Multivariate analysis of factors associated with early-onset segmental and nonsegmental vitiligo: a prospective observational study of 213 patients

Background Although mixed forms have been described recently, segmental (SV) and nonsegmental vitiligo (NSV) are considered as clinically distinct. However, limited epidemiological data are available to help distinguish associated factors, and recent genome‐wide association studies have been restricted to NSV. The higher prevalence of SV in children is helpful when comparing the two major presentations of the disease. Objective To compare factors associated with SV and NSV, especially for markers of autoimmunity or autoinflammation. Methods We conducted a single‐centre prospective observational study in patients aged 17 years or under with a confirmed diagnosis of SV or NSV at the vitiligo clinic between 1 January 2006 and 1 July 2010. The Vitiligo European Task Force questionnaire was completed for each patient, and thyroid function and antithyroid antibodies were screened if not obtained in the previous year. Other forms of vitiligo (focal, mucosal, not classifiable) were excluded. Results A total of 213 children were included, 142 with NSV, 59 with SV and 12 with mixed vitiligo. There was no significant statistical difference for sex or age at onset between patients with SV and NSV. Halo naevi were significantly more frequent in NSV than in SV [odds ratio (OR) 7·58, P < 0·01). Patients with NSV more frequently had a positive family history of vitiligo (OR 2·25, P = 0·02) and a marked familial autoimmunity background (OR 2·22, P = 0·01). Conclusions Our study clearly shows that features of inflammation (pruritus)/autoimmunity (halo naevi, thyroid antibodies) are strongly linked to NSV, together with a familial background of vitiligo and autoimmunity.     

Halo naevi and leukotrichia are strong predictors of the passage to mixed vitiligo in a subgroup of segmental vitiligo

Background Until now, segmental vitiligo has been considered as a stable entity and mixed vitiligo, the association of segmental and nonsegmental vitiligo, has been reported rarely. Objectives The aim of this study was to search for factors associated with the generalization of vitiligo in patients with segmental vitiligo. Patients and methods This was a prospective observational study conducted in the vitiligo clinic of the Department of Dermatology of Bordeaux, France. The Vitiligo European Task Force questionnaire was completed for each patient attending the clinic with a confirmed diagnosis of segmental vitiligo after exclusion of other forms of vitiligo (focal, mucosal, not classifiable.) Thyroid function and antithyroid antibodies were screened if not obtained in the previous year. Results One hundred and twenty‐seven patients were recruited: 101 had segmental vitiligo and 26 had segmental vitiligo that evolved into mixed vitiligo; 56 were male and 71 were female. Most patients had onset of segmental vitiligo before the age of 18. When conducting multivariate analysis, we found the following to be independent factors associated with the evolution of patients’ disease from segmental vitiligo to mixed vitiligo: initial percentage of body surface involvement of the segment > 1% [odds ratio (OR) 15·14, P = 0·002], the presence of halo naevi (OR 24·82, P = 0·0001) and leukotrichia (OR 25·73, P = 0·0009). Conclusions Halo naevi association and leukotrichia at first consultation in segmental vitiligo are risk factors for the progression of segmental vitiligo to mixed vitiligo. In addition, this progression of segmental vitiligo to mixed vitiligo carries a stronger link if initial segmental involvement is situated on the trunk.     

Comorbidities in vitiligo: comprehensive review

Vitiligo is a common skin disorder characterized by idiopathic, progressive cutaneous hypomelanosis. Vitiligo is associated with several comorbid autoimmune, systemic, and dermatological diseases, primarily thyroid disease, alopecia areata, diabetes mellitus, pernicious anemia, systemic lupus erythematosus, rheumatoid arthritis, Addison's disease, inflammatory bowel disease, Sjögren's syndrome, dermatomyositis, scleroderma, ocular and audiological abnormalities, psoriasis, and atopic dermatitis. It is essential to increase awareness of these comorbidities in order to improve the disease burden and quality of life of patients with vitiligo. Herein, we review the association with the most frequent comorbidities associated with vitiligo.     

