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Healthy lifestyle choices: new insights into vitiligo management.

  • 2024-11-18
  • Frontiers in immunology 15
    • Xin Liang
    • Fei Guo
    • Qian Fan
    • Xiaoce Cai
    • Jiao Wang
    • Jiale Chen
    • Fang Liu
    • Yuhua Du
    • Yan Chen
    • Xin Li

Study Design

Type
Meta-Analysis
Sample size
n = 542
Population
8,542 patients with vitiligo
Methods
Four databases (PubMed, Embase, Cochrane, and China National Knowledge Internet) were searched for articles published between 1980 and December 2022. Keywords such as smoking, drinking, exercise, diet, and sleep were used.

Background

The treatment of vitiligo is complex, and providing guidance based on lifestyle habits is a good option that has not been summarized or analyzed.

Objective

To elucidate the relationship between vitiligo and lifestyle factors.

Methods

Four databases (PubMed, Embase, Cochrane, and China National Knowledge Internet) were searched for articles published between 1980 and December 2022. Keywords such as smoking, drinking, exercise, diet, and sleep were used.

Results

Based on the search strategy, 875 relevant studies were retrieved, and 73 were included in this study, of which 41 studies with 8,542 patients with vitiligo were included in the meta-analysis. Vitamin C [mean difference (MD), -0.342; 95% confidence interval (CI), -1.090-0.407; p >0.05), folic acid (MD, -1.463; 95% CI, -7.133-4.208; p >0.05), and selenium (MD, 0.350; 95% CI, -0.687-1.387; p >0.05) levels did not differ between the groups. Vitamin E (MD, -1.408; 95% CI, -2.611--0.206; p <0.05), vitamin B12 (MD, -0.951; 95% CI, -1.672--0.275; p <0.05), copper (MD, -0.719; 95% CI, -1.185--0.252, p <0.005), and zinc (MD, -0.642; 95% CI, -0.731--0.554; p <0.001) levels were lower in the vitiligo group than in the control group. The serum iron level of the vitiligo group was significantly higher than that of the control group (MD, 1.181; 95% CI, 0.390-1.972; p <0.005). Finally, more participants in the vitiligo group smoked and drank alcohol than those in the control group.

Limitations

Most studies are from Eastern countries; thus, extrapolating these results to Western populations is questionable. The significant heterogeneity may be attributed to the different stages, types, duration, center settings, population registries, etc., which seriously impair the validity of the results.

Conclusions

Patients with vitiligo should reduce smoking and alcohol consumption and take appropriate vitamin E, B12, copper, and zinc supplements. However, vitamin C, vitamin D, selenium, iron, and folic acid supplements are unnecessary. Moreover, they should consider sun protection and avoid permanent hair dye use. Patients with vitiligo may experience sleep disturbances and sexual dysfunction, and these patients should seek help from a specialist if necessary.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails, identifier CRD42023480757.

Research Insights

  • Copper→Reduced Copper Level

    copper (MD, -0.719; 95% CI, -1.185--0.252, p <0.005) ... levels were lower in the vitiligo group than in the control group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Iron→Improved Iron Levels

    The serum iron level of the vitiligo group was significantly higher than that of the control group (MD, 1.181; 95% CI, 0.390-1.972; p <0.005).

    Effect
    Harmful
    Effect size
    Moderate
  • Selenium→Reduced Selenium Level

    selenium (MD, 0.350; 95% CI, -0.687-1.387; p >0.05) levels did not differ between the groups.

    Effect
    Neutral
    Effect size
    Small
  • Vitamin B12→Reduced Vitamin B12 Level

    vitamin B12 (MD, -0.951; 95% CI, -1.672--0.275; p <0.05) ... levels were lower in the vitiligo group than in the control group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Vitamin B9→Reduced Folic Acid Level

    folic acid (MD, -1.463; 95% CI, -7.133-4.208; p >0.05) ... levels did not differ between the groups.

    Effect
    Neutral
    Effect size
    Small
  • Vitamin C→Reduced Vitamin C Level

    Vitamin C [mean difference (MD), -0.342; 95% confidence interval (CI), -1.090-0.407; p >0.05] ... levels did not differ between the groups.

    Effect
    Neutral
    Effect size
    Small
  • Vitamin E→Reduced Vitamin E Level

    Vitamin E (MD, -1.408; 95% CI, -2.611--0.206; p <0.05) ... levels were lower in the vitiligo group than in the control group.

    Effect
    Beneficial
    Effect size
    Moderate
  • Zinc→Reduced Zinc Level

    zinc (MD, -0.642; 95% CI, -0.731--0.554; p <0.001) levels were lower in the vitiligo group than in the control group.

    Effect
    Beneficial
    Effect size
    Large
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