Background: Vitiligo is a common disorder of depigmentation that has been associated with other autoimmune diseases. No recent large-scale data exist on the rates of comorbidities associated with vitiligo from the United States population. Objectives: To identify the prevalence of comorbidities as well as associated laboratory abnormalities in vitiligo patients. Methods: All medical records dating from January 1, 2000 to June 21, 2011 within the Research Patient Data Repository were evaluated retrospectively using a novel artificial intelligence-based computer program. A total of 3,280 patients carrying the diagnosis of vitiligo were identified using ICD-9 code 709.01. We randomly selected 300 patients and validated the diagnosis by manually reviewing their medical records. These results were used to create a model that was then applied to the larger set yielding 2,441 true vitiligo patients. 1,657 (68%) were diagnosed by dermatologists and 784 (32%) by non-dermatologists. We identified the prevalence of other comorbid autoimmune conditions by searching problem lists of vitiligo patients and collected laboratory data from the first available data point in the system for each patient. Results: Women were more frequently represented (57.6%) than men (42.4%). The majority of vitiligo patients were White/Caucasian (56.9%), followed by Hispanic/Latino (19.4%). 565 (23%) had one of the following comorbidities: 287 thyroid-related, 186 psoriasis, 72 rheumatoid arthritis, 59 alopecia areata, 55 inflammatory bowel disease, 53 systemic lupus and 20 type I diabetes mellitus. 41% had elevated anti-nuclear antibody levels. Almost half of the patients tested had elevated thyroid peroxidase antibodies. Over 50% of the patients tested had low or insufficient levels of 25-OH vitamin D. Conclusion: We found a high prevalence of comorbidities among individuals with vitiligo presenting to teaching hospitals in Boston, Mass. Comorbid autoimmune conditions were seen in 23% of vitiligo patients, thyroid disorders and psoriasis being the most common. Screening for these conditions, especially thyroid disorders, should be considered in vitiligo patients.

Keywords:
Vitiligo, Autoimmune, Comorbidity, Thyroid, Psoriasis
1.
Halder RM, Chappell JL: Vitiligo update. Semin Cutan Med Surg 2009;28:86-92.
2.
Akay BN, Bozkir M, Anadolu Y, Gullu S: Epidemiology of vitiligo, associated autoimmune diseases and audiological abnormalities: Ankara study of 80 patients in Turkey. J Eur Acad Dermatol Venereol 2010;24:1144-1150.
3.
Nunes DH, Esser LM: Vitiligo epidemiological profile and the association with thyroid disease. An Bras Dermatol 2011;86:241-248.
4.
Narita T, Oiso N, Fukai K, Kabashima K, Kawada A, Suzuki T: Generalized vitiligo and associated autoimmune diseases in Japanese patients and their families. Allergol Int 2011;60:505-508.
5.
Poojary SA: Vitiligo and associated autoimmune disorders: a retrospective hospital-based study in Mumbai, India. Allergol Immunopathol (Madr) 2011;39:356-361.
6.
Pradhan V, Patwardhan M, Thakkar V, Kharkar V, Khopkar U, Ghosh K, Weetman AP, Gawkrodger DJ, Kemp EH: 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;27:279-286.
7.
Shankar DSK, Shashikala K, Madala R: Clinical patterns of vitiligo and its associated co-morbidities: a prospective controlled cross-sectional study in South India. Indian Dermatol Online J 2012;3:114-118.
9.
D'Avolio LW, Nguyen TM, Farwell WR, Chen Y, Fitzmeyer F, Harris OM, Fiore LD: Evaluation of a generalizable approach to clinical information retrieval using the automated retrieval console (ARC). J Am Med Inform Assoc 2010;17:375-382.
10.
Farwell WR, D'Avolio LW, Scranton RE, Lawler EV, Gaziano JM: Statins and prostate cancer diagnosis and grade in a veterans population. J Natl Cancer Inst 2011;103:885-892.
11.
Dittmar M, Kahaly GJ: Polyglandular autoimmune syndromes: immunogenetics and long-term follow-up. J Clin Endocrinol Metab 2003;88:2983-2992.
12.
Zhu KJ, Lv YM, Yin XY, Wang ZX, Sun LD, He SM, Cheng H, Hu DY, Zhang Z, Li Y, Zuo XB, Zhou YW, Yang S, Fan X, Zhang XJ, Zhang FY: Psoriasis regression analysis of MHC loci identifies shared genetic variants with vitiligo. PLoS One 2011;6:e23089.
13.
Amerio P, Di Rollo D, Carbone A, Auriemma M, Marra ME, De Remigis P, Feliciani C, Tracanna M, Tulli A: Polyglandular autoimmune diseases in a dermatological clinical setting: vitiligo-associated autoimmune diseases. Eur J Dermatol 2010;20:354-358.
14.
Silverberg JI, Silverberg AI, Malka E, Silverberg NB: A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol 2010;62:937-941.
15.
Birlea SA, Costin GE, Norris DA: Cellular and molecular mechanisms involved in the action of vitamin D analogs targeting vitiligo depigmentation. Curr Drug Targets 2008;9:345-359.
16.
Yamanaka KI, Kakeda M, Kitagawa H, Tsuda K, Akeda T, Kurokawa I, Gabazza EC, Kupper TS, Mizutani H: 1,24-dihydroxyvitamin D (tacalcitol) prevents skin T-cell infiltration. Br J Dermatol 2010;162:1206-1215.
17.
Travis LB, Silverberg NB: Calcipotriene and corticosteroid combination therapy for vitiligo. Pediatr Dermatol 2004;21:495-498.
18.
Gamil H, Attwa E, Ghonemy S: Narrowband ultraviolet B as monotherapy and in combination with topical calcipotriol in the treatment of generalized vitiligo. Clin Exp Dermatol 2010;35:919-921.
19.
Oh SH, Kim T, Jee H, Do JE, Lee JH: Combination treatment of non-segmental vitiligo with a 308-nm xenon chloride excimer laser and topical high-concentration tacalcitol: a prospective, single-blinded, paired, comparative study. J Am Acad Dermatol 2011;65:428-430.
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2013
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