Review: Serum Concentrations of Vitamin D, Vitamin E, and Zinc Lower in Patients With Vitiligo

Individuals with vitiligo generally exhibit significantly lower serum concentrations of vitamin D, vitamin E, and zinc versus an otherwise healthy population, according to a review published in the Journal of the European Academy of Dermatology and Venereology.¹

In addition, levels of selenium and folic acid tend to be significantly higher in patients with vitiligo, while serum levels of vitamin B12 and copper do not exhibit detectable differences among individuals.

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Background and Methods

Researchers Iraji et al noted that because autoimmune and genetic factors have historically been considered important to the pathophysiology of vitiligo,² researchers have previously explored the relationship between pigmentation, oxidative stress, and serum levels of vitamins A, B, C, D and E, zinc, selenium, iron and copper.³

Despite this existing research, authors of the review argue that the findings remain inconclusive and controversial in nature. Thus, they sought to better understand existing scientific literature related to the role of vitamins and minerals in vitiligo.

The scoping review examined English and Persian language papers uploaded to PubMed, EMBASE, Scopus, Web of Science, Magiran, SID, and ISC through December 2022. Key search terms included "vitiligo," "depigmented lesions," and names of respective vitamins and minerals, among others.

Studies included in the review were observational in nature and met population–exposure–comparator–outcome criteria, while in vitro studies or studies involving animal subjects, were excluded from the review.

Findings

The initial search yielded a total of 281 studies, which involved the filtering of studies from databases and the identification of studies identified from citation searches. Of these, only 47 papers were included in the final review.

The review uncovered a significant difference in copper levels between vitiligo patients and healthy individuals, with low heterogeneity. Sensitivity analysis showed that after excluding one study, the difference in copper levels was no longer significant.

Researchers noted a significant difference in vitamin E levels between patients with vitiligo and healthy subjects, with patients showing lower levels of vitamin E. There was significant heterogeneity in the results, indicating variability across studies.

Zinc levels were also significantly lower in patients with vitiligo compared to healthy controls with considerable heterogeneity.

For vitamin D, no significant difference in levels was observed between patients with vitiligo and healthy individuals, despite high heterogeneity. Likewise, selenium levels did not show a significant difference between patients with vitiligo and healthy controls initially, though there was high heterogeneity. However, sensitivity analysis indicated that after excluding one study, selenium levels were significantly higher in vitiligo patients.

Furthermore, there was no significant difference in folic acid levels between vitiligo patients and healthy controls, with low heterogeneity. Sensitivity analysis revealed that after excluding a specific study, folic acid levels were significantly higher in patients with vitiligo.

No significant difference was found in vitamin B12 levels between vitiligo patients and healthy subjects, with high heterogeneity.

Conclusions

Researchers concluded that the amount of evidence suggestive of the role of vitamin C, vitamin A, and iron was insufficient to include in the analysis, calling for additional, larger population-based studies.

Limitations of the review include a limited number of studies leading to limited/non-easily generalizable data, as well as the potential implications of disease status when it comes to serum levels.

"Our meta-analysis revealed no significant differences in serum levels of Vitamin B12 and copper. It was concluded that serum concentrations of Vitamin D, Vitamin E and zinc were lower in vitiligo patients. Conversely, these patients exhibited higher levels of selenium and folic acid compared with healthy individuals," wrote Iraji et al. "Overall, this result may be effective in determining the course of treatment and whether to prescribe supplements or not."

References

1. Iraji F, Seyedyousefi S, Heidari A. Serum vitamins and trace elements in vitiligo patients: A systematic review and meta-analysis of observational studies. J Am Acad Dermatol Venereol. April 28, 2024. https://doi.org/10.1002/jvc2.432
2. Alkhateeb A, Fain PR, Thody A, Bennett DC, Spritz RA. Epidemiology of vitiligo and associated autoimmune diseases in Caucasian probands and their families. Pigm Cell Res. 2003; 16(3): 208–214.
3. Huo J, Liu T, Huan Y, Li F, Wang R. Serum level of antioxidant vitamins and minerals in patients with vitiligo, a systematic review and meta-analysis. J Trace Elem Med Biol. 2020; 62:126570.