Dr John Harris Discusses Vitiligo and the Most Common Comorbidities of the Disease

Vitiligo, an autoimmune disease of the skin, can be debilitating for patients. While more study is needed to better understand relationships, John Harris, MD, PhD, details the most common comorbidities of vitiligo. Dr Harris is the chair of dermatology, founding director of the Vitiligo Clinic and Research Center, and founding director of the Autoimmune Therapeutics Institute at UMass Medical School in Worcester, MA.

Transcript

Dr Harris: Hashimoto's thyroiditis is probably the most common comorbidity that we see, and it happens in about 17% to 20% of vitiligo patients, about one in five. That one's the most common. Other autoimmune diseases occur more commonly in vitiligo than in the control population. Having vitiligo puts you on an increased risk of getting many different autoimmune diseases, but unlike Hashimoto's thyroiditis, the other ones are still very uncommon.

I live in the Northeast, and a common term that we'll use is wicked: that's wicked bad, or that's wicked good even. What I tell people is, for example, Addison's disease. The risk of Addison's disease is about 80-fold more increased if you have vitiligo. I say, Addison's disease is wicked rare. If you take wicked rare and multiply it by 80, it's still wicked rare. [laughs] We still very rarely see Addison's disease in vitiligo patients even though the risk is much higher, 80-fold increase. Other things, type 1 diabetes is increased, lupus is increased.

I tell people, even though there's this increased risk for autoimmunity with vitiligo, you're still unlikely to get any of these. You're more likely to have that vitiligo—80% of patients with vitiligo will only ever get vitiligo—about 20% that, 17% of thyroid, maybe 3% of some others are comorbidities.

There's also some belief in data to support the idea that hearing can be changed if you have vitiligo, and sometimes people get visual symptoms. Those aren't well-established. We don't have good numbers to know how many. As far as I know, we haven't had people go deaf from having vitiligo, but some subtle frequency changes in their hearing.

Finally, there's a syndrome called the Vogt-Koyanagi-Harada syndrome, which essentially begins with flu-like symptoms and meningitis pain, headaches, photosensitivity, but then is followed by vitiligo. Eye changes, vision changes, sometimes pain in the eye, and that can cause blindness.

That's a very rare syndrome where you get vitiligo plus eye symptoms and headaches and things, but most people don't have that. Nobody goes from having regular vitiligo to Vogt-Koyanagi-Harada syndrome. They all start with the headaches and then visual changes and then vitiligo comes later.