Autoimmune thyroid disease in vitiligo: multivariate analysis indicates intricate pathomechanisms

Background Vitiligo/nonsegmental vitiligo (NSV) is often associated with thyroid dysimmunity although very few reports have studied this association using multivariate logistic regression. Objective To identify weighted factors associated with the presence of autoimmune thyroid disease (AITD) in a large cohort of patients with vitiligo/NSV. Methods This was a prospective observational study in 626 patients with a confirmed diagnosis of vitiligo/NSV attending the vitiligo clinic of the University Hospital Department of Dermatology, Bordeaux, France, from 1 January 2006 to 1 May 2012. The Vitiligo European Task Force (VETF) questionnaire was completed for each consecutive patient. AITD was defined as the presence of significant levels of serum antithyroperoxidase antibodies or evidence of autoimmune thyroiditis. Univariate and multivariate logistic regression procedures were conducted to identify factors associated with AITD in this cohort of patients with vitiligo/NSV. Results A total of 626 patients with vitiligo/NSV were included, of whom 131 had AITD (AITD‐vitiligo). Stress as an onset factor, familial history of AITD, body surface involvement and duration of the disease were positively associated with AITD‐vitiligo using univariate analysis, whereas female sex, age at onset of vitiligo, personal history of autoimmune disease and localization on the trunk were found to be independently associated with AITD‐vitiligo. Conclusion Vitiligo associated with AITD has clinical features distinct from vitiligo without AITD. In particular, female patients, and patients with longer duration of disease and greater body surface involvement are more likely to present with AITD and should thus be monitored for thyroid function and antithyroid antibodies on a regular basis.     

Relevance of autoimmune thyroiditis in children and adolescents with vitiligo

Background Vitiligo is the most common pigmentation‐related disorder worldwide. An autoimmune etiology is widely considered, and genetic factors may play an important role in its pathogenesis. The purpose of this study was to assess the incidence of thyroid dysfunctions and autoimmune thyroiditis in children with vitiligo and to identify related factors. Methods Fifty children with vitiligo and 50 control children were enrolled. Data on age, onset, duration, disease activity, presence of thyroid disorder, other autoimmune diseases, halo nevi, poliosis, and mucosal vitiligo were determined. Serum free triiodothyronine, free thyroxine, total T3, total T4, thyroid‐stimulating hormone, and antibodies to thyroperoxidase and thyroglobulin were measured. Thyroid gland efficiency was evaluated. Results The mean age at onset of vitiligo was 7.26 ± 4.43 years. The duration of vitiligo was 2.26 ± 2.95 years. Vulgaris‐type vitiligo was the most common form in our patients (56%), and 42% reported at least one family member with thyroid disorder, autoimmune disease, or both. Overt hypothyroidism or hyperthyroidism were not detected. We found a significant association between autoimmune thyroiditis and both sex and disease duration (P = 0.046 and P = 0.07, respectively), but no association between autoimmune thyroiditis and age, age at onset of vitiligo, halo nevi, poliosis, mucosal involvement, disease activity, or family history of vitiligo, autoimmunity, or thyroid disorders. Conclusions Children with vitiligo show an increased incidence of autoimmune thyroiditis. Children with vitiligo, especially girls and subjects with generalized/vulgaris‐type vitiligo, should be screened annually for thyroid function and antithyroid antibodies to assist in the early diagnosis and therapy of autoimmune thyroiditis.     

