It’s essential for physicians to consider the psychological effects on patients with vitiligo in addition to the physiological elements of the disease.


Vitiligo, a chronic condition characterized by loss of skin pigmentation, can impact patients’ psychological well-being, according to clinical research. Studies show that vitiligo has been associated with generalized anxiety and depressive disorders, social phobias, obsessive symptoms, and hypochondria. Other analyses have shown that stress may trigger the progression of vitiligo. Furthermore, research has shown that certain patient characteristics like gender and skin color can impact QOL in people with vitiligo in different ways.

“Published studies have individually investigated how neuroticism, stress, anxiety, and depression are associated with the onset and development of vitiligo,” says Emerson Do Bú, PhD candidate. “Among people with vitiligo, social contact with others who do not have the skin condition and the constant worry about the development and appearance of new vitiligo spots on the body may generate higher levels of rumination.”

For a study published in Acta Psychologica, Do Bú and colleagues aimed to verify how stress and rumination affect the relationship between neuroticism, anxiety, and depression symptoms in both men and women with vitiligo. The study team also examined if gender might favor the onset or worsening of the psychological consequences of these disorders. “We jointly investigated these psychological aspects and proposed a predictive model for anxiety and depression in people with vitiligo,” adds Do Bú. “This is important because it combines multiple psychological dimensions in predicting anxiety and depression disorders that appear to commonly impact people with vitiligo.”

Stress and Rumination Impact Psychological Well-Being

The study, which included 324 individuals with vitiligo, demonstrated that the relationship between neuroticism, anxiety, and depression is mediated by stress and rumination. Most of the patient population was classified as “normal” with regards to stress, anxiety, or depression. However, more than 11% of participants displayed stress, anxiety, and depression scores that ranged from moderate to extremely severe (Table). “In general, the higher the level of neuroticism of people with vitiligo, the greater their levels of stress and rumination,” explains Do Bú. “In turn, the more stress and rumination, the higher the anxiety and depression symptomatology of this social group.”

In addition, the study investigated the impact of differences by gender, income, skin color, and time with vitiligo. “In women with vitiligo, reflection and stress predicted anxiety and depression symptoms,” Do Bú says. “In men, brooding predicted anxiety and depression symptoms.” Participants who were from lower-income households had higher scores on the constructs of neuroticism, stress, rumination, anxiety, and depression constructs when compared with those from higher-income households. In addition, it was observed that people who had vitiligo for less than 12 years showed greater brooding than those who had it for longer than 12 years.

Findings May Help Envision How Patients Are Managed

The study results indicate that psychological processes appear to aggravate anxiety and depression in people with vitiligo. “Based on our data, it’s essential to consider the psychological effects of having vitiligo in addition to treating the physiological elements of the disease,” says Do Bú. “We recommend that dermatologists and psychologists review the psychological factors investigated in our study to help envision the management of patients with vitiligo while also accounting for their mental healthcare. An interdisciplinary healthcare group can map out therapeutic possibilities, tailoring treatments based on the unique characteristics of patients.”

Findings from the study may guide future research and clinical interventions for this patient population. Do Bú and colleagues note that it is critical to consider the psychological consequences of vitiligo, not just its physiological aspects. “We propose that future research investigate how the treatment of anxiety and depression in individuals with vitiligo contributes to remission of the skin disease in a practical and longitudinal manner,” Do Bú says. “A study of this nature is necessary because patients with vitiligo consistently attribute its onset and progression to psychological causes and mental issues.”