Comorbidities in Vitiligo

Vitiligo is a chronic, acquired pigmentary disorder characterized by the progressive loss of function or destruction of melanocytes in the skin, hair follicles, and mucous membranes.¹ It is the most common hypopigmentary disorder, affecting 0.5% to 2% of the global population, with no predilection for age or gender.² Although its pathophysiology is still debated, proposed mechanisms include autoimmunity, genetic predisposition, and oxidative stress.² Vitiligo is classified into nonsegmental and segmental types, distinguished by the distribution pattern of depigmentation and disease progression over a patient’s lifetime.³ Once considered a disease limited to the skin, vitiligo is now known to be associated with several systemic disorders. In this article, part of a series on comorbidities associated with immune-mediated skin diseases, we explore the comorbidities associated with vitiligo (see Table).

Autoimmune Conditions

Among the proposed pathogenic theories, the autoimmune theory is the most plausible. Comorbid autoimmune conditions occur more frequently in patients with vitiligo compared with the general population. Involvement of the inner ear and the eyes, as well as response to immunosuppressive therapy, further support the autoimmune basis of vitiligo. The prevalence of comorbid autoimmune conditions in vitiligo ranges from approximately 3% in reports from India to 55% in reports from Turkey. Prevalence rates in North America are reportedly 19% to 30%. This prevalence variation depends widely on the study population.¹

The most common comorbid autoimmune condition is autoimmune thyroid disorder, with a prevalence ranging from 2% to 37% among patients with vitiligo, compared with 1% in the general population.¹ Other associated autoimmune conditions include type 1 diabetes mellitus, alopecia areata, connective tissue disorders (eg, discoid lupus erythematosus, Sjögren’s syndrome, myasthenia gravis, systemic lupus erythematosus, rheumatoid arthritis), pernicious anemia, and inflammatory bowel disease.¹ Screening for autoimmune conditions is an essential component of vitiligo management in both adult and pediatric patients.

Psychosocial Comorbidities

Psychosocial comorbidities and social stigmatization are also notably prevalent among patients with vitiligo.⁵ A variety of psychiatric conditions, including but not limited to body dysmorphic disorder, adjustment disorder, impulse control disorder, suicide and intentional self-inflicted injury, and attention-deficit/hyperactivity disorder have been reported among patients with vitiligo to occur more commonly than in the general population.⁴ Obsessive-compulsive disorder leading to scratching behaviors that induce or worsen vitiligo has also been reported. A Canadian study found a statistically significant increase in depression among patients with vitiligo, although data on anxiety have been inconsistent.⁶ Addressing psychosocial comorbidities is an integral part of vitiligo management.

Integumentary Disorders

An increased prevalence of other integumentary disorders, including psoriasis and atopic dermatitis, has been observed in patients with vitiligo. Some studies have also noted a higher prevalence of melanoma, although findings have been inconsistent. Variability in reported melanoma risk may be due to racial and genetic differences, as well as cultural practices such as sun exposure.⁴

Ocular and Auditory Abnormalities

Ocular and auditory abnormalities have also been reported in association with vitiligo in various syndromes, possibly due to the role of melanocytes in these organs. Retinal pigment epithelium changes and sensorineural hypoacusis have been reported to be statistically significantly higher in patients with vitiligo compared with controls.⁴ Studies on these comorbidities are limited, and more research is needed to make recommendations for routine screening for these conditions in patients with vitiligo.

Metabolic Abnormalities

A meta-analysis found no significant association between vitiligo and metabolic abnormalities. Proposed explanations for this observation include the autoimmune pathogenesis of vitiligo, rather than the inflammatory pathogenesis encountered in psoriasis or similar conditions. Additionally, long-term phototherapy for the treatment of vitiligo may contribute to the reduced inflammatory burden in these patients. Hypertension, hyperlipidemia, and obesity have not been observed to be clinically or statistically linked to vitiligo.⁴

Pregnancy Outcomes

Vitiligo can affect pregnancy outcomes, as do most other autoimmune-mediated diseases. Higher rates of miscarriage were reported in patients with vitiligo in a meta-analysis. An increase in Th1 and Th17 cells in the blood is found in women with recurrent miscarriages as well as in those with vitiligo. The authors postulated that this increase could be contributing to higher miscarriage rates.⁷ Most women reported either stabilization or improvement of vitiligo during pregnancy.⁸

Understanding the prevalence of comorbid conditions in vitiligo is vital for both patient care and for further understanding the pathogenesis of this condition. Despite its autoimmune nature, the association with metabolic abnormalities appears to be less significant in patients with vitiligo compared with other disorders such as psoriasis and hidradenitis suppurativa. Other autoimmune conditions have been found to have a strong association with vitiligo, including autoimmune thyroid disease and various integumentary and connective tissue disorders. Further research into vitiligo comorbidities may guide management and deepen understanding of its pathophysiology. 

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2. Hu Z, Wang T. Beyond skin white spots: vitiligo and associated comorbidities. Front Med (Lausanne). 2023;10:1072837. doi:10.3389/fmed.2023.1072837

3. Ezzedine K, Lim HW, Suzuki T, et al. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res. 2012;25(3):E1-E13. doi:10.1111/j.1755-148X.2012.00997.x

4. Lee JH, Park KH, Kim BJ, et al. Comorbidities in patients with vitiligo: a systematic review and meta-analysis. J Invest Dermatol. 2023;143(5):777-789.e6. doi:10.1016/j.jid.2022.11.038

5. Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol. 2021;22(6):757-774. doi:10.1007/s40257-021-00618-4

6. Ringuet J, Pirbhai A, Draelos ZD, et al. Burden of vitiligo in Canada: retrospective analysis of a Canadian public claims database. J Cutan Med Surg. 2025;29(3):234-242. doi:10.1177/12034754241253243

7. Lima de Oliveira LM, Balieiro CCA, Hespanhol LC, Wantowski S, Reis IA, Pitombeira VG, Olavarria-Bernal D, Qureshi AA. The impact of vitiligo on pregnancy and perinatal outcome: a systematic review and meta-analysis. Br J Dermatol. 2023;189(2):228-230. doi:10.1093/bjd/ljaf266

8. Abdelhafez MMA, Mohamed AM, Elghazaly EA, et al. Vitiligo and pregnancy: how do each affect the other? Ann Med Surg (Lond). 2021;70:102833. doi:10.1016/j.amsu.2021.102833