Vitiligo as a Potential Overlooked Comorbidity in Schizophrenia: Insights From Two Case Reports

The co-occurrence of dermatological and psychiatric conditions has long been recognized, owing in part to the shared ectodermal origin of the skin and the nervous system. Vitiligo, an autoimmune depigmenting disorder, and schizophrenia, a chronic psychotic illness increasingly associated with immune dysregulation, represent two conditions whose potential relationship remains insufficiently explored in the literature. We report two cases of male patients with long-standing schizophrenia who developed vitiligo over the course of their illness. The first patient, a 38-year-old man, presented with acrofacial vitiligo evolving over 11 years under long-acting injectable fluphenazine. The second patient, a 43-year-old man with a dark skin phototype, exhibited predominantly acral vitiligo with islands of repigmentation, evolving over 17 years, with exposure to haloperidol and chlorpromazine for 24 years. Both patients displayed classic schizophrenic symptomatology, including delusions, impaired judgment, and poor insight. The association between vitiligo and schizophrenia is supported by epidemiological evidence, with vitiligo patients carrying a significantly elevated risk of developing schizophrenia. Several converging biological mechanisms may underlie this relationship, including shared immune dysregulation, oxidative stress, lipid abnormalities, and a common neuroectodermal origin. Additionally, phenothiazine-class antipsychotics - to which both patients were exposed - have been shown to exert cytotoxic effects on melanocytes and inhibit melanogenesis in vitro, suggesting that drug-induced depigmentation may represent an additional contributing factor in this population. These cases illustrate the complex and potentially multifactorial relationship between vitiligo and schizophrenia. A holistic, interdisciplinary approach involving both dermatologists and psychiatrists is essential for the optimal management of patients presenting with both conditions. Further prospective and mechanistic studies are needed to better characterize the nature of this association and to identify potential shared therapeutic strategies.