LISBON – Comorbid vitiligo and psoriasis is a red flag signaling the need to dig deeper looking for potentially associated diseases, including cardiovascular, autoimmune, or psychiatric diagnoses.
A study of 154 Italian vitiligo patients showed that a family history of cardiovascular disease was present in none of 54 participants with vitiligo alone compared to one-third of the 19 patients with both vitiligo and psoriasis, Dr. Silvia Moretti reported at the annual congress of the European Academy of Dermatology and Venereology.
Subjects with strong genetic loading for either or both of the skin diseases also tended to have an increased prevalence of a positive family history of cardiovascular disease, although this trend did not reach statistical significance. For example, a family history of cardiovascular disease was present in 10% of 52 patients with vitiligo and a family history of vitiligo, 13% of 15 patients with vitiligo as well as a family history of both vitiligo and psoriasis, and 18% of the 16 patients with vitiligo and a family history of psoriasis, according to Dr. Moretti of the University of Florence.
Similarly, a strong family history of hypertension was present in 4% of vitiligo patients, 8% of those with both vitiligo and a family history of vitiligo, 13% with vitiligo and a family history of both psoriasis and vitiligo, 25% of vitiligo patients with a family history of psoriasis, and 26% of patients carrying diagnoses of both vitiligo and psoriasis but no family history of either dermatologic disease. In only the group with both vitiligo and psoriasis was a family history of hypertension significantly more common than in patients with vitiligo alone.
The investigators also checked for a grab bag of comorbid, nondermatologic diseases they suspect might be genetically linked to vitiligo and psoriasis, including lupus, celiac disease, megaloblastic anemia, and allergic rhinitis. Vitiligo patients with a family history of both vitiligo and psoriasis had a 47% prevalence of one or more of these conditions, significantly greater than in the other subgroups, where the prevalence ranged from 11% to 37%. In patients with comorbid vitiligo and psoriasis but no family history of either skin disease, the rate was 21%.
The prevalence of a diagnosed psychiatric disorder was zero in patients with vitiligo with or without a family history of vitiligo, 7% in those with vitiligo and a family history of both vitiligo and psoriasis, 6% in those with vitiligo and a family history of psoriasis, and 5% in patients with comorbid vitiligo and psoriasis.
Seventy-two percent of patients with both vitiligo and psoriasis were Fitzpatrick phototype 2 and the rest were phototype 3. Seventy-nine percent of those with vitiligo and a family history of both psoriasis and vitiligo were phototype 2, as were 56% of vitiligo patients with a family history of psoriasis.
In contrast, 60% of patients with only vitiligo were phototype 3 and 40% were phototype 2. The same 60/40 split held for patients with vitiligo and a family history of vitiligo.
Dr. Moretti declared having no financial conflicts of interest.