Effects of age of onset on disease characteristics in non‐segmental vitiligo

In patients with vitiligo, the clinical and laboratory features of the disease may vary according to time of onset. This is addressed in the literature by only a few studies with conflicting results. The aim of this study was to determine the demographic and clinical features of patients with non‐segmental vitiligo and to establish the association between vitiligo and autoimmune diseases with a focus on time of disease onset. A total of 224 vitiligo patients for whom complete medical records were available were evaluated retrospectively. Demographic data, scores on the Vitiligo Area Score Index (VASI), clinical features, vitiligo disease activity, repigmentation status, presence of any accompanying autoimmune disease, antinuclear antibody (ANA) titers, serum levels of glucose, thyroid‐stimulating hormone (TSH), thyroxine (T4) hormone, anti‐thyroid peroxidase (anti‐TPO), and anti‐thyroglobulin (anti‐TG) were recorded. The prevalence of halo nevi was significantly higher (P < 0.001) among children than in other patient groups. The prevalence of leukotrichia was higher in adults with adult‐onset disease than in either pediatric patients or adults with childhood‐onset disease (P = 0.002). Both anti‐TG and anti‐TPO levels were significantly higher in adults with adult‐onset disease than in pediatric patients and adult patients with childhood‐onset disease. The prevalence of autoimmune disease was 22.2%. Anti‐TG levels were significantly higher in patients with treatment‐related repigmentation than in those without repigmentation. This study shows that clinical features and associations with autoimmune disease may vary according to the age of onset of vitiligo.     

Pregnancy outcome in women with vitiligo

Background Vitiligo, characterized by destruction of melanocytes, causes a patchy depigmentation of the skin. It has been hypothesized to have an autoimmune pathogenesis. Autoimmune disorders are more common among women and may be associated with adverse pregnancy outcomes, such as recurrent abortions, intrauterine growth restriction (IUGR), and pre‐eclampsia. Objective The purpose of this study was to investigate whether patients with vitiligo have increased rates of gestational complications. Methods A retrospective comparative study was undertaken comparing pregnancy complications of patients with and without vitiligo. The population was composed of all singleton deliveries that occurred at the Soroka University Medical Center in Israel during the years 1988–2006. Women lacking prenatal care and multiple gestations were excluded from the study. A multivariable logistic regression model was constructed to control for confounders. Results Of 186,222 singleton deliveries, 79 (0.04%) were patients with vitiligo. Vitiligo was not found to be associated with adverse pregnancy outcomes, including obstetric risk factors, labor characteristics and complications, and birth outcome. Using multivariable analysis, only grand multiparity (above five deliveries) was independently associated with vitiligo (OR = 2.01; 95% CI 1.2–3.2; P = 0.007). Limitations Retrospective analysis was a limitation. Conclusion Vitiligo is not associated with adverse pregnancy outcomes. Accordingly, patients with vitiligo should not be managed differently from the general obstetric population.     

Filaggrin null mutations increase the risk and persistence of hand eczema in subjects with atopic dermatitis: results from a general population study

Summary Background Hand eczema is prevalent in the general population. It remains unclear whether or not filaggrin gene (FLG) null mutations increase the overall risk of hand eczema or only increase the risk of hand eczema in subjects with atopic dermatitis. Objectives To investigate the association between FLG null mutations and hand eczema. Methods A random sample of 3335 adults from the general population in Denmark was patch tested, FLG genotyped for R501X and 2282del4 null mutations and questioned about hand eczema. Results Participants with combined presence of atopic dermatitis and FLG null mutation status had a significantly higher prevalence of hand eczema, an earlier onset of hand eczema and a higher persistence of hand eczema compared with subjects with normal FLG status and absence of atopic dermatitis. Logistic regression analyses revealed positive associations between hand eczema within the past 12 months and FLG null mutation status in participants with a history of atopic dermatitis [odds ratio (OR) 2·98; 95% confidence interval (CI) 1·27–7·01], but not in subjects without atopic dermatitis (OR 0·82; 95% CI 0·41–1·67). Conclusions FLG null mutations were significantly associated with hand eczema (< 12 months) in subjects with atopic dermatitis. Combined atopic dermatitis and filaggrin null mutation status was strongly associated with early onset of hand eczema and hand eczema persistence.     

