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Vitiligo and thyroid disease: a systematic review and meta-analysis

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European Journal of Dermatology Aims and scope

Abstract

Vitiligo is associated with (autoimmune) thyroid disease. However, confounding factors, including type and onset of vitiligo, require elucidation. We conducted a meta-analysis to identify vitiligo patients with increased risk of (autoimmune) thyroid disease. Studies were identified based on searches in PubMed, MEDLINE, Embase, and the Cochrane Library from inception of these databases to August 31st, 2017. Odds ratios (ORs) for the prevalence of (autoimmune) thyroid disease and thyroid antibodies in vitiligo patients were pooled, and subgroup analysis was performed. Thirty-seven studies with 78,714 vitiligo patients met the inclusion criteria. The prevalence of thyroid disease (TD) (OR: 3.932; 95% CI: 2.230–6.933), autoimmune TD (OR: 5.879; 95% CI: 2.682–12.885), anti-thyroperoxidase (TPO) antibody (OR: 3.838; 95% CI: 2.968–4.963), and anti-thyroglobulin antibody (OR: 3.513; 95% CI: 2.346–5.260) was significantly higher in vitiligo patients than in controls. Notably, the prevalence of TD and anti-TPO antibody was significantly higher in patients with non-segmental vitiligo, compared to those with segmental vitiligo. In contrast, the prevalence of TD was significantly lower in early-, compared to the late-onset vitiligo group (OR: 0.333; 95% CI: 0.244–0.453). Physicians should be aware of the increased risk of (autoimmune) thyroid disease in vitiligo patients. We recommend routine screening for anti-thyroid antibodies in vitiligo patients.

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References

  1. Ezzedine K, Eleftheriadou V, Whitton M, van Geel N. Vitiligo. Lancet 2015; 386: 74–84.

    Article  PubMed  Google Scholar 

  2. Kovacs SO. Vitiligo. J Am Acad Dermatol 1998; 38: 647–66 (quiz: 667–8).

    Article  CAS  PubMed  Google Scholar 

  3. Njoo MD, Westerhof W. Vitiligo. Pathogenesis and treatment.Am J Clin Dermatol 2001; 2: 167–81.

    Article  CAS  PubMed  Google Scholar 

  4. Mohammed GF, Gomaa AH, Al-Dhubaibi MS. Highlights in pathogenesis of vitiligo. World J Clin Cases 2015; 3: 221–30.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kruger C, Schallreuter KU. Stigmatisation, avoidance behaviour and difficulties in coping are common among adult patients with vitiligo. Acta Derm Venereol 2015; 95: 553–8.

    Article  PubMed  Google Scholar 

  6. 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: E1–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Colucci R, Dragoni F, Moretti S. Oxidative stress and immune system in vitiligo and thyroid diseases. Oxid Med Cell Longev 2015; 2015: 631927.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Oiso N, Suzuki T, Fukai K, et al. Nonsegmental vitiligo and autoimmune mechanism. Dermatol Res Pract 2011; 2011: 518090.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Spritz RA. Shared genetic relationships underlying generalized vitiligo and autoimmune thyroid disease. Thyroid 2010; 20: 745–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Czajkowski R, Mecinska-Jundzill K. Current aspects of vitiligo genetics. Postep Dermatol Alergol 2014; 31: 247–55.

    Article  Google Scholar 

  11. Vrijman C, Kroon MW, Limpens J, et al. The prevalence of thyroid disease in patients with vitiligo: a systematic review. Br J Dermatol 2012; 167: 1224–35.

    Article  CAS  PubMed  Google Scholar 

  12. Ezzedine K, Diallo A, Leaute-Labreze C, et al. Pre- vs. post-pubertal onset of vitiligo: multivariate analysis indicates atopic diathesis association in pre-pubertal onset vitiligo. Br J Dermatol 2012; 167: 490–5.

    Article  CAS  PubMed  Google Scholar 

  13. Lazzeri L, Colucci R. Adult onset vitiligo: multivariate analysis suggests the need for a thyroid screening. Biomed Res Int 2016; 2016: 8065765.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Nicolaidou E, Antoniou C, Miniati A, et al. Childhood- and later-onset vitiligo have diverse epidemiologic and clinical characteristics. J Am Acad Dermatol 2012; 66: 954–8.

    Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, Altman DG, & The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; 6: e1000097.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Radulescu M, Diepgen T, Williams HC. What makes a good prevalence survey?. In: Williams HC, Bigby M, Diepgen T, Herxheimer A, Naldi L, Rzany B, editors. Evidence-based dermatology, 2nd ed. Oxford: Blackwell Publishing, 2008, p. 61–7.

