Vitiligo is a multifactorial, acquired depigmenting disorder of unclear etiology, with several theories proposed to explain its pathogenesis. Among these, autoimmune dysfunction remains the most widely supported mechanism.¹ Globally, vitiligo affects approximately 0.5% to 2.0% of the adult population, with the highest onset reported between 10 and 30 years of age.² Although the condition is not life-threatening, its clinical significance lies in its association with other autoimmune disorders such as Hashimoto’s thyroiditis, type 1 diabetes mellitus, and Addison’s disease.³˒⁴ Vitamin D is increasingly recognized for its immune regulatory functions. Previous studies have examined the role of vitamin D deficiency and vitamin D receptor (VDR) gene polymorphisms in autoimmune diseases, including vitiligo; however, the findings remain inconclusive.⁵ Given these uncertainties, the present study aimed to evaluate serum vitamin D levels in patients with vitiligo.

This hospital-based study was conducted from April 2020 to March 2021 in the Department of Dermatology, Bhima Bhoi Medical College, Balangir, following approval from the Institutional Ethics Committee. A total of 150 clinically confirmed vitiligo patients were enrolled. After obtaining written informed consent, detailed demographic and clinical histories were recorded. Comprehensive dermatological examinations, including mucocutaneous assessment, were performed to document vitiligo subtype and features such as trichrome patterns, quadrichrome patterns, and leukotrichia. Relevant systemic evaluations were conducted to screen for associated autoimmune or endocrinological disorders. Blood samples were collected for serum vitamin D measurement. The comparison group consisted of age- and sex-matched healthy controls without dermatological or autoimmune diseases. Data analysis was performed using R software (version 4.x.). Descriptive statistics were generated and comparisons between groups were assessed using the Chi-square test and Student’s t-test. Statistical significance was set at p ≤ 0.05.

A total of 150 participants were enrolled in the study, comprising 75 clinically diagnosed vitiligo cases and 75 age- and sex-matched healthy controls. Table 1 summarizes the demographic characteristics of the study population. Among the cases, 43 (57.3%) were males and 32 (42.7%) were females, whereas the control group consisted of 41 (54.7%) males and 34 (45.3%) females. The mean age of the vitiligo cohort was 35.2 ± 10.4 years, while the mean age among controls was 36.8 ± 9.9 years. No statistically significant differences were observed between the groups with respect to age or sex distribution (p > 0.05). Table 1. Demographic characteristics of study participants Variable Cases (n=75) Controls (n=75) Male, n (%) 43 (57.3%) 41 (54.7%) Female, n (%) 32 (42.7%) 34 (45.3%) Mean age (years) ± SD 35.2 ± 10.4 36.8 ± 9.9 p-value >0.05 — Table 2 shows the distribution of serum vitamin D concentrations across both groups. Vitamin D deficiency (10–30 ng/mL) was identified in 47 (62.7%) of vitiligo cases and severe deficiency (<10 ng/mL) in 19 (25.3%) of cases. In contrast, the control group demonstrated largely normal vitamin D levels (>30 ng/mL) in 48 (64.0%) participants, with deficiency observed in 22 (29.3%) and severe deficiency in only 5 (6.7%). Statistical comparison revealed a significant association between vitamin D status and vitiligo (p < 0.05). Table 2. Serum vitamin D3 levels in cases and controls Vitamin D status (ng/mL) Cases (n=75) Controls (n=75) <10 (Severe deficiency) 19 (25.3%) 5 (6.7%) 10–30 (Deficiency) 47 (62.7%) 22 (29.3%) >30 (Normal) 9 (12.0%) 48 (64.0%) Total 75 75 p-value 0.0016 For further analysis, participants were categorized into age groups to assess patterns of vitamin D distribution (Table 3). Notably, severe deficiency was more common among vitiligo patients in the 20–40 year age range compared to older individuals, although this trend did not achieve statistical significance (p > 0.05). These findings suggest that reduced vitamin D levels may be more prominent among younger vitiligo patients. Overall, the results indicate that hypovitaminosis D was substantially more prevalent in vitiligo patients compared to healthy controls. Statistical analysis conducted using R software (version 4.x) confirmed a significant difference in serum vitamin D levels between cases and controls. Table 3. Comparison of serum vitamin D status with age distribution among participants Age Group (years) Severe Deficiency Deficiency Normal p-value <20 4 (5.3%) 5 (6.7%) 3 (4.0%) >0.05 20–40 12 (16.0%) 32 (42.7%) 18 (24.0%) >0.05 >40 8 (10.7%) 32 (42.7%) 36 (48.0%) >0.05 The prevalence of vitamin D deficiency was significantly higher in vitiligo patients compared to healthy controls. Furthermore, the distribution pattern indicates that both deficiency and severe deficiency clusters predominantly among younger vitiligo patients. While the age-group comparison did not reach statistical significance, the observed trends support the hypothesis that vitamin D dysregulation may contribute to vitiligo pathophysiology.

