Comorbid Autoimmune Diseases More Prevalent in People With Vitiligo

Patients with vitiligo — especially older individuals and women — have an increased prevalence of comorbid autoimmune diseases compared with the general population, according to study results published in the Archives of Dermatological Research.

Researchers assessed the association of vitiligo with autoimmune and inflammatory diseases by evaluating 2015 to 2019 Nationwide Emergency Department Sample (NEDS) data from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality.

They conducted a large cross-sectional study and searched for a primary or secondary diagnosis of vitiligo and 38 autoimmune and inflammatory comorbidities based on International Classification of Diseases, Tenth Revision, Clinical Modification codes. The control group included all patients without a diagnosis of vitiligo presenting to the emergency department (ED) during the study period.

Among 612,084,148 adult and pediatric ED visits, 39,173 (6.4 per 100,000 visits) patients had a diagnosis of vitiligo (mean age, 52.3±0.46 years; 51.7% female). A total of 17.7% of patients with vitiligo had at least 1 autoimmune disease, and 273 (0.69%) patients had 3 or more autoimmune diseases. Type 1 diabetes (4.5%), rheumatoid arthritis (2.8%), and systemic lupus erythematosus (SLE, 2.5%) were the most common autoimmune comorbidities in patients with vitiligo.

Vitiligo had a significant association with any autoimmune disorder in multivariable models that controlled for age, sex, and insurance status (adjusted odds ratio [aOR], 1.45; 95% CI, 1.32-1.58). Patients with vitiligo had significantly higher odds (aOR, 39.10; 95% CI, 29.43-51.94) of having 3 or more comorbid autoimmune diseases vs patients without vitiligo.

Vitiligo had a strong association with several cutaneous autoimmune diseases, including alopecia areata (aOR, 186.22; 95% CI, 115.31-300.72), systemic sclerosis (SSc; aOR, 32.13; 95% CI, 25.28-40.82), and pyoderma gangrenosum (aOR, 8.07; 95% CI, 2.99-21.75). A strong association also was found for primary sclerosing cholangitis (aOR, 43.12; 95% CI, 18.98-97.99), pernicious anemia (aOR, 41.26; 95% CI, 31.66-53.78), Addison disease (aOR, 33.85; 95% CI, 26.68-42.9), and autoimmune thyroiditis (aOR, 31.65; 95% CI, 26.34-38.02).

Multiple sclerosis, myasthenia gravis, polymyositis and dermatomyositis, thyroiditis in general, and giant cell arteritis were among other autoimmune diseases found to be associated with vitiligo.

In multivariable models that assessed associations of demographics with the 10 most common autoimmune comorbid diseases with vitiligo, female sex was associated with increased prevalence of SLE (aOR, 3.87; 95% CI, 2.66-5.64), Sjögren syndrome (aOR, 4.45; 95% CI, 1.97-10.07), scleroderma (aOR, 4.2; 95% CI, 2.28-7.75), rheumatoid arthritis (aOR, 3.39; 95% CI, 2.4-4.8), and autoimmune thyroiditis (aOR, 2.20; 95% CI, 1.48-3.27).

SLE, Sjögren syndrome, SSc, rheumatoid arthritis, and pernicious anemia were associated with increasing age. Patients who had at least 3 autoimmune diseases were more likely to be female (aOR, 2.22; 95% CI, 1.26-3.91), although no association was found for age.

Among several limitations, NEDS likely includes patients with more severe vitiligo and comorbid diseases compared with the general population. In addition, data were unavailable for vitiligo severity, phenotypes, chronicity, longitudinal course, age of onset, and treatment history.

“Multiple autoimmune diseases affecting the skin, endocrine, digestive, hematologic, and musculoskeletal systems were increased in patients with vitiligo,” the researchers concluded. They added, “These associations require confirmation. Mechanisms and specific risk factors for concomitant autoimmune disease in vitiligo need to be identified, and strategies to screen and monitor for them need to be developed.”