Heterogeneity of anxiety in vitiligo: A systematic review and quantitative analysis with a focus on adolescents

Although anxiety has emerged as a prevalent comorbidity among vitiligo patients, a comprehensive investigation into its relationship with the disorder, incorporating recent discoveries, remains elusive.

This study aims to conduct a systematic review with quantitative synthesis examining the anxiety-vitiligo relationship across populations, with an emphasis on adolescents.

A systematic search was conducted across four major databases, spanning their inception to April 30, 2025. Quantitative analysis was performed using Stata 18.0, employing subgroup and sensitivity analyses to explore and address the heterogeneity across the pooled results.

A total of 26 studies were evaluated, revealing that anxiety is present in 33.5 % of patients with vitiligo. The pooled results indicated a 1.84-fold elevated risk of anxiety in these patients in comparison to controls (95 %CI [1.50, 2.26], P < 0.001). Subgroup analyses identified a significant age-dependent risk gradient, with the children and adolescent cohort demonstrating substantially greater vulnerability (OR = 2.77, 95 %CI [1.80-4.26], P < 0.001) compared to adult populations (OR = 1.67, 95 %CI [1.25-2.22], P < 0.001). Meanwhile, vitiligo patients exhibited significantly higher mean anxiety scores than controls (SMD = 1.26, 95 %CI [0.09, 2.43], P = 0.034).

Our findings show that vitiligo and anxiety are related across varieties of age groups, which may raise awareness of the regarding the anxiety associated with vitiligo among physicians and patients. Future research should focus on standardized assessments and mechanisms underlying the anxiety-vitiligo relationship to inform comprehensive treatment strategies, particularly for adolescents. However, our results should be interpreted cautiously due to the broad diversity of anxiety measurement methods and the high level of heterogeneity across studies.