    Chapter  Google Scholar 

  17. Hutfless S, Matos P, Talor MV, et al. Significance of prediagnostic thyroid antibodies in women with autoimmune thyroid disease. J Clin Endocrinol Metab 2011; 96: E1466–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Ezzedine K, Diallo A, Leaute-Labreze C, et al. Multivariate analysis of factors associated with early-onset segmental and nonsegmental vitiligo: a prospective observational study of 213 patients. Br J Dermatol 2011; 165: 44–9.

    Article  CAS  PubMed  Google Scholar 

  19. Van Geel N, Mollet I, Brochez L, et al. New insights in segmental vitiligo: case report and review of theories. Br J Dermatol 2012; 166: 240–6.

    Article  CAS  PubMed  Google Scholar 

  20. Weisberg EL, Le LQ, Cohen JB. A case of simultaneously occurring lichen sclerosus and segmental vitiligo: connecting the underlying autoimmune pathogenesis. Int J Dermatol 2008; 47: 1053–5.

    Article  PubMed  Google Scholar 

  21. Kovacevic M, Stanimirovic A, Vucic M, et al. Mixed vitiligo of Blaschko lines: a newly discovered presentation of vitiligo responsive to combination treatment. Dermatol Ther 2016; 29: 240–3.

    Article  PubMed  Google Scholar 

  22. Kakourou T, Kanaka-Gantenbein C, Papadopoulou A, et al. Increased prevalence of chronic autoimmune (Hashimoto’s) thyroiditis in children and adolescents with vitiligo. J Am Acad Dermatol 2005; 53: 220–3.

    Article  PubMed  Google Scholar 

  23. Yang Y, Lin X, Fu W, et al. An approach to the correlation between vitiligo and autoimmune thyroiditis in Chinese children. Clin Exp Dermatol 2010; 35: 706–10.

    Article  CAS  PubMed  Google Scholar 

  24. Cho SB, Kim JH, Cho JM. Vitiligo in children and adolescents: association with thyroid dysfunction. J Eur Acad Dermatol Venereol 2011; 25: 64–7.

    Article  CAS  PubMed  Google Scholar 

  25. Uncu S, Yayli S, Bahadir S, et al. Relevance of autoimmune thyroiditis in children and adolescents with vitiligo. Int J Dermatol 2011; 50: 175–9.

    Article  PubMed  Google Scholar 

  26. Xianfeng C, Yuegen J, Zhiyu Y, et al. Pediatric patients with vitiligo in eastern China: abnormalities in 145 cases based on thyroid function tests and immunological findings. Med Sci Monit 2015; 21: 3216–21.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Cunliffe WJ, Hall R, Newell DJ, Stevenson CJ. Vitiligo, thyroid disease and autoimmunity. Br J Dermatol 1968; 80: 135–9.

    Article  CAS  PubMed  Google Scholar 

  28. Brostoff J. Autoantibodies in patients with vitiligo. Lancet 1969; 2: 177–8.

    Article  CAS  PubMed  Google Scholar 

  29. Woolfson H, Finn OA, Mackie RM, et al. Serum antitumour antibodies and auto-antibodies in vitiligo. Br J Dermatol 1975; 92: 395–400.

    Article  CAS  PubMed  Google Scholar 

  30. Grimes PE, Halder RM, Jones C, et al. Autoantibodies and their clinical significance in a black vitiligo population. Arch Dermatol 1983; 119: 300–3.

    Article  CAS  PubMed  Google Scholar 

  31. Betterle C, Caretto A, De Zio A, et al. Incidence and significance of organ-specific autoimmune disorders (clinical, latent or only autoantibodies) in patients with vitiligo. Dermatologica 1985; 171: 419–23.

    Article  CAS  PubMed  Google Scholar 

  32. Hann SK, Im S, Kim HI, et al. Increased incidence of antismooth muscle antibody in Korean vitiligo patients. J Dermatol 1993; 20: 679–83.

    Article  CAS  PubMed  Google Scholar 

  33. Schallreuter KU, Lemke R, Brandt O, et al. Vitiligo and other diseases: coexistence or true association? Dermatology 1994; 188: 269–75.

    Article  CAS  PubMed  Google Scholar 

  34. Hegedus L, Heidenheim M, Gervil M, et al. High frequency of thyroid dysfunction in patients with vitiligo. Acta Derm Venereol 1994; 74: 120–3.

