Serum level of antioxidant vitamins and minerals in patients with vitiligo, a systematic review and meta-analysis

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Abstract

Background

Antioxidant status is considered as important factor in the pathogenesis of vitiligo. However, there are controversial findings about serum status of antioxidants in vitiligo patients. The purpose of this study was to systematically review the evidences comparing the serum levels of antioxidant vitamins and minerals between vitiligo patients and controls, and performing meta-analysis of the results.

Methods

A comprehensive search was performed for studies comparing the serum status of antioxidant vitamins and minerals using following databases since inception up to 30 April 2020; PubMed, EMBASE, Scopus, and Web of Science. Data extraction was done by two independent reviewers. The data was pooled for serum level of each antioxidant comparing between vitiligo and control groups.

Results

Thirteen studies were included in this systematic review. The serum level of vitamin A, C, E, selenium, zinc and copper were compared between vitiligo patients and controls in these studies. Eleven studies including 570 vitiligo cases and 580 controls were included in the meta-analysis. Serum vitamin A and copper level in vitiligo patients were only evaluated in single studies and not included in meta-analysis. Based on fixed effect model, there were no statistical difference between two groups regarding serum vitamin C (OR = 1.17, 95 % CI, 0.74–1.84, P = 0.495), and vitamin E (OR = 0.61, 95 % CI, 0.30–1.25, P = 0.180). Higher serum zinc can decrease the risk of vitiligo based on sensitivity analysis of the results. (OR = 0.29, 95 % CI 0.15−0.54, P < 0.001). Higher serum selenium level significantly increased the risk of vitiligo (OR = 4.31, 95 % CI, 2.72–6.81, P < 0.001). Vitamin A was not significantly different in two reported groups (6.35 ± 1.53 vs 6.77 ± 1.46 μg/mL, P > 0.05). Copper was significantly higher in vitiligo patients compared to controls (129 ± 33 vs 99 ± 19 μg /100 mL, P = 0.002).

Conclusion

The current meta-analysis of data on serum level of most studied antioxidants (vitamin C, vitamin E, zinc and selenium) in patients suffering vitiligo showed that higher serum selenium (OR = 4.31) and lower zinc level (OR = 0.29) can increased the risk of vitiligo. Potential mechanism associated with preventive effects of zinc and the depigmentation effect of selenium should be more elucidated in further studies.

Introduction

Vitiligo is a common acquired hypopigmentation disorder of the skin, mucous membranes and the retina [1]. The mean prevalence of vitiligo is estimated to be 0.2 % in population studies [2]. Vitiligo affects all age groups, all races and both sexes with higher prevalence in adult African females [2]. This disorder has major impact on quality of life of patients [3].

The pathophysiology of vitiligo is remained unclear. Oxidative stress has been evaluated as an important factor in the pathophysiology of vitiligo [4]. Some studies have demonstrated impaired antioxidant function in melanocytes of patients with vitiligo [5]. Melanocyte degeneration caused by free radical damage is shown in patients with vitiligo. Reduced catalase activity is previously demonstrated in the blood of vitiligo patients [6]. It is also shown to be associated with significant rise in epidermal free radicals [6] Serum level of different antioxidant vitamins and minerals including vitamin A, C, E, selenium, zinc and copper have been compared between patients with vitiligo and controls in different studies. However, the results are controversial.

The purpose of this study was to systematically review the evidences comparing the serum level of antioxidant vitamins and minerals between vitiligo patients and controls, and performing meta-analysis of the results.

Section snippets

Search strategy

A comprehensive search was performed to retrieve any study comparing the serum status of antioxidant vitamins and minerals from published literature. The following databases were evaluated since inception up to 30 April 2020; PubMed, EMBASE, Scopus, and Web of Science. The term “vitiligo” was added to keywords of antioxidants including “antioxidant”, “antioxidative”, “vitamin”, “zinc”, “selenium”, “copper” and “zinc” for database search. This review was restricted to studies reported in the

Description of search

After searching all international databases, 132 articles were found and after removing duplicate articles, 72 articles were examined in terms of topic and abstract, out of which 36 articles entered the next stage. After reviewing their topics and abstracts at this stage, the full texts of the articles were examined and 13 articles entered the systematic review. The serum level of vitamin A, C, E, selenium, zinc and copper w ere compared between vitiligo patients and controls in these studies.

Discussion

The importance of antioxidant activity in the pathogenesis of vitiligo has been evaluated in multiple investigations [19]. Stress, considered as initiating event in many patients with vitiligo, causes catecholamines rise in microenvironment of melanocytes [20] which is followed by sympathetic induced vasoconstriction of the dermis vasculature and cell damage by accumulation of free radicals [21].

Some researches on antioxidants status in vitiligo have shown no significant change in the systemic

Conclusion

The current meta-analysis of the results of 10 researches on serum level of most studied antioxidants in patients suffering vitiligo showed that higher serum selenium (OR = 4.31) and lower zinc level (OR = 0.29) can increased the risk of vitiligo. Potential mechanism associated with preventive effects of zinc and the depigmentation effect of selenium should be more elucidated in further studies.

Declaration of Competing Interest

No conflict of interest.

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