Lipid Risk Factors in Vitiligo: Homocysteine the Connecting Link?

Background: Vitiligo is an acquired, depigmenting skin disease with unclear, multifactorial etiopathogenesis affecting not only skin but also connected with metabolic abnormalities, including glucose and lipid abnormalities, confirming the systemic nature of the disease. Vitamin B12 and folic acid deficiencies have also been implicated in vitiligo that can lead to increased homocysteine levels in the circulation, a finding that can be expected in vitiligo. Further, an association between hyperlipidemia and hyperhomocysteinemia has been suggested in vitiligo patients showing the eminent need of management of vascular risk factors especially in diseases with metabolic abnormalities. The present study was thus aimed to assess homocysteine levels and lipid risk factors in vitiligo patients and to study their interrelationship to predict the cardiometabolic risk in vitiligo and its management.

Methods: The present cross-sectional study included 54 case of generalized vitiligo and 54 age and gender-matched healthy adults as controls. Patients were assessed for disease activity and severity (VASI Score). All the subjects were evaluated for the lipid profile and serum homocysteine levels.

Results: Lipid profile analysis showed significantly higher LDL-cholesterol concentration (p = 0.010), significantly lower HDL-cholesterol concentration (p = 0.003) and significantly higher LDL/HDL ratio (p = 0.001) in patients with vitiligo in comparison with the control group. The mean serum homocysteine levels in vitiligo patients (18.76 ± 10.02 µmol/L) were significantly higher than in controls (10.04 ± 5.34 μmol/L) (p = 0.000). Serum homocysteine levels showed a positive correlation with the duration of disease which was near to significant (p = 0.064) and VASI score (p = 0.000). No significant correlation was observed between serum Hcy levels and lipid profile.

Conclusions: The present study showed significantly higher Hcy levels in vitiligo patients than controls which may be a precipitating factor in the pathogenesis of vitiligo in predisposed individuals. The results of our study are also indicative of lipid disturbances in vitiligo. These findings may reflect some ongoing abnormal metabolic processes in patients with vitiligo. Therefore, we recommend routine estimation of homocysteine and lipid profile in vitiligo patients both of which should be regarded as independent significant contributing factors of cardiometabolic risk worth considering in the management of patients with vitiligo.