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Exposome Risk Factors for Vitiligo: A Systematic Evidence Review.

Jaime Piquero-Casals1, Clémence Bertold2, Agustín Alomar3

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Environmental factors like drugs, chemicals, and infections are key triggers for vitiligo onset and progression. Lifestyle factors also play a role, but require further investigation for definitive links to this autoimmune skin disorder.

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Area of Science:

  • Dermatology
  • Autoimmune Diseases
  • Environmental Health

Background:

  • Vitiligo is an autoimmune skin condition influenced by multiple factors, including environmental exposures.
  • The role of the exposome in vitiligo pathogenesis is increasingly recognized but not systematically reviewed.
  • Understanding environmental triggers is crucial for managing vitiligo onset and progression.

Purpose of the Study:

  • To systematically review and evaluate the evidence linking exposomal factors to vitiligo.
  • To focus on quantifiable associations and the quality of evidence for environmental triggers.
  • To synthesize findings on factors contributing to vitiligo onset, flares, and progression.

Main Methods:

  • Systematic literature search of PubMed and Embase databases up to August 25, 2024.
  • Adherence to PRISMA 2020 guidelines and PROSPERO registration (CRD42024529828).
  • Inclusion of observational studies, case series, clinical trials, and pharmacovigilance reports, with narrative synthesis of findings.

Main Results:

  • Drug-associated vitiligo, especially from immune checkpoint inhibitors (7-25% in melanoma patients), shows robust evidence.
  • Phenol-based chemicals are consistently linked to melanocyte toxicity.
  • COVID-19 infection showed a modest increased risk (HR ≈ 1.11), while vaccination did not; other factors like stress, trauma, and smoking had lower-level evidence.

Conclusions:

  • Environmental factors, including medications, chemicals, and infections, are significant triggers for vitiligo.
  • Further research is needed to clarify the role of lifestyle factors in vitiligo development and exacerbation.
  • This review underscores the importance of considering environmental exposures in vitiligo management and research.