Psychiatric Comorbidities, Quality-of-Life Burdens Associated with Pediatric Vitiligo

Pediatric vitiligo is linked with increased symptom burden, psychiatric comorbidity prevalence, and mild-to-moderate quality of life (QoL) impairment, new findings suggest, indicating the necessity of psychosocial evaluation integration.1

These results were the conclusion of a recent analysis conducted to expand upon the previously sparse pediatric data on psychiatric comorbidities and QoL outcomes in vitiligo, with investigators seeking to identify factors linked with increased mental health burdens. Chaocheng Liu, MD, from the Department of Dermatology and Skin Science at the University of British Columbia, Vancouver, led a team of investigators in authoring this study.

In their analysis, Liu and coauthors highlighted prior systematic reviews largely aimed at adult subjects, noting the distinct problems faced by pediatric populations related to acceptance among peers and related issues.2

“Despite evidence linking childhood vitiligo experiences to lasting psychosocial impairments, systematic reviews specifically addressing psychiatric and QoL outcomes in pediatric patients remain limited,” Liu et al said.1 “This systematic review synthesizes evidence on psychiatric comorbidities and QoL in pediatric vitiligo, including clinical and demographic correlates.”

Study Design and Findings on Psychosocial Burdens

The investigative team implemented a systematic search following PRISMA guidelines was conducted using the Embase, Pubmed, and MEDLINE databases, with searches being from inception through March 15, 2025. Research deemed eligible by the team would include pediatric patients with vitiligo in the age range of 0–18 years. Such patients would have been assessed via validated psychiatric or QoL measures.

Liu and colleagues had 2 authors assigned to screen the studies independently on Covidence and extracted data, with discrepancies being addressed through consensus. Quality of data was evaluated by the investigators through the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence. The team used random-effects meta-analyses for outcomes reported consistently across eligible studies to obtain pooled means, with 95% confidence intervals (CI) and I2 for heterogeneity.

The certainty of available evidence collected from databases was assessed by Liu et al via the Grading of Recommendations, Assessment, Development, and Evaluation framework. There were 14 studies (n = 1576) included in the final analysis.

Overall, the investigative team found pooled means for depression (CDI: 9.93) and anxiety scores (STAI-State: 37.07; STAI-Trait: 38.27) did not exceed thresholds for probable clinical diagnosis, noting heterogeneity was considerable. In their pooled means for QoL burden (CDLQI: 3.00; PedsQL: 80.55), the team's data suggested mild-to-moderate QoL impairment.

Multiple individual comparative studies were shown to identify greater psychiatric symptom burden and increased prevalence of depression and anxiety among patients with vitiligo versus controls. Subgroup findings from selected studies also suggested worsened QoL among adolescents and those with extensive or visible lesions.

Consequently, the team's conclusions pointed to pediatric vitiligo as being linked with elevated psychiatric comorbidity prevalence, mild-to-moderate QoL impairment, and symptom burdens among included studies. These data point to the necessity for clinicians to pursue the integration of psychosocial assessments into routine care.

Despite such findings, Liu and coauthors did note the restrictions of their conclusions by limited and heterogeneous data. Pooled estimates did not exceed clinical thresholds, heterogeneity was substantial, and much of the data was drawn from small, cross-sectional studies. Therefore, higher-quality longitudinal research with standardized outcome measures is essential to characterize the magnitude and trajectory of psychosocial burden more accurately in pediatric vitiligo.

“Future efforts should validate pediatric-specific vitiligo QoL tools and conduct well-powered longitudinal studies. Current evidence emphasizes the importance of incorporating routine mental health screening and multidisciplinary support into pediatric dermatology care for children with vitiligo,” the investigators concluded.1

References

1. N Tarafdar, M Varambally, C Liu. Psychiatric Comorbidities and Quality-of-Life Burden in Pediatric Patients With Vitiligo: A Systematic Review and Meta-Analysis. Pediatric Dermatology (2025): 1–11, https://doi.org/10.1111/pde.70066.

2. Silverberg JI, Silverberg NB. Quality of life impairment in children and adolescents with vitiligo. Pediatr Dermatol. 2014 May-Jun;31(3):309-18. doi: 10.1111/pde.12226. Epub 2013 Oct 18. PMID: 24304125.