The known melanocyte destruction explains the hearing loss, but not the visual disorders.
A first-of-its-kind study from the US links paediatric vitiligo with auditory and ocular manifestations.
Vitiligo has been linked to hearing loss and ocular disorders in adults. But less is known about these relationships in children, where the majority of vitiligo’s disease burden occurs.
Now, a new research letter published in JAMA Dermatology reports that children with vitiligo are 86% more likely to develop sensorineural hearing loss (SNHL) and 56% more likely to develop retinal and choroidal disorders compared to children without vitiligo.
Researchers retrospectively analysed electronic health record data from over 40,000 paediatric patients in the US. A total of 21,833 children with vitiligo were matched with vitiligo-free children on a 1:1 basis according to their age, sex, race, socioeconomic status, history of congenital abnormalities affecting the eye, ear, face or neck and the presence of autoimmune conditions such as type 1 diabetes, alopecia, psoriasis and thyroid diseases.
Paediatric patients with vitiligo were more likely to go on to develop SNHL (hazard ratio 1.86, 95% confidence interval 1.38-2.51), mixed hearing loss (2.10, 1.29-3.44) and retinal and choroidal disorders (1.56, 1.06-2.31) compared to children who did not have vitiligo.
Further analyses revealed that the association between vitiligo and SNHL was more prominent in patients followed up one to three years (2.03, 1.12-3.14) or more than three years (2.56, 1.55-4.22) after being diagnosed with vitiligo compared to patients followed up in the first 12 months after receiving their diagnosis.
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There was no association between being diagnosed with vitiligo and the manifestation of conductive hearing loss, vision impairment, dry eye disease, uveitis or glaucoma. There was also no association between time since vitiligo diagnosis and the likelihood of developing retinal and choroidal disorders.
The researchers hypothesised that the sensorineural and mixed hearing loss was due to the autoimmune destruction of melanocytes – which regulate ion channels required for hearing – in the skin and inner ears.
“[This] attack could eventually lead to SNHL, while conductive hearing loss rarely occurs without additional contributing factors. Our observation of increased SNHL risk, particularly after the first year of follow-up, aligns with the theory that hearing loss develops progressively through cumulative cochlear damage, correlating with disease duration and extent,” they wrote.
The researchers were less confident about the potential mechanism underlying the association between vitiligo and the likelihood of developing retinal and choroidal disorders. Unlike cochlear melanocytes, retinal melanocytes are not involved in visual processing, acuity or perception.
“Prior research has primarily reported an association between vitiligo and retinal pigment abnormalities and, more recently, an association with retinal detachment, although the underlying mechanism remains unclear… Further prospective studies are needed to illuminate the mechanisms underlying these associations and guide clinical practice,” the researchers concluded.
The study was limited by its retrospective design and the absence of important data relating to the severity, phenotypes and location of vitiligo. Data from further audiometry and/or visual function testing were also not available.
