Insulin resistance and metabolic syndrome in patients with vitiligo: a systematic review and narrative synthesis

Abstract

Vitiligo is a chronic autoimmune skin disorder characterized by the loss of melanocytes. Recent studies suggest an association between vitiligo and systemic metabolic abnormalities, including insulin resistance (IR) and metabolic syndrome (MetS). This systematic review aimed to assess the prevalence of IR and MetS in patients with vitiligo and examine their potential relationship with disease severity and duration. Following PRISMA guidelines, a systematic search of PubMed and Web of Science databases was conducted up to April 16, 2025. A total of 33 studies involving 4,286 vitiligo patients were included. Data regarding metabolic parameters, IR (primarily assessed using HOMA-IR), and MetS (most commonly defined by NCEP-ATP III criteria) were extracted and analyzed. The prevalence of MetS among vitiligo patients ranged from 6.7% to 50.7%, with a pooled rate of 34.3%, compared to 18.6% in control groups. IR, based on HOMA-IR values, was more frequent in vitiligo patients (56.5%) than in controls (32.9%). Several studies reported positive associations between metabolic abnormalities and higher vitiligo severity scores (e.g., VASI, VIDA) or longer disease duration, although findings were inconsistent across studies. Vitiligo appears to be linked to an increased metabolic risk profile. Further prospective, multicenter studies are needed to better understand this relationship and its potential implications for clinical management.