Vitiligo: The Association With Metabolic Syndrome and the Role of Simvastatin as an Immunomodulator

Abstract

Vitiligo is an autoimmune condition primarily affecting the skin where there is destruction of melanocytes characterized by pinkish-white patches on the skin. It is associated with other autoimmune diseases such as thyroid disease, rheumatoid arthritis, diabetes mellitus, and metabolic syndrome. Metabolic syndrome is a constellation of disorders including insulin resistance, hypertension, dyslipidemia, and obesity, and is considered a leading cause of cardiovascular morbidity. Simvastatin is a potent hypolipidemic drug that also possesses immunomodulating properties and is a common drug used in dyslipidemia and cardiovascular diseases. This study aimed to assess the association between vitiligo and metabolic syndrome and explore the immunomodulating properties of simvastatin for use in vitiligo. We reviewed various articles from PubMed, ResearchGate, and Google Scholar using different keywords and Medical Subject Headings and finalized 33 studies to be used in our review. The articles selected showed a positive association between vitiligo and metabolic syndrome or one of the component diseases of metabolic syndrome. The benefits of using simvastatin were also addressed by few articles attributing to its antioxidant and immunomodulating effect. However, there was no concrete explanation justifying the association between vitiligo and metabolic syndrome due to a limited number of studies and smaller sample size. Large-scale clinical trials should be conducted to evaluate the use of simvastatin as an immunomodulator in vitiligo to prevent possible metabolic complications.

Cardiovascular Disease-Associated Skin Conditions

“… 95 Also, simvastatin, a statin drug, has been tried as a vitiligo treatment, showing beneficial effects, attributed to its antioxidant and immunomodulating effect. 96 Despite these findings, further studies are needed.…”

Potential Role of Chronic Physical Exercise as a Treatment in the Development of Vitiligo

“…Today, little attention has been paid to the role of environmental factors like diet or PE training or the level of habitual physical activity in vitiligo disease. In fact, to the best of our knowledge, there are no studies focused on PE or habitual physical activity level and vitiligo disease, although several studies with similar etiological factors have consistently identified significant associations between vitiligo (as well as its severity) with MetS ( Ataş and Gönül, 2017 ; Sharma et al, 2017 ; Tanacan and Atakan, 2020 ; Verma et al, 2021 ) or related dysfunctions such as higher blood plasma concentrations of low-density lipoprotein (LDL- cholesterol), low high-density lipoprotein (HDL-cholesterol), and insulin resistance ( Karadag et al, 2011 ; Azzazi et al, 2021 ; Demirbaş et al, 2021 ; D’Arino et al, 2021 ). It is well established that a mainly sedentary lifestyle behavior and poor nutritional patterns are the most important risk factors for the onset of MetS or cholesterol disorders ( Lira et al, 2010 ; Edwardson et al, 2012 ).…”

“…Vitiligo severity has also been associated with metabolic syndrome (MetS), increasing the prevalence and incidence of MetS or associated disorders such as insulin resistance and hypercholesterolemia ( Ataş and Gönül, 2017 ; Sharma et al, 2017 ; Tanacan and Atakan, 2020 ; Verma et al, 2021 ). Etiologically, MetS are associated with a sedentary lifestyle ( Edwardson et al, 2012 ), cellular inflammation, and OS mechanisms ( Bonomini et al, 2015 ) that may be involved in the onset of vitiligo.…”

Natural and Synthetic Agents Targeting Reactive Carbonyl Species against Metabolic Syndrome

“…Simvastatin reduces myeloperoxidase-dependent AGE production, inhibiting macrophage RAGE expression. This effect, in turn, may help to stabilize plaques by blocking the release of PGE2-dependent MMPs that cause plaque rupture [ 105 ].…”

“…With the increase in evidence of the role of oxidative stress in the etiology of diabetes, there have been studies that cross-link the use of antioxidant Simvastatin against diabetes [ 107 ]. They have demonstrated a significant drop in the level of protein carbonyl groups, a type of AGE product in T2DM patients treated with Simvastatin [ 105 ]. This suggests that simvastatin could protect against protein damage in such patients.…”