Diabetes & Metabolic Syndrome: Clinical Research & Reviews
Original ArticleMetabolic syndrome in vitiligo patients among a semi-urban Maharashtrian population: A case control study
Introduction
Vitiligo—from Latin ‘vitium', meaning fault, or “vitelius” meaning, spotted calf [1]—is an acquired, depigmenting, idiopathic disease, resulting from the progressive loss of dihydroxyphenylalanine- positive melanocytes in the basal layer of epidermis and is clinically characterized by milky-white sharply demarcated macules/patches [2].
Vitiligo has recently been classified into 3 major forms—non-segmental, segmental and undetermined/unclassified [2]. Non-segmental vitiligo, by far the commonest form, is increasingly being considered a systemic disorder, rather than a mere depigmenting dermatosis, due to growing evidence of genetic, immunological, cytotoxic, neuronal, and inflammatory mechanisms in its complex multifactorial pathogenesis [3]. Among the many additional hypotheses put forward, lipid peroxidation—resulting from diminished scavenging of reactive oxygen species (ROS) by reduced number of melanocytes in the adipose tissue and having a significant role in the pathogenesis of metabolic syndrome—has also been shown to contribute to its pathogenesis, thereby raising the possibility of concurrence of metabolic syndrome and vitiligo [4]. The studies on this concurrence being scarce in English literature, one such was undertaken by us.
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Material and methods
After obtaining clearance from the Ethics Committee of our tertiary care institute, a total of one hundred patients aged >20 years and diagnosed by a dermatologist as having non-segmental vitiligo attending our dermatology outpatient were included in the study. Pregnant and lactating women were excluded. Equal number of controls were selected from among healthy volunteers awaiting cosmetic procedures. A detailed history including age, gender, smoking/alcohol consumption, diabetes mellitus,
Results
The study included 100 cases and 100 controls. The age of the cases ranged from 24 to 67 (mean: 43.5 ± 10.5) years and of the controls, 21 to 68 (mean: 42.3 ± 11.5) years; the male/female ratio of cases being 1.94:1 and controls, 1.77:1 [Table 1].
Waist circumference of cases ranged from 52 to 110 cm and of controls, 62 to 103 cm. Prevalence of obesity neither differed nor correlated significantly with increasing age, gender, smoking, or alcohol intake of either the cases or controls. The mean values of
Discussion
Metabolic syndrome—a constellation of interrelated risk factors of metabolic origin that appear to directly promote the development of atherosclerotic cardiovascular disease—was first described in 1923 by Kylin as clustering of hypertension, hyperglycaemia and gout [5].
Gerald Heaven, an American endocrinologist, in 1988 proposed the concept of ‘syndrome X’ encompassing 6 variables – high blood pressure, insulin resistance, hyperglycemia, hyperinsulinemia, increased plasma concentration of
Conclusion
The significant increase in the prevalence of metabolic syndrome and abnormalities of lipid components thereof in absence of significant differences in the waist circumference and BMI in vitiligo patients of our study would suggest that these lipid disturbances may plausibly have resulted from the disturbed metabolic processes in adipose tissue per se. However, the paucity of data regarding metabolic syndrome in patients of vitiligo in the Indian population necessitates further larger,
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