Vitiligo—Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review
Abstract
:1. Introduction
2. Materials and Methods
2.1. Search Strategies
2.2. Laboratory Tests Used in Reviewed Studies
2.3. Interventions
2.4. Data Extraction
3. Results
4. Discussion
4.1. Temporal Association
4.2. Characteristics of Age Groups
4.3. Particular Features of the Body Distribution of Vitiligo according to Autoimmune Thyroid Pathology
4.4. Prognosis of the Association between Vitiligo, Autoimmune Thyroid Pathologies, and Oncological Treatment
5. Conclusions
- Autoimmune thyroid disease is more common among people with NSV than among the general population. Women with vitiligo more frequently presented autoimmune pathologies than men, with a higher prevalence of autoimmune thyroiditis.
- Screening for thyroid pathologies is particularly recommended for older patients with a family history of thyroid pathologies. The most common antibodies in vitiligo patients are anti-thyroid antibodies (ATPO, anti-Tg). Screening of asymptomatic patients together with early treatment of the underlying pathology leads to better results in terms of the prognosis of the pathology and the evolution of the patients compared to subjects who were not screened beforehand and presented to the doctor with an already-clinically-manifested pathology.
- Anti-TPO antibodies are a sensitive way to detect subclinical forms of autoimmune thyroiditis early. ATPO titers do not seem to correlate with the extent of vitiligo or a particular subtype of vitiligo. On the other hand, the percentage of total body surface area affected by vitiligo was found to be significantly higher in the presence of thyroid pathology, which, in turn, is more common among women.
- Patients with coexisting thyroid pathologies have a predisposition to developing acral vitiligo and depigmentation of the wrists. The association between concomitant thyroid dysfunction and depigmentation of the hands is so strong that the absence of depigmented macules on the hands may exclude the coexistence of autoimmune thyroid pathology. Taken together, autoimmune thyroid pathologies appear to be the only coexisting autoimmune or inflammatory diseases in vitiligo patients to show a pattern of distribution. Although the frequency of acral involvement in patients with associated autoimmune pathologies is higher, the mechanism by which thyroid pathology influences this distribution pattern remains incompletely elucidated. One possible explanation is that these areas are more prone to the Koebner phenomenon, which, in patients with associated autoimmune pathologies, can occur through a loss of peripheral tolerance and a resulting increase in the inflammatory response. These non-specific stimuli most likely initiate an immune response that causes the recruitment of CD8+ lymphocytes directed against melanocytes.
- Vitiligo tends to precede the onset of thyroid pathology, and patients who lack other associated autoimmune or inflammatory pathologies but have a positive family history of these pathologies tend to have an early onset of vitiligo.
- The chances of repigmentation among patients with vitiligo and associated autoimmune pathologies are not statistically significant compared to the chances among patients without associated autoimmune pathologies.
- Both autoimmune thyroiditis and vitiligo can be considered immune adverse reactions during antitumor therapy, and both are positive prognostic factors for therapeutic response and survival.
- Vitiligo should be considered an integrative pathology with which other autoimmune pathologies may be associated. This framework should form the basis of clinical reasoning and guide relevant screening modalities in order to detect the onset of other diseases as early as possible. This process should be understood as reciprocal so that more attention is given to the skin in order to detect possible depigmented macules in patients with associated autoimmune polyglandular syndromes, pernicious anemia, rheumatological pathologies, alopecia areata, or thyroiditis of an autoimmune etiology.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Chivu, A.M.; Bălășescu, E.; Pandia, L.D.; Nedelcu, R.I.; Brînzea, A.; Turcu, G.; Antohe, M.; Ion, D.A. Vitiligo—Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review. J. Pers. Med. 2022, 12, 2048. https://doi.org/10.3390/jpm12122048
Chivu AM, Bălășescu E, Pandia LD, Nedelcu RI, Brînzea A, Turcu G, Antohe M, Ion DA. Vitiligo—Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review. Journal of Personalized Medicine. 2022; 12(12):2048. https://doi.org/10.3390/jpm12122048
Chicago/Turabian StyleChivu, Ana Maria, Elena Bălășescu, Larisa Diana Pandia, Roxana Ioana Nedelcu, Alice Brînzea, Gabriela Turcu, Mihaela Antohe, and Daniela Adriana Ion. 2022. "Vitiligo—Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review" Journal of Personalized Medicine 12, no. 12: 2048. https://doi.org/10.3390/jpm12122048
APA StyleChivu, A. M., Bălășescu, E., Pandia, L. D., Nedelcu, R. I., Brînzea, A., Turcu, G., Antohe, M., & Ion, D. A. (2022). Vitiligo—Thyroid Disease Association: When, in Whom, and Why Should It Be Suspected? A Systematic Review. Journal of Personalized Medicine, 12(12), 2048. https://doi.org/10.3390/jpm12122048