COVID‐19 vaccine–associated vitiligo: A cross‐sectional study in a tertiary referral center and systematic review

Abstract

Vitiligo is an autoimmune skin disorder that occurs due to immunemediated loss of functional melanocytes, leading to patchy skin depigmentation. The triggering of an autoimmune phenomena in patients infected with coronavirus disease 2019 (COVID-19) and those receiving COVID-19 vaccinations has been increasingly reported, and these adverse events have also been seen in vitiligo. Cases of new-onset and exacerbation of vitiligo following COVID-19 vaccination have been reported in individuals of all ages, ethnicities, and with different vaccine types. While current guidelines and consensus recommend COVID-19 vaccination for most patients, including those with autoimmune diseases, 1,2 practitioners must assess the risk and potential for disease onset or flare-up. According to the Taiwan Centers for Disease Control, around 21.7 million people in our population have received at least one primary COVID-19 vaccine, with 94% of them having been vaccinated, while 88% have received at least two doses and 74% have received at least three doses. In light of the emergence of new Delta and Omicron variants, booster vaccination programs are now underway to enhance the humoral response. Some eligible groups can now receive the fourth vaccination booster and a fifth booster dose of Moderna's next-generation bivalent vaccine.Our study aims to report the incidence of vitiligo following primary and booster COVID-19 vaccines. We retrospectively reviewed electronic medical records of new-onset and exacerbations of vitiligo following COVID-19 vaccinations at our vitiligo clinic, which is located at a tertiary referral center. In addition, we conducted a systematic review to analyze the current evidence regarding COVID-19 vaccine-associated vitiligo. | MATERIAL S AND ME THODSWe conducted a retrospective study at our vitiligo clinic, which is located at a Taiwanese tertiary medical center (Chang Gung Memorial Hospital, Linkou, and Taipei branches). The study included patients with new-onset vitiligo or exacerbations of preexisting vitiligo that were diagnosed within a month of receiving COVID-19 vaccination between January 1, 2021, and September 30, 2022. We clinically diagnosed vitiligo based on the presence of acquired amelanotic macules and patches with well-defined margins and typical distribution. Wood's lamp examination was used to identify vitiligo lesions

Impact of COVID-19 Vaccine and COVID-19 Infection on Vitiligo Activity and Progression

“… 2 Tsai et al conducted a systematic review and reported that 12 patients had new-onset vitiligo, while the other two had preexisting vitiligo that was exacerbated by COVID-19 vaccination. 5 In our study, we found that most patients (104, 55.6%) had disease progression within 3 months after the second dose. Patients who were in active stage (OR = 0.182, 95% CI: 0.099–0.336) had higher risk for further progression.…”

Presentation of vitiligo in a case of COVID‐19 infection concomitant with receiving remdesivir

“…Moreover, evidence shows that SARS‐CoV‐2 vaccine is related to development of autoimmune diseases such as vitiligo 14,15 . In fact, vaccines stimulate the immune system to produce antibodies.…”

“…9 Moreover, evidence shows that SARS-CoV-2 vaccine is related to development of autoimmune diseases such as vitiligo. 14,15 In fact, vaccines stimulate the immune system to produce antibodies. Some of these antibodies may be more harmful to the host, as they can provoke autoimmune diseases in genetically susceptible individuals.…”

Post-COVID pigment loss: the connection between vitiligo and the pandemic

“…A study by Tsai et al reported that the VASI score was significantly lower in COVID-19 patients with vitiligo than in those without vitiligo. This finding may suggest that COVID-19 may have a protective effect on vitiligo or that patients with less severe vitiligo may be more susceptible to COVID-19 [ 22 ]. While there are several studies that have reported a significant difference in age, duration, and VASI score between patients with vitiligo+COVID-19 and those with vitiligo only, there are also studies that have reported conflicting results.…”