Willingness-to-pay and quality of life in patients with vitiligo

Background Vitiligo is a chronic pigmentary disorder of the skin, affecting 1–2% of the general population. Although not life threatening, vitiligo may considerably influence patients’ health‐related quality of life (QoL) and psychological well‐being. Willingness‐to‐pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. Objectives To assess the WTP and the QoL of patients with vitiligo. Methods Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ‐5D) questionnaire. QoL data were compared with n = 1511 patients from a national survey on psoriasis. Results The questionnaire was completed by 1023 patients (71·5% women, mean age 44·4 years, mean disease duration 20·3 years) with vitiligo. The mean DLQI was 7·0 (7·5 in women, 5·5 in men) compared with 8·6 in psoriasis. Of the patients with vitiligo, 24·6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34·1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20–29 years. EQ‐5D mean score was 83·6 compared with 75·3 in psoriasis. Of the patients with vitiligo, 32·9% would pay more than 5000 Euro in order to achieve complete disease remission. WTP was highest among middle‐aged patients (30–60 years). There was a significant correlation between DLQI scores and WTP (χ² = 65·43, P < 0·001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0·001). Conclusions Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients’ compliance and empowerment.     

A single nucleotide polymorphism rs9468925 of MHC region is associated with clinical features of generalized vitiligo in Chinese Han population

Background Vitiligo has been found to be associated with different HLA antigens in different ethnic groups. In our previous genome‐wide association study (GWAS), we identified independent association signal of rs9468925 (P = 2.21 × 10^?33, OR = 0.74) within HLA‐C‐HLA‐B region. Objectives To explore the association between rs9468925 polymorphism within MHC and the clinical features of generalized vitiligo. Methods The study, using 5566 cases and 6462 controls from previous GWA study investigated the single and combined (GA + GG) genotypic distribution of rs9468925 in subsets of vitiligo patients having different clinical features. We performed a QTL analysis (quantitative trait locus) for age of onset with genotype of rs9468925. Results The GA + GG genotypic distribution of SNP rs9468925 tested with an additive model was found to be significantly different in subgroups of patients of >20 vs. <20 years old (genotypic P = 2.57 × 10^?4, combined P = 3.0 × 10^?3, OR = 0.77, 95% CI: 0.64–0.92), and in patients with different clinical subtypes of vitiligo (genotypic P = 0.03, combined P = 5.0 × 10^?3). However, there was no statistical significance for familial history, halo nevi involvement and autoimmune disease involvement. Conclusions Allele G of rs9468925 on HLA‐C‐HLA‐B may be associated with a higher risk of vitiligo. Our study showed a significant genotypic variation between patients with age of onset ≤20 years and age of onset >20 years. Obvious clinical differences of generalized vitiligo related to genotypic variation found in the Chinese Han population were confirmed in this study.     

Dermatology life quality index scores in children with vitiligo: comparison with atopic dermatitis and healthy control subjects

Vitiligo and atopic dermatitis (AD) are two major cutaneous diseases that affect quality of life (QoL) by causing functional and psychosocial disorders. Our objective was to calculate Children’s Dermatology Life Quality Index (CDLQI) scores in children with vitiligo and to compare these values with those in AD patients and healthy control subjects. The CDLQI was completed for 50 vitiligo and 50 AD patients presenting at the dermatology polyclinic, as well as for 50 age‐ and sex‐matched healthy controls. All subgroups in the vitiligo patient group had significantly higher total CDLQI scores than healthy controls. Vitiligo patients were found to have increased scores on all parameters, except itch, clothes/shoes, and sleep, compared with the AD patient group. Scores on itch and sleep were significantly higher in the AD group than in the vitiligo patients. Quality of life in children with vitiligo is substantially lower than in children with AD. This decline in QoL is critical in the psychosocial development of the former group.     

Epidemiology of vitiligo in the French West Indies (Isle of Martinique)

BACKGROUND: The frequency of vitiligo in white populations has been generally estimated to be about 0.5-1%. The same prevalence is expected in black populations, despite the few investigations reported. No studies have been performed in black populations living in the Caribbean Islands. Therefore, our purpose was to report an epidemiologic study of vitiligo in the French West Indies (Isle of Martinique). METHODS: We performed a prospective study between October 1995 and March 1996; 2077 outpatients of the Department of Dermatology at the Fort de France University Hospital were examined to detect vitiligo. Concurrently, 32 patients (23 women and nine men), presenting with vitiligo, were questioned about their family history, personal diseases, age, and circumstances of vitiligo occurrence. RESULTS: Vitiligo was found in seven patients (five women and two men) out of 2077. The prevalence in the studied population was 0.34%. Of the 32 patients with vitiligo who were investigated, 11 (34%) had a family history of vitiligo, two (6%) suffered from thyroid disease, two (6%) from psoriasis, and one (3%) from atopic dermatitis. The median age at vitiligo onset was 29 years. CONCLUSIONS: Despite the bias due to the recruitment of patients in the Dermatology Department, this study demonstrates a prevalence in a black population comparable, or slightly inferior, to the currently accepted data in white people. Our results concerning the age of onset and pathologic associations showed no difference with the literature data related to white populations.     

