All of Us: An Analysis of the Current Vitiligo Treatment Landscape in America

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In a new analysis, data from the National Institute of Health’s “All of Us” campaign was used to assess the US’s current landscape in vitiligo management.¹ Investigators evaluated trends in diagnosis, treatment, comorbidities, genetics, and ethnicities from over 200,000 patients.

Study Method

The cross-sectional study, which took place from 2017 to 2022, used the “All of Us” research program. This controlled tier dataset (Version 7) comes from the National Institute of Health’s large-scale initiative for patients with vitiligo, which has never been seen at this size before.² This program also has a large push for diversity, as many recruited participants come from underrepresented groups. Surveys, health records, and genomic data from 206,173 patients were utilized. Treatment regimens were separated into these categories to be evaluated;

• Topical corticosteroids (betamethasone)
• Topical pimecrolimus and topical tacrolimus
• Oral corticosteroids (dexamethasone, prednisone)
• JAK inhibitors (ruxolitinib)
• Other oral immunosuppressive drugs (azathioprine, cyclosporine, methotrexate, and minocycline)

To assess the prescribing rates in patients with comorbid conditions, those with type 1 diabetes mellitus, autoimmune thyroid disease (Hashimoto’s and Grave’s Diseases), and systemic lupus erythematosus were compared to those with just vitiligo. The investigators also recorded age distribution and gene variants for further analysis.

Diagnosis Trends

Although diagnoses have increased over the last 6 years, females of all ages typically had higher rates of diagnosis. Most diagnoses occurred later between the ages of 40 and 70 years in both sexes. Additionally, there were diagnosis peaks in 2018 and 2019 and then decreases in 2020, due to the COVID-19 pandemic. This overall increase could be because of increased disease awareness, knowledge via social media, and the availability of modern therapies.

Treatment Trends

Oral corticosteroids were the most commonly used drug in both males and females. At the time of this study, there was little data on the use of JAK inhibitors. For topical medications, pimecrolimus and tacrolimus are generally prescribed more than topical corticosteroids. Even so, the use of oral medications is greater than that of topical prescriptions, especially when it comes to long-term management as about 40% of patients with vitiligo experience relapse.³

Comorbidity Trends

Patients with systemic lupus erythematosus were more likely to receive topical (OR (95% CI) 2.89 (1.35–6.20), p = 0.0101) or oral corticosteroids (OR (95% CI) 1.88 (1.04–3.41), p = 0.0382). Other oral immunosuppressive drugs were also prevalent (OR (95% CI) 3.97 (1.83–8.60), p = 0.0016) as conditions like systemic lupus erythematosus often require oral therapy to manage the disease.

Genetic and Ethnic Trends

While assessing single nucleotide polymorphisms (SNP) with vitiligo risk, it was found that HLA-DRA SNPs A, D, E and HLA-G SNP D are associated with an increased incidence of vitiligo. More specifically, in Caucasian patients, only HLA-DRA SNP A and HLA-G SNP D are connected while intragenic region SNP B in African American and Hispanic patients are linked to a higher risk.

In non-MHC/HLA genes for all ethnicities, NOTCH4 SNPs A and B are associated with a higher incidence while TYR SNP C shows a decreased incidence. After further analysis, PTPN22 and NOTCH4 SNP F are connected to a lower risk in Black patients and NOTCH4 SNP D shows a lower risk in Hispanic patients.

“This genetic variation is also extremely important to keep in mind when developing new therapies for vitiligo, as these differences could impact efficacy and the development process,” the authors wrote.

Conclusion

Although there may be some small discrepancies with electronic data or self-reports, the research does provide some valuable novel insights into the current landscape of the disease. Understanding the type of care patients are receiving is vital in improving future outcomes like management strategies and overall quality of life.

“As public awareness of this disorder increases, it is important to understand how the general population—including patients from diverse ethnic backgrounds and with co-existing conditions—may be impacted,” the authors concluded.

References

1. Gupta AK, Economopoulos V. Epidemiology, genetics and management of vitiligo in the USA: an All of Us investigation. J Dermatolog Treat. 2025;36(1):2471451. doi:10.1080/09546634.2025.2471451

2. LaBerge GS, Bennett DC, Fain PR, Spritz RA. PTPN22 is genetically associated with risk of generalized vitiligo, but CTLA4 is not. J Invest Dermatol. 2008;128(7):1757-1762. doi:10.1038/sj.jid.5701233

3. Seong SH, Oh SH. Up-and-Coming Drugs for the Treatment of Vitiligo. Ann Dermatol. 2024;36(4):197-208. doi:10.5021/ad.24.038