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• W2953142845 abstract "To the Editor: Vitiligo is an acquired disorder of depigmentation resulting from a loss of cutaneous melanocytes.1Ezzedine K. Sheth V. Rodrigues M. et al.Vitiligo is not a cosmetic disease.J Am Acad Dermatol. 2015; 73: 883-885Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Aside from cosmetic concerns, many genetic and epidemiology studies have demonstrated an association of vitiligo with several comorbid systemic diseases.2Spritz R.A. Andersen G.H. Genetics of vitiligo.Dermatol Clin. 2017; 35: 245-255Abstract Full Text Full Text PDF PubMed Scopus (98) Google Scholar Diabetes mellitus (DM) is a chronic disease featuring an impaired ability to process blood sugar. The prevalence of DM is increasing throughout the world, and its complications are associated with substantial morbidity and mortality.3Papatheodorou K. Banach M. Bekiari E. Rizzo M. Edmonds M. Complications of diabetes 2017.J Diabetes Res. 2018; 2018: 3086167Crossref PubMed Scopus (217) Google Scholar To our knowledge, no large quantitative study has evaluated the association between vitiligo and DM; we therefore conducted this meta-analysis. We identified all studies published before February 28, 2019, and included case-control studies describing the prevalence of DM in vitiligo patients and controls or the prevalence of vitiligo in DM patients and controls. Review articles, case series, and conference abstracts were excluded. The quality of each study was evaluated by using the Newcastle-Ottawa scale. A random effects model was used for the meta-analysis. Odds ratios (ORs) with 95% confidence intervals (CIs) were used to compare the prevalence of DM in patients with vitiligo and controls. Subgroup analyses were performed according to the type of DM (type 1, type 2, or mixed). Heterogeneity across studies was assessed using the χ2 statistic and I2 statistic, and the risk of publication bias was assessed using the Egger test. All analyses were performed with Comprehensive Meta Analysis version 3 (Biostat, Englewood, NJ). Nine studies with a total of 15,657 vitiligo patients met the inclusion criteria. A summary of the characteristics of included studies is shown in Table I. Seven studies reported the prevalence of DM (5 with mixed-type DM and 2 with type 1 DM) among vitiligo patients, and 2 studies reported the prevalence of vitiligo among type 2 DM patients. The pooled estimate of 9 studies showed that vitiligo was significantly associated with DM (OR 2.515, 95% CI 1.972-3.208; P < .001; Fig 1). The subgroup analysis showed that vitiligo was significantly associated with type 1 DM (OR 2.899, 95% CI 1.532-5.482; P = .001) and also type 2 DM (OR 2.371, 95% CI 1.712-3.283; P < .001; Fig 1). No significant publication bias was noted (P = .66654), and a leave-1-out sensitivity analysis also confirmed the robustness of our findings.Table IBasic characteristics of included studies for meta-analysisStudy∗Birlea S, Birlea M, Cimponeriu D, et al. Autoimmune diseases and vitamin D receptor Apa-I polymorphism are associated with vitiligo in a small inbred Romanian community. Acta Derm Venereol. 2006;86(3):209-14. Gopal KV, Rama Rao GR, Kumar YH, Appa Rao MV, Vasudev P; Srikant. Vitiligo: a part of a systemic autoimmune process. Indian J Dermatol Venereol Leprol. 2007;73(3):162-5. Nejad SB, Qadim HH, Nazeman L, Fadaii R, Goldust M. Frequency of autoimmune diseases in those suffering from vitiligo in comparison with normal population. Pak J Biol Sci. 2013;16(12):570-4. Afkhami-Ardekani M, Ghadiri-Anari A, Ebrahimzadeh-Ardakani M, Zaji N. Prevalence of vitiligo among type 2 diabetic patients in an Iranian population. Int J Dermatol. 2014;53(8):956-8. 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(4):456-60. Chen YT, Chen YJ, Hwang CY, et al. Comorbidity profiles in association with vitiligo: a nationwide population-based study in Taiwan. J Eur Acad Dermatol Venereol. 2015;29(7):1362-9. Al Houssien AO, Al Houssien RO, Al Ajroush W, Al Kahtani HS. Chronic diseases among vitiligo patients. A case control study. Saudi Med J. 2017;38(4):400-4. Mubki T, Alissa A, Mulekar S, et al. Association of vitiligo with anemia vitamin B12 deficiency, diabetes mellitus, and thyroid dysfunction in Saudi Arab patients: a case control study. J Dermatol Dermatol Surg 2017;21(2):72-6. Raveendra L, Hemavathi RN, Rajgopal S. A study of vitiligo in type 2 diabetic patients. Indian J Dermatol. 