Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo

Background Limited epidemiological data exist that compare clinical features of pre‐ and post‐pubertal nonsegmental vitiligo. Objectives To compare factors associated with pre‐ and post‐pubertal onset vitiligo. Patients and methods A prospective observational study was conducted of patients with vitiligo attending the clinic between 1 January 2006 and 1 July 2011. The Vitiligo European Task Force questionnaire was completed for each patient and thyroid function and antithyroid antibodies were screened. Other forms of vitiligo (segmental, focal, mucosal, not classifiable) were excluded. Results A total of 679 patients were included; 422 had post‐pubertal and 257 pre‐pubertal onset of vitiligo. Vitiligo universalis was seen only in post‐pubertal onset. In univariate analysis, there was no significant statistical difference for sex, Koebner phenomenon or disease activity between both groups; thyroid disease or presence of thyroid antibodies was more frequent in post‐pubertal onset odds ratio (OR) 0·31, P < 0·003] whereas atopic dermatitis was more often associated with or preceding pre‐pubertal onset (OR 2·42, P = 0·006). In multivariate analysis, halo naevi, family history of vitiligo, premature hair greying, atopic dermatitis and previous episode of spontaneous repigmentation were independently associated with pre‐pubertal onset. In contrast, stress as onset factor, personal history of thyroid disease and acrofacial type were associated with post‐pubertal onset. Conclusions Pre‐pubertal onset vitiligo is strongly associated with personal and family history of atopy, suggesting that the predisposing immune background in vitiligo is not limited to autoimmunity, as also noted in alopecia areata. This study also suggests reconsidering the epidemiological data on sex ratio in vitiligo.