especially tumor necrosis factor inhibitors. The more common IMIDs associated with IBD have been widely described, so this review focuses on the less frequent associations. The IMIDs discussed here are skin disorders (psoriasis, atopic dermatitis, vitiligo, epidermolysis bullosa acquisita, cutaneous polyarteritis nodosa, and hidradenitis suppurativa), hepato-pancreatic diseases (autoimmune hepatitis, granulomatous hepatitis, and autoimmune pancreatitis), endocrine diseases (autoimmune thyroid diseases, and type 1 diabetes mellitus), multiple sclerosis, and respiratory diseases (asthma, bronchiectasis, and interstitial pneumonia). The early detection of IMIDs in IBD patients is important to prevent their deleterious clinical course and limit their psychological impact. Care for IBD patients with IMIDs should be multispecialist, with a single therapeutic strategy instead of treating each disease separately.

Ocular Abnormalities in Patients with Vitiligo: A Systematic Review and Meta-Analysis

BACKGROUND

Vitiligo is a skin depigmentation disorder that results from the autoimmune destruction of cutaneous melanocytes. Several ocular abnormalities, including uveitis, dry eye, glaucoma, and retinal diseases, have been reported in patients with vitiligo. The aim of our study was to investigate the association of ocular abnormalities with vitiligo.

METHODS

This meta-analysis was registered in PROSPERO (CRD42021224167) and adhered to MOOSE checklist and PRISMA guidance for all processes. PubMed, Embase, Web of Science, and Cochrane databases were searched for studies examining the association between ocular abnormalities and vitiligo from inception to December 10, 2020. Studies recruiting patients with Sjogren's syndrome or Vogt-Koyanagi-Harada syndrome were excluded. The primary outcomes were the Schirmer test, tear film break-up time (TBUT), and ocular surface disease index (OSDI) of vitiligo patients compared to the controls. The risk of bias of the selected studies was assessed using the Newcastle-Ottawa Scale (NOS) of case-control studies.

RESULTS

This meta-analysis of 16 case-control studies showed that patients with vitiligo had significantly lower Schirmer test values (mean difference [MD], -1.65; 95% CI, -2.81 to -0.49), shorter TBUTs (MD, -4.66; 95% CI, -7.05 to -2.26), higher ocular surface disease indices (MD, 18.02; 95% CI, 5.7-30.35), and thinner subfoveal choroidal thicknesses (MD, -53.10; 95% CI, -69.84 to -36.36). No significant differences were found in the prevalence of glaucoma and the level of intraocular pressure.

CONCLUSIONS

Our study supports an association between dry eye and thinner subfoveal choroidal thickness in patients with vitiligo. Dermatologists should be aware of these possible comorbidities and refer vitiligo patients with ocular symptoms to ophthalmologists for further management.