    CAS  PubMed  Google Scholar 

  35. Zettinig G, Tanew A, Fischer G, et al. Autoimmune diseases in vitiligo: do anti-nuclear antibodies decrease thyroid volume? Clin Exp Immunol 2003; 131: 347–54.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Daneshpazhooh M, Mostofizadeh GM, Behjati J, et al. Anti-thyroid peroxidase antibody and vitiligo: a controlled study. BMC Dermatol 2006; 6: 3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Gopal KVT, Rao GRR, Kumar YHK. Vitiligo: a part of a systemic autoimmune process. Indian J Dermatol Venereol Leprol 2007; 73: 162–5.

    Article  CAS  PubMed  Google Scholar 

  38. Rodriguez-Martin M, Saez M, Merino de Paz N, et al. When are laboratory tests indicated in patients with vitiligo? Dermatoendocrinol 2012; 4: 53–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Kasumagic-Halilovic E, Ovcina-Kurtovic N, Jukic T, et al. Vitiligo and autoimmunity. Med Arch 2013; 67: 91–3.

    Article  PubMed  Google Scholar 

  40. Nejad SB, Qadim HH, Nazeman L, et al. Frequency of autoimmune diseases in those suffering from vitiligo in comparison with normal population. Pak J Biol Sci 2013; 16: 570–4.

    Article  PubMed  Google Scholar 

  41. Gopal KV, Rao GR, Kumar YH. Increased prevalence of thyroid dysfunction and diabetes mellitus in Indian vitiligo patients: a case-control study. Indian Dermatol Online J 2014; 5: 456–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Yang Y, Huang G, Yan X, Qing Z. Clinical analysis of thyroglobulin antibody and thyroid peroxidase antibody and their association with vitiligo. Indian J Dermatol 2014; 59: 357–60.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Zamanian A, Mobasher P, Ansar A, et al. Autoimmune thyroid disorders in patients with vitiligo. J Skin Stem Cell 2014; 1: e22113.

    Article  Google Scholar 

  44. Biswas M, Chattopadhyay A, Mridha K, et al. A study on association between vitiligo and thyroid dysfunction. IOSR-JDMS 2015; 14: 34–7.

    Google Scholar 

  45. Diaz-Angulo S, Lopez-Hoyos M, Munoz-Cacho P, et al. High prevalence of thyroid autoimmunity in patients with alopecia areata and vitiligo: a controlled study. Australas J Dermatol 2015; 56: 142–3.

    Article  PubMed  Google Scholar 

  46. Bae JM, Lee JH, Yun JS, Han B, Han TY. Vitiligo and overt thyroid diseases: a nationwide population-based study in Korea. J Am Acad Dermatol 2017; 76: 871–8.

    Article  PubMed  Google Scholar 

  47. Iacovelli P, Sinagra JL, Vidolin AP, et al. Relevance of thyroiditis and of other autoimmune diseases in children with vitiligo. Dermatology 2005; 210: 26–30.

    Article  PubMed  Google Scholar 

  48. Arycan O, Koc K, Ersoy L. Clinical characteristics in 113 Turkish vitiligo patients. Acta Dermatovenerol Alp Pannonica Adriat 2008; 17: 129–32.

    PubMed  Google Scholar 

  49. Tanioka M, Yamamoto Y, Katoh M, et al. Vitiligo vulgaris and autoimmune diseases in Japan: a report from vitiligo clinic in Kyoto University Hospital. Dermatoendocrinol 2009; 1: 43–5.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Nunes DH, Esser LM. Vitiligo epidemiological profile and the association with thyroid disease. An Bras Dermatol 2011; 86: 241–8.

    Article  PubMed  Google Scholar 

  51. Pradhan V, Patwardhan M, Thakkar V, et al. Vitiligo patients from India (Mumbai) show differences in clinical, demographic and autoantibody profiles compared to patients in western countries. J Eur Acad Dermatol Venereol 2013; 27: 279–86.

    Article  CAS  PubMed  Google Scholar 

  52. Dash R, Mohapatra A, Manjunathswamy BS. Anti-thyroid peroxidase antibody in vitiligo: a prevalence study. J Thyroid Res 2015; 2015: 192736.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Kartal D, Borlu M, Cinar SL, et al. Thyroid abnormalities in paediatric patients with vitiligo: retrospective study. Postep Dermatol Alergol 2016; 33: 232–4.

    Article  Google Scholar 

  54. Lim HK, Bae MI, Jeong KH, et al. Positivity rates of antithyroid antibody, antinuclear antibody and thyroid peroxidase antibody in different types of vitiligo. Clin Exp Dermatol 2016; 41: 242–7.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Yu-Chen Huang.

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Fan, KC., Yang, TH. & Huang, YC. Vitiligo and thyroid disease: a systematic review and meta-analysis. Eur J Dermatol 28, 750–763 (2018). https://doi.org/10.1684/ejd.2018.3449

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