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Just under 2 million adults in the United States have vitiligo, an autoimmune disease that causes white patches on your skin. Recent evidence suggests a strong link between vitiligo and autoimmune Hashimoto’s thyroiditis.
It may seem odd that a skin condition is related to your thyroid function, but it is true. Ahead, learn about vitiligo and its link with autoimmune thyroiditis and hypothyroidism.
Vitiligo is an autoimmune condition that results in the skin losing color --- known as depigmentation. In vitiligo, your immune system destroys melanocytes, the cells that give skin pigment. As a result, patchy white areas appear on your skin.
Besides white patches of skin, symptoms and clinical presentation seen in patients with vitiligo may include:
- Premature graying of hair, including eyebrows, eyelashes, and facial hair
- Color changes inside your nose or mouth
- Inflammation of your eyes or ears
Vitiligo is classified into two types based on the appearance of the patches:
- Non-segmental vitiligo (NSV): Patches appear symmetrical and typically progress over time.
- Segmental vitiligo (SV): Patches only appear on one side of your body and stop progressing after 6 to 12 months.
Another significant difference between these two subtypes is the age at which the vitiligo patches start occurring. NSV is more common in adults, while SV is primarily seen in children. Overall, NSV is much more common than SV.
As mentioned, vitiligo is an autoimmune disorder. Like other autoimmune disorders, it is unclear what triggers the immune system to attack melanocytes. Those with a family history of vitiligo or other autoimmune diseases are at a higher risk. External vitiligo triggers may include stress, sunburn, or exposure to certain chemicals.
But, not all vitiligo is caused by an autoimmune disorder. SV is more frequently associated with allergic-related causes rather than autoimmunity, which is the primary cause of NSV.
Vitiligo patients with the NSV form of the disease are more likely to have another autoimmune disorder, with Hashimoto’s being the most common. And Hashimoto’s is the number one cause of hypothyroidism (low thyroid hormone levels).
Research shows that over 25% of those with vitiligo have mild or subclinical hypothyroidism. In some cases, people with subclinical hypothyroidism can develop overt hypothyroidism. Typically vitiligo will appear before the diagnosis of a thyroid disorder. It’s less common, but a thyroid diagnosis can sometimes come before the development of vitiligo.
Antibodies are your immune system’s way of tagging foreign invaders, allowing for easy identification and destruction. In autoimmune disorders, your body develops antibodies against your own cells, and the immune system mistakenly destroys healthy cells.
Studies have shown that thyroid antibodies are significantly higher in those with vitiligo than in healthy individuals. The most common antibodies seen are anti-thyroid peroxidase (TPOAb) and anti-thyroglobulin antibodies (TGAb).
One study showed that 40% of those with a progressive form of vitiligo had high TPO antibodies. Another study had similar results, with elevated levels of TG and TPO antibodies found in those with vitiligo.
In summary, the presence of thyroid antibodies in those with vitiligo may lead to overt hypothyroidism. But, less than 7% of those with an autoimmune thyroid disorder later develop vitiligo.
Those with vitiligo and Hashimoto’s have a predetermined set of genes susceptible to various triggers. These triggers, such as environmental ones, determine the onset of the disorder. At the same time, the genetic changes caused by the trigger determine the specific autoimmune disease. More research is needed, but vitiligo and autoimmune thyroid disorders may have a common set of susceptible genes.
Different types of skin cells also have thyroid-specific antigens, such as TG and TPO. So, as your immune system attacks your skin cells, you can develop antibodies against your thyroid, leading to full-blown autoimmune thyroid disease later.
It may sound unusual, but the specific location of skin depigmentation may signal the presence of autoimmunity.
Higher rates of depigmentation of the hands -- especially in areas around the joints -- are seen in those with an underlying autoimmune thyroid condition. Patients with discoloration primarily on their legs typically have non-autoimmune vitiligo.
Unfortunately, there’s no evidence that taking thyroid hormone replacement medication for hypothyroidism treats vitiligo or prevents the further destruction of melanocytes. However, there are various treatment options to manage -- not cure -- vitiligo.
Vitiligo treatment requires a consultation with a board-certified dermatologist. Together, you will come up with a treatment plan with the following goals in mind:
- Stop white patches from getting bigger
- Prevent new patches from appearing
- Restore skin color and achieve repigmentation
Vitiligo treatment options include:
- Topical prescription medications and creams applied to vitiligo patches or spots
- Oral medications
- Light therapy using different forms of light to help return color to the skin
- Laser treatments
- Surgery such as a cell transplant or a skin graft
- Makeup, self-tanners, and skin dyes
Janus kinase inhibitors (JAK inhibitors) are promising novel treatment options for vitiligo and are being studied to help manage melanocyte destruction in vitiligo. Ruxolitinib cream (Opzelura) is the first FDA-approved JAK inhibitor for skin repigmentation in people with vitiligo.
An important note: People with vitiligo should avoid sun exposure because they lack melanin, the body’s natural protection from the sun, making them more susceptible to sunburn and skin damage. Sunburn can also be a trigger for developing vitiligo. Experts recommend that people with vitiligo use broad-spectrum sun protection with an SPF of 30 and above and avoid sun exposure from 10 am to 4 pm
Given the strong association between Hashimoto’s, hypothyroidism, and vitiligo, if you have vitiligo, you should periodically have routine screening for thyroid dysfunction.
Paloma Health’s at-home testing kit gives you a complete picture of how your thyroid functions. It analyzes four common thyroid markers, including TPO antibodies, and only requires a finger prick blood sample. You can expect your results and a personalized analysis within five business days of mailing your sample.
Paloma Health’s support doesn’t have to stop once you get your test results. You can schedule a telemedicine appointment with one of our leading thyroid specialists. Our practitioners can further help you understand your results and develop a plan for optimal treatment of your hypothyroidism.