The Effect of Isotretinoin on Vitiligo and Autoimmune Comorbidity

Several case reports have noted development of vitiligo as a potential side-effect of isotretinoin. In an IRB approved on-line survey of vitiligo patients we queried 1,301 vitiligo patients, 1115 with generalized vitiligo responding as to whether they had taken isotretinoin to address whether this issue was a common phenomenon amongst vitiligo patients. 3.6% of respondents had taken isotretinoin, 1.4% (n=16) before onset of vitiligo, and 2.2% (n=24) after onset of vitiligo. When compared with age-matched vitiligo peers who had not taken isotretinoin before onset of vitiligo (n=64), isotretinoin use prior to onset of vitiligo was associated with: decreased disease body surface area (conditional logistic regression: OR of BSA≥50% (95% CI)=0.12 (0.03-0.57), P=0.007); decreased odds of body and face involvement when compared with either body or face alone (OR (95% CI)=0.20 (0.06-0.73), P=0.02); and decreased co-morbid autoimmunity (OR (95% CI)=0.17 (0.04-0.58), P=0.01). The volume of isotretinoin usage in vitiligo patients is additionally suggestive of a link between cystic acne and vitiligo.