In the present study, a statistically significant association was observed between vitiligo and reduced serum vitamin D levels. Among the 75 vitiligo cases, only a small proportion exhibited normal vitamin D levels, whereas the majority demonstrated deficiency or severe deficiency. In contrast, most healthy controls had normal serum vitamin D concentrations. These findings highlight a possible link between hypovitaminosis D and vitiligo pathogenesis and are consistent with previously published research. Vitamin D plays a recognized role in immune regulation, melanocyte differentiation and melanogenesis, suggesting that vitamin D deficiency may influence the development or progression of vitiligo via immunomodulatory pathways. The results of the present study align with those of Varikasuvu et al.⁶, who demonstrated significantly lower serum vitamin D concentrations in patients with vitiligo compared to controls. Their meta-analysis further revealed that indoor/urban workers had more pronounced deficiency than outdoor/rural individuals, suggesting that environmental factors and sun exposure may modulate vitamin D status among individuals with vitiligo. Similarly, Mahmmod et al.⁷ examined vitamin D levels in vitiligo patients and reported a high prevalence of deficiency, particularly among female patients. Although no significant relationship was found between vitamin D levels and disease extent, their findings support the observation that hypovitaminosis D is common in vitiligo. The absence of a correlation with severity indices such as the Vitiligo Extent Tensity Index (VETI) suggests that vitamin D deficiency may be more relevant to disease susceptibility than to disease severity. Karagün et al.⁸ evaluated serum vitamin D concentrations in vitiligo patients compared with controls and reported lower levels in the vitiligo group, although the difference did not achieve statistical significance. Their conclusion that the causal direction remains uncertain reflects ongoing debate about whether vitamin D deficiency contributes to vitiligo pathogenesis or simply coexists due to behavioral, environmental or autoimmune factors. In a case-control study conducted by Saleh et al.⁹, markedly lower serum 25(OH)D levels were observed in vitiligo patients compared with matched controls, with deficiency documented in over 97% of the vitiligo cohort. They further noted that the presence of systemic autoimmune disease did not significantly alter vitamin D levels among vitiligo patients. Their findings reinforce the hypothesis that vitamin D deficiency may constitute a shared immune dysregulation factor rather than a consequence of disease severity or duration. Taken together, these studies, along with the findings of the present investigation, suggest a consistent pattern of reduced serum vitamin D levels in individuals with vitiligo. While vitamin D deficiency alone may not determine disease severity, its immunoregulatory properties and effects on melanocyte biology provide biological plausibility for a contributory role in vitiligo pathophysiology. Furthermore, sunlight exposure — a key determinant of cutaneous vitamin D synthesis — may represent a modifying factor in disease expression and warrants further exploration. However, it remains unclear whether hypovitaminosis D is a causal factor, a consequence of photoprotection practices among patients, or an epiphenomenon associated with autoimmunity. Longitudinal studies and interventional trials, particularly those assessing vitamin D supplementation, may clarify the clinical relevance of correcting vitamin D deficiency in vitiligo patients.

The findings of the present study demonstrate a significant association between vitiligo and reduced serum vitamin D levels. Vitamin D deficiency and severe deficiency were markedly more prevalent in vitiligo patients compared to healthy controls, suggesting that hypovitaminosis D may play a role in disease predisposition or reflect underlying immune dysregulation associated with vitiligo. While the study supports a potential link between vitamin D status and vitiligo, it does not establish causality, and the clinical relevance of correcting vitamin D levels in these patients remains to be fully elucidated. Given the biological functions of vitamin D in melanocyte regulation and immune modulation, further research—particularly longitudinal studies and randomized supplementation trials—is warranted to assess whether vitamin D optimization can influence disease onset, progression, or therapeutic response. Routine screening for vitamin D status in vitiligo patients may be considered, especially in populations at high risk for deficiency. Excellent — your references section is complete and correctly formatted for dermatology literature. If you plan to finalize the manuscript, here’s how the Conclusion + References would appear together in a clean, journal-ready format: Conclusion The present study demonstrated a significant association between vitiligo and reduced serum vitamin D levels, with deficiency being substantially more common among vitiligo patients compared to healthy controls. Although the findings support a potential contributory role of vitamin D in vitiligo pathophysiology, the relationship appears associative rather than causal. Given the immunomodulatory and melanocyte-regulatory functions of vitamin D, further prospective and interventional studies are warranted to determine whether vitamin D supplementation may influence disease onset, activity, or treatment response. Screening for vitamin D deficiency may be considered in clinical practice, particularly in populations at increased risk for hypovitaminosis D.

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