The angiotensin‐converting enzyme gene insertion/deletion polymorphism in Indian patients with vitiligo: a case–control study and meta‐analysis

Background  Vitiligo is a common, acquired, idiopathic depigmenting skin disorder. Although the exact pathogenesis remains unknown, genetic susceptibility and autoimmune responses play a role in vitiligo development. Previous studies have suggested that the D allele of the insertion/deletion (I/D) polymorphism of the angiotensin‐converting enzyme (ACE) gene is associated with vitiligo in Indians and Koreans. Furthermore, significantly higher serum ACE levels have been demonstrated in patients with some autoimmune and autoinflammatory disorders. Objectives  The objectives were to investigate any association between the ACE I/D polymorphism and vitiligo susceptibility in an Indian population, and to compare serum ACE levels in patients with vitiligo and healthy subjects. Methods  The ACE I/D genotypes of 79 patients with vitiligo and 100 normal individuals were determined by polymerase chain reaction amplification. A meta‐analysis was done to compare the distribution of the ACE I/D alleles and genotypes in the current and three previous studies. Serum ACE levels were evaluated by enzyme‐linked immunosorbent assay. Results  A significant increase in the frequency of the ACE I/D D allele was evident in patients with vitiligo in both the case–control study [P = 0·005; odds ratio (OR) 1·87; 95% confidence intervals (CI) 1·22–2·85] and the meta‐analysis (P = 0·044; OR 1·44; 95% CI 1·01–2·06). Serum ACE levels were significantly increased in patients with vitiligo compared with healthy subjects (P < 0·0001). Conclusions  In agreement with earlier reports, the ACE I/D D allele is associated with vitiligo susceptibility in the Indian population. The significantly elevated serum ACE levels in our cohort of patients with vitiligo concur with those previously found in patients with some other autoimmune diseases.     

Prognostic value and clinical significance of halo naevi regarding vitiligo

Background Vitiligo and halo naevi can present together or separately. Whether they are different entities remains unclear. Objectives To assess the clinical significance of halo naevi, both with respect to the future development of vitiligo, and to the clinical profile and course of vitiligo. Methods In total, 291 patients were included in this study: patients with only halo naevi (group 1; n = 40), patients with generalized vitiligo without halo naevi (group 2; n = 173) and patients with generalized vitiligo with halo naevi (group 3; n = 78). Results Patients with only halo naevi (group 1) reported significantly less associated autoimmune disease (P = 0·001), were less likely to have a family history of vitiligo (P = 0·013) and were less likely to have presence of Koebner phenomenon (P < 0·001) compared with patients with generalized vitiligo (groups 2 + 3). Multiple halo naevi (≥ 3) were significantly more frequently observed (P = 0·002) in patients from group 1 compared with patients from group 3. In group 3, halo naevi were reported prior to the development of vitiligo in 61% (mean ± SD time interval of 33·7 ± 5·17 months). No significant correlation was observed between the presence of halo naevi and the extent, activity or subtype of vitiligo. However, halo naevi in patients with vitiligo significantly reduced the risk for associated autoimmune diseases, and age at onset of vitiligo was significantly lower compared with patients with vitiligo without halo naevi (P < 0·001). Conclusions Our results support the hypothesis that halo naevi can represent a distinct condition. In a subset of patients, the occurrence of halo naevi may be an initiating factor in the pathogenesis of vitiligo.     

