Vitiligo is a skin condition that leads to patches of depigmented skin. It has been shown to be associated with various autoimmune disorders, such as thyroid disease, rheumatoid arthritis, psoriasis, and pernicious anemia

 

Autoimmunity and Vitiligo

What are autoimmune conditions?

Autoimmune conditions are a set of disorders that occur when your immune system starts to see a part of your body as a foreign invader and begins to attack it. For example, in autoimmune thyroid disease, your body starts attacking the thyroid gland, which then is not able to properly regulate important thyroid hormones.

Why do autoimmune conditions tend to appear more in those with vitiligo?

Vitiligo itself appears to be an autoimmune condition, where the body attacks it’s own skin cells (in this case, the pigment-producing melanocytes). This leads to the death or dysfunction of these melanocytes, creating areas of depigmentation on the skin.^[2]

These attacks lead to white patches on the skin. The most common type of vitiligo can appear anywhere on the body and is often symmetrical. This is referred to as general or nonsegmental vitiligo. Vitiligo that just appears on one side of the body or another, and not symmetrically, is called segmental or focal vitiligo.^[3]

Are all types of vitiligo associated with another separate autoimmune condition?

The answer appears to be no. The association with autoimmunity has only been found in nonsegmental/general vitiligo.^[2] Those with segmental vitiligo seem unaffected by autoimmune conditions at a higher rate than the general public.

 

Commonly Associated Conditions with Vitiligo

In both children and adults with nonsegmental vitiligo, they appear to be affected at a greater rate with other common autoimmune disorders, than those without vitiligo. In particular, those with vitiligo are at almost double the risk of developing thyroid disease compared to the general population.^[4]

According to one study, the most commonly seen associated autoimmune conditions in children are:^[5]

• Thyroid disorders
• Rheumatoid arthritis
• Psoriasis
• Alopecia areata (hair loss)

Adults are most affected by:

• Thyroid disorders
• Pernicious anemia
• Celiac disease
• Type 2 diabetes
• Pemphigus vulgaris (blistering of the skin)
• Addison disease

 

Risk for Another Autoimmune Disease

Not all of those who suffer from vitiligo will also have another autoimmune condition. So how do you know if a patient should be tested or screened for one or more of these associated conditions? One indicator could be their Vitamin D level. A second indicator could be the presence of certain symptoms.

Vitamin D and autoimmune disease

While Vitamin D deficiency is common throughout the United States, it has been shown that when patients with vitiligo (age 3 and above) have a vitamin D level at or below 15ng/mL (optimal levels are 25-80ng/mL), secondary autoimmune diseases arise more frequently.^[5]

While these are promising findings, the data still does not give us a clear answer about vitamin D levels and increased susceptibility to vitiligo or other autoimmune conditions^[7]. For this reason, it is important for a patient to talk to their doctor about their own risks of developing a secondary autoimmune condition, and discuss with them if screening, including testing of your vitamin D levels, may be right for them.

Other symptoms

It’s important for those with vitiligo to have a primary care physician who sees them at least annually, who can help them notice subtle changes in their health. Sometimes a doctor will look for the presence of other autoimmune diseases by asking about symptoms or through an examination. The presence (or absence) of certain symptoms can help the patient and doctor decide if further testing is the right decision for them.

Typical symptoms of some autoimmune disease are listed in the table below. These symptoms are not comprehensive, and many can be seen in a wide variety of conditions. In many cases, these symptoms will not relate to an autoimmune disease. 

Table 1. Some symptoms of autoimmune diseases

Autoimmune Disease	Symptoms/Signs
Overactive thyroid	Weight loss
Underactive thyroid	Weight gain, fatigue
Alopecia areata	Hair loss in patches
Rheumatoid arthritis	Painful, swollen joints
Pernicious anemia	Fatigue, weakness
Celiac disease	Diarrhea, bloating, fatigue
Type 2 diabetes	Increased thirst, frequent urination
Pemphigus vulgaris	Blisters (skin and mouth)
Addison’s disease	Fatigue, nausea
Psoriasis	Red scaling lesions on skin; joint pain

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