A large U.S.-based cohort analysis found that pediatric vitiligo may be associated with increased risks of sensorineural and mixed hearing loss, along with a transient elevation in certain retinal and choroidal disorders.
Investigators analyzed electronic health records from 89 health care organizations on 21,833 pediatric patients with vitiligo and an equal number of matched controls. The study population included children younger than 18 years diagnosed between January 2016 and December 2024. After propensity-score matching, both groups had a mean age of 9.6 years, and males represented 50.1% of the vitiligo cohort. Baseline data showed that 27% of patients were Hispanic or Latino, 14.1% were Black or African American, 6.6% were Asian, and 44.7% were White. Comorbidities included type 1 diabetes (1.1%), thyroid disease (2.9%), alopecia areata (0.8%), psoriasis (0.5%), and systemic connective tissue disorders (0.5%).
There was a significantly higher risk for sensorineural hearing loss in patients with vitiligo, with a hazard ratio (HR) of 1.86 (95% confidence interval [CI] = 1.38–2.51). There was also an elevated risk for mixed hearing loss (HR = 2.10; 95% CI = 1.29–3.44). No significant difference in risk was observed for conductive hearing loss between patients with vitiligo and matched controls (HR = 1.23; 95% CI = 0.98–1.55).
Time-stratified analyses showed that sensorineural hearing loss risk increased after the first year of follow-up. Between 1 and 3 years, the HR was 2.03 (95% CI = 1.21–3.41), rising to 2.56 (95% CI = 1.55–4.22) after 3 years. Mixed hearing loss risk was highest in the first year (HR = 4.87; 95% CI = 1.65–14.4), but not elevated thereafter.
Researchers also identified an elevated risk for retinal and choroidal disorders (HR = 1.56; 95% CI = 1.06–2.31), including chorioretinal inflammation, degeneration, retinal detachments, breaks, and other abnormalities. However, this association was not sustained in sensitivity or time-stratified analyses, and the study found no overall association between vitiligo and vision impairment (HR = 0.91; 95% CI = 0.81–1.03), dry eye disease (HR = 1.30; 95% CI = 0.95–1.80), uveitis (HR = 1.65; 95% CI = 0.89–3.06), or glaucoma (HR = 1.34; 95% CI = 0.90–2.01).
The investigators noted that melanocyte destruction in vitiligo may contribute to hearing loss, as melanocytes in the cochlea regulate ion channels essential for hearing. The increasing risk of sensorineural hearing loss over time may reflect cumulative cochlear damage, they hypothesized.
Limitations of the study included its retrospective design; reliance on ICD-10-CM coding; absence of data on vitiligo severity, phenotype, or location; and lack of audiometric and visual function testing. The rarity of some outcomes may also have introduced bias.
The authors concluded that pediatric vitiligo was associated with increased risks of sensorineural and mixed hearing loss, but not with ocular conditions overall. They called for further prospective studies to clarify these associations and guide clinical management.
Full disclosures can be found in the published study.
Source: JAMA Dermatology