Low yield of routine screening for thyroid dysfunction in asymptomatic patients with vitiligo

Background Nonsegmental vitiligo is considered to be an autoimmune disease and is known to be associated with other autoimmune diseases, particularly affecting the thyroid. Screening patients with nonsegmental vitiligo for thyroid function and for the presence of thyroid autoantibodies has been recommended. Objective To investigate the prevalence of thyroid dysfunction and thyroid peroxidase‐specific (TPO) antibodies in a large cohort of patients with nonsegmental vitiligo in order to help decide whether routine screening is justified. Methods A total of 434 adults with nonsegmental vitiligo who were referred to our institute were enrolled. Thyroid function and anti‐TPO antibody titres were assessed in those patients who had no history of thyroid disease or recent thyroid screening. Results Forty‐three patients had already been diagnosed with thyroid dysfunction, and in 27 patients the general practitioner had performed a thyroid function test with negative results < 3 months previously. In these patients, thyroid function assessment was not repeated. The remaining 364 patients were screened for thyroid dysfunction. Overt hypothyroidism was newly diagnosed in three (0·8%) patients; subclinical disease was found in 10 (2·7%) patients and increased levels of TPO antibodies, without thyroid disease, were found in 49 (13·5%) patients. An elevated risk for thyroid disease was found among older women and in women with a positive family history of thyroid disease. Conclusion The overall prevalence of thyroid dysfunction in adult patients with nonsegmental vitiligo was higher than reported in the general population. However, the number of newly diagnosed cases with overt and subclinical thyroid dysfunction in our population was low. Most patients had already been diagnosed by their general practitioner and had symptoms indicative for thyroid disease. Thyroid disease was found predominantly among older women and in subjects with a positive family history of thyroid disease. Thyroid screening including anti‐TPO antibodies is advisable in these high‐risk subpopulations.     

TLR2 and TLR4 gene polymorphisms in Turkish vitiligo patients

Background It has been shown that toll like receptors (TLR) may be involved in some inflammatory skin diseases such as psoriasis, atopic dermatitis. Vitiligo is an acquired pigmentation disorder of unknown aetiology. A number of genes playing a role in inflammatory response may be associated with development of vitiligo. Objectives To investigate whether there is an association between TLR 2 and TLR4 gene polymorphisms in Turkish patients with vitiligo. Methods A total of 100 patients (59 women and 41 men) with vitiligo and 100 controls (58 women and 42 men) were included in the study. The TLR2 gene Arg753Gln and TLR4 gene Asp299Gly and Thr399Ile polymorphisms were genotyped by using polymerase chain reaction and restriction fragment length polymorphism method. The data were analysed by Mann–Whitney U‐test, chi‐squared test and logistic regression analysis. Results Significant difference was found in the distribution of TLR2 Arg753Gln genotype and in the allele frequencies TLR2 753Gln between vitiligo patients and healthy subjects (P < 0.05). The distribution of TLR4 Asp299Gly genotype was significantly higher in the patient group (10%) than in the control group (%2) (P < 0.05). The TLR4 Thr399Ile distribution did not show any difference in both vitiligo and healthy groups. Conclusions Our findings suggest that Toll‐like receptor 2 gene Arg753Gln and Toll‐like receptor 4 Asp299Gly gene polymorphisms are associated with vitiligo susceptibility in Turkish patients.     

Late onset vitiligo: a study of 182 patients

The elderly constitute a large and rapidly growing segment of the population; however, there is complete lack of information about the epidemiology of vitiligo in this age group. To study the clinical and epidemiological profile of vitiligo in the elderly, we retrospectively analyzed the data of patients with vitiligo having onset of disease after 50 years of age attending the pigmentary clinic of our center. Of the 182 patients, 87 (47.8%) were males and 95 (52.2%) were females. The mean age of onset of disease was 55 +/- 2.3 years. Vitiligo vulgaris was the most common (83.5%) followed by focal (5.5%), segmental (4.4%), acrofacial (3.8%), mucosal (2.2%), and universal (0.5%). The most common site of onset was the head and neck (24.2%) followed by the upper limbs (23%), trunk (22%), lower limbs (17.6%), oral/genital mucosae (7.1%), and flexures (6%). Koebner's phenomenon was observed in 14.8% while leukotrichia was present in 47.3% of the patients. Halo nevi were observed in 3.8% of patients, and vitiligo was stable in 64.8%. Twenty-nine (15.9%) patients had family history of vitiligo. Associated autoimmune autoimmune/endocrine disorders were present in 39 (21.4%) of the patients. Differences in disease characteristics compared with vitiligo in children and young adults are discussed.     

