Stress and vitiligo: a cause and effect relationship?

What is the impact of vitiligo on stress?

Vitiligo is a skin condition characterised by loss of pigmentation in certain areas of the body due to the destruction of melanocytes, which can have a significant psychological impact. Those affected may experience anxiety and stress due to the altered appearance of their skin, which can affect their self-esteem. This stress is often exacerbated by social stigma and difficulties in accepting the condition.

A study hypothesised that patients suffering from vitiligo are more prone to stress than those who are not affected. For this, 102 patients were analysed with 54.8% being men and 45.2% women, bearing in mind that women are often more prone to stress than men. Patients are more concerned about vitiligo developing in the most visible areas of their skin, which is why the study tracked the development of vitiligo in different parts of the body, particularly on visible areas. They found that people with vitiligo had more difficulty managing stress than the control group. Indeed, the study mentions an average PSS score (Perceived Stress Scale), which measures the level of stress, was higher in patients with vitiligo (19.3%), compared to the control group (13.8%), suggesting these patients experience a higher level of stress. Although in this study neither age, duration of vitiligo, nor disease status were associated with the perception of stress and the PSS only measures a person's perception of stress over the past few months, one could question the different factors that could explain the onset of this stress other than vitiligo.

Another study sought to evaluate the association between stress-related hormone levels and psychological stress in individuals with vitiligo. The 46 patients studied frequently experienced stress and anxiety, partly due to the stigma associated with the disease. The aim was therefore to determine the impact of stress hormones on this population. The results show that the levels of cortisol and dehydroepiandrosterone (DHEAS), a hormone associated with stress resistance, do not significantly differ between patients with vitiligo and healthy individuals. Indeed, the average DHEAS was 192.31 in the patients compared to 224.82 in the unaffected individuals. Moreover, the probability value obtained (P = 0.158) is above the threshold of 0.05 required to conclude a significant difference. These results therefore do not confirm a clear difference between the two groups.

However, a more in-depth analysis showed that, despite the absence of a significant statistical difference, healthy individuals generally had higher levels of DHEAS. This suggests that patients with vitiligo might have a reduced ability to manage stress. DHEAS indeed plays a crucial role in the modulation of cortisol effects, the stress hormone. A low level of DHEAS limits this natural protection, which could worsen the psychological state of patients. Moreover, DHEAS has antioxidant properties, helping to reduce oxidative stress. A deficiency in DHEAS could thus promote the worsening of depigmented lesions observed in vitiligo.

However, due to the small number of participants and the lack of significant results, further research is required to establish a clear link between vitiligo and impaired stress management.

Can stress cause vitiligo?

The relationship between stress and vitiligo is not one-directional. While vitiligo can cause stress and psychological disorders, some studies suggest that stress could also be a triggering factor for the disease.

As previously mentioned, one might wonder if a low DHEAS level could promote the onset of vitiligo. This hormone, with antioxidant properties, plays a role in regulating the immune and inflammatory response in stressful situations. An insufficient concentration of DHEAS could lead to an excessive inflammatory response, potentially triggering or exacerbating the disease. Furthermore, a questionnaire study was conducted among 1541 adults with vitiligo to assess the impact of psychological stress on the onset of the disease. The researchers first sought to establish a correlation between the occurrence of stressful events in the two years preceding the onset of vitiligo and the triggering of the disease. They also studied the impact of stress on the progression of vitiligo and the appearance of secondary symptoms.

The questionnaire, consisting of 77 questions, aimed to identify the psychological factors preceding the onset of vitiligo. The results show that 56.6% of participants (821 patients) experienced at least one stressful event in the two years preceding the onset of the disease. These data suggest that stress could potentially play a role in triggering vitiligo. However, due to the lack of significant difference, the study does not allow for a direct correlation between stress and vitiligo to be concluded.