Psychosocial Effects of Vitiligo: A Systematic Literature Review

Am J Clin Dermatol. 2021 Nov;22(6):757-774. doi: 10.1007/s40257-021-00631-6. Epub 2021 Sep 23.


Background: Patients with vitiligo experience reduced quality of life.

Objective: To comprehensively describe the available evidence for psychosocial burden in vitiligo.

Methods: A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis.

Results: Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1-62.3%) and anxiety (20 studies, 1.9-67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3-100%), adjustment disorders (12 studies, 4-93.9%), sleep disturbance (seven studies, 4.6-89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0-81.8%), and avoidance or restriction behavior (12.5-76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment.

Limitations: Available studies were heterogeneous and often had limited details; additionally, publication bias is possible.

Conclusions: The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease.

Protocol registration: PROSPERO (CRD42020162223).

Publication types

  • Systematic Review

MeSH terms

  • Adaptation, Psychological
  • Adjustment Disorders / epidemiology*
  • Adjustment Disorders / psychology
  • Age Factors
  • Body Surface Area
  • Clinical Trials as Topic
  • Comorbidity
  • Female
  • Humans
  • Male
  • Observational Studies as Topic
  • Personality Disorders / epidemiology*
  • Personality Disorders / psychology
  • Prevalence
  • Quality of Life*
  • Risk Factors
  • Severity of Illness Index
  • Social Stigma*
  • Vitiligo / complications
  • Vitiligo / diagnosis
  • Vitiligo / epidemiology
  • Vitiligo / psychology*