2017;62(2):168-70.CountryGroupType 1 DM, nType 2 DM, nTotal, nAge, y, mean (SD) or rangeSex, M:F, nNOS†Scale for case-control studies (score: 0-9).Birlea et al, 2006RomaniaVitiligo3NA3153.0 (17.1)10:216Nonvitiligo1NA33NANAGopal et al, 2007IndiaVitiligo30 (mixed)1502381:698Nonvitiligo5 (mixed)100matchedmatchedNejad et al, 2013IranVitiligo4 (mixed)8528.11 (12.5)33:528Nonvitiligo3 (mixed)8532.60 (13.8)35:50Afkhami-Ardekani et al, 2014IranVitiligoNA547416-95 [DM]589:511 [DM]7NonvitiligoNA1046212610-98 [non-DM]609:491 [non-DM]Gopal et al, 2014IndiaVitiligo24 (mixed)15024 (10.28)83:678Nonvitiligo5 (mixed)10026 (9.81)54:46Chen et al, 2015TaiwanVitiligo15NA14,883446391:84928Nonvitiligo21NA59,5324425,564:33,968Al Houssien et al, 2017Saudi ArabiaVitiligo31 (mixed)6145 (19)17:448Nonvitiligo20 (mixed)6140 (17)17:44Mubki et al, 2017Saudi ArabiaVitiligo9 (mixed)11529.53 (9.22)51:648Nonvitiligo4 (mixed)8930.73 (10.56)37:52Raveendra et al, 2017IndiaVitiligoNA7210855.07 [DM]72:368NonvitiligoNA528109248.47 [non-DM]NADM, Diabetes mellitus; NA, not available; NOS, Newcastle-Ottawa scale; SD, standard deviation.∗ Birlea S, Birlea M, Cimponeriu D, et al. Autoimmune diseases and vitamin D receptor Apa-I polymorphism are associated with vitiligo in a small inbred Romanian community. Acta Derm Venereol. 2006;86(3):209-14. Gopal KV, Rama Rao GR, Kumar YH, Appa Rao MV, Vasudev P; Srikant. Vitiligo: a part of a systemic autoimmune process. Indian J Dermatol Venereol Leprol. 2007;73(3):162-5. Nejad SB, Qadim HH, Nazeman L, Fadaii R, Goldust M. Frequency of autoimmune diseases in those suffering from vitiligo in comparison with normal population. Pak J Biol Sci. 2013;16(12):570-4. Afkhami-Ardekani M, Ghadiri-Anari A, Ebrahimzadeh-Ardakani M, Zaji N. Prevalence of vitiligo among type 2 diabetic patients in an Iranian population. Int J Dermatol. 2014;53(8):956-8. 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(4):456-60. Chen YT, Chen YJ, Hwang CY, et al. Comorbidity profiles in association with vitiligo: a nationwide population-based study in Taiwan. J Eur Acad Dermatol Venereol. 2015;29(7):1362-9. Al Houssien AO, Al Houssien RO, Al Ajroush W, Al Kahtani HS. Chronic diseases among vitiligo patients. A case control study. Saudi Med J. 2017;38(4):400-4. Mubki T, Alissa A, Mulekar S, et al. Association of vitiligo with anemia vitamin B12 deficiency, diabetes mellitus, and thyroid dysfunction in Saudi Arab patients: a case control study. J Dermatol Dermatol Surg 2017;21(2):72-6. Raveendra L, Hemavathi RN, Rajgopal S. A study of vitiligo in type 2 diabetic patients. Indian J Dermatol. 2017;62(2):168-70.† Scale for case-control studies (score: 0-9). Open table in a new tab DM, Diabetes mellitus; NA, not available; NOS, Newcastle-Ottawa scale; SD, standard deviation. The significant correlation between vitiligo and type 1 DM might result from a similar pathogenesis of autoreactive cytotoxic T-cell–mediated destruction in both diseases.1Ezzedine K. Sheth V. Rodrigues M. et al.Vitiligo is not a cosmetic disease.J Am Acad Dermatol. 2015; 73: 883-885Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar, 4van den Boorn J.G. Konijnenberg D. Dellemijn T.A. et al.Autoimmune destruction of skin melanocytes by perilesional T cells from vitiligo patients.J Invest Dermatol. 2009; 129: 2220-2232Abstract Full Text Full Text PDF PubMed Scopus (336) Google Scholar Current results also showed that type 2 DM was comparably associated with vitiligo. Oxidative stress is thought to be involved in the pathogenic mechanism of both vitiligo and type 2 DM.5Elbuluk N. Ezzedine K. Quality of life, burden of disease, co-morbidities, and systemic effects in vitiligo patients.Dermatol Clin. 2017; 35: 117-128Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar These findings suggest that both autoimmune and nonautoimmune components are involved in the pathogenesis of vitiligo. Limitations of the current study included insufficient data for subgroup analyses of different vitiligo variants or ethnicity. In conclusion, our meta-analysis confirms a significant association of vitiligo with both type 1 and 2 DM. Clinicians should be aware of the risk of DM in patients with vitiligo." @default.
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• W2953142845 title "The association between vitiligo and diabetes mellitus: A systematic review and meta-analysis" @default.
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