Decreased risk of melanoma and nonmelanoma skin cancer in patients with vitiligo: a survey among 1307 patients and their partners

Background Vitiligo is a common skin disease characterized by autoimmune melanocyte destruction. Recent genetic studies suggest a lower susceptibility to melanoma in patients with vitiligo; however, lifetime melanoma prevalence in patients with vitiligo has not previously been studied. Nonmelanoma skin cancer (NMSC) prevalence has been studied, but only in small studies and with contradictory results. Objectives This retrospective, comparative cohort survey was designed to assess lifetime prevalences of melanoma and NMSC in patients with vitiligo compared with nonvitiligo controls. Methods Patients with nonsegmental vitiligo, who visited our clinic between January 1995 and September 2010, and were aged 50 years or older at the time of the study, were invited to participate in a postal survey. The questions regarded demographics, vitiligo characteristics, phototherapy history, skin cancer risk factors and the number of skin cancers experienced during the patient’s lifetime. Patients were asked to have their partner fill in a control questionnaire. All skin cancers were validated by a pathology report. In total 2635 invitations were sent and 1307 eligible questionnaires were returned (50%). Multivariate logistic regression models were used to quantify adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for associations between vitiligo and lifetime prevalences of melanoma and NMSC. Results Adjusted for confounders, patients with vitiligo had a threefold lower probability of developing melanoma (adjusted OR 0·32; 95% CI 0·12–0·88) and NMSC (adjusted OR 0·28; 95% CI 0·16–0·50). Subgroup analyses of patients treated with narrowband ultraviolet (UV) B, and psoralen and UVA did not show dose‐related trends of increased age‐adjusted lifetime prevalence of melanoma or NMSC. Conclusions Our findings suggest that patients with vitiligo have a decreased risk of both melanoma and NMSC.     

An approach to the correlation between vitiligo and autoimmune thyroiditis in Chinese children

Background. Vitiligo is a common skin depigmenting disease, which is thought to have, at least partly, an autoimmune aetiology. Aim. To explore the correlation between paediatric vitiligo and other associated diseases, with an emphasis on autoimmune thyroiditis (AT). Methods. In total, 363 paediatric patients (198 boys, 165 girls) with vitiligo and 93 healthy children (55 boys, 38 girls) were screened for autoimmune thyroiditis. The two groups were matched for age and gender. Children with vitiligo were split into two groups according to type (segmental and nonsegmental vitiligo). Demographic data, clinical features and examinations were recorded using questionnaires. Thyroid function tests including free triiodothyronine, free thyroxine and thyroid‐stimulating hormone were performed. Anti‐thyroid peroxidase antibody) and anti‐thyroglobulin antibody levels were assessed as well. Other associated diseases were also monitored in this study. Results. Of the 363 patients, 43 (11.8%) had abnormal levels of studied thyroid parameters, compared with 4 of the 93 controls (4.3%); the difference was significant (P = 0.04). The alterations of thyroid parameters and the incidence of AT in patients with nonsegmental vitiligo were both significantly different (P < 0.05, P = 0.04) relative to the segmental vitiligo group. Of the 363 patients, 67 (18.5%) had other associated diseases. There were no differences in the rates of other associated diseases between patients with segmental vitiligo and those with nonsegmental vitiligo (P > 0.05). Conclusions. A significant incidence of thyroid dysfunction was found in paediatric patients with nonsegmental vitiligo. As vitiligo usually appears before the development of the thyroid disease, it may be advantageous to screen thyroid functions and antibody levels in all paediatric patients with vitiligo, especially those with nonsegmental vitiligo.