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. 2016 Sep 27;11(9):e0163806. doi: 10.1371/journal.pone.0163806

The Prevalence of Vitiligo: A Meta-Analysis

Yuhui Zhang 1, Yunfei Cai 1, Meihui Shi 1, Shibin Jiang 1, Shaoshan Cui 2,*, Yan Wu 1,*, Xing-Hua Gao 1, Hong-Duo Chen 1
Editor: Naoki Oiso3
PMCID: PMC5038943  PMID: 27673680

Abstract

Objective

To conduct a meta-analysis assessing the prevalence of vitiligo.

Methods

Literatures that reported prevalence rates of vitiligo were identified using EMBASE, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and Weipu database for the period from inception to May 2016. We performed stratified analyses on possible sources of bias, including areas difference, years of publication, gender and age. Publication bias was assessed with Egger’s test method.

Results

A total of 103 studies were eligible for inclusion. The pooled prevalence of vitiligo from 82 population- or community-based studies was 0.2% (95%CI: 0.1%–0.2%) and from 22 hospital-based studies was 1.8% (95%CI: 1.4%–2.1%). A relatively high prevalence of vitiligo was found in Africa area and in female patients. For population- or community-based studies, the prevalence has maintained at a low level in recent 20 years and it has increased with age gradually. For hospital-based studies, the prevalence has showed a decreased trend from 60s till now or from young to old. No significant publication bias existed in hospital-based studies (t = 0.47, P = 0.643), while a significant publication bias existed in population- or community-based studies (t = 2.31, P = 0.026).

Conclusion

A relatively high prevalence of vitiligo was found in Africa area and in female patients. The prevalence has maintained at a low level in recent years. It showed an inverse trend with age increment in population- or community-based studies and hospital-based studies.

Introduction

Vitiligo refers to an acquired, idiopathic, and common de-pigmentation disorder of the skin [1]. The clinically characteristic symptoms of the vitiligo are pale or milk-white macules or patches due to the selective destruction of melanocytes. They occur on the skin in different parts of the body and sometimes also on the mucous membranes. The exact pathogenesis of vitiligo is still to be elucidated. Multiple mechanisms, including metabolic abnormalities, oxidative stress, generation of inflammatory mediators, cell detachment and autoimmune responses, might contribute to the pathogenesis. In particular, the autoimmune mechanism is now clearly established. Vitiligo may appear at any age and affect both sexes. It tends to occur or recur in spring and/or summer [2, 3].

Some previous reports on vitiligo epidemiology were based on population surveys, while others were performed in patients of dermatology clinics. However, the prevalence of vitiligo varies in different geographic regions and different sample size, and the data have limitations and localizations. Besides, the disorder afflicts various ethnic populations with varying prevalence estimates ranging from 0.1% to 2.0% based on the general populations in previous studies [4, 5]. But recently, some papers suggested that previous epidemiological data were exaggerated. To date, no meta-analysis on the prevalence of vitiligo has been conducted. Accordingly, it seems that an international and pooled estimate based on the various populations is necessary.

The main objective of this meta-analysis is to summarize all available data to give a description of a worldwide picture on the prevalence of vitiligo. The information was collected from both population- or community studies and hospital-based studies. Various epidemiological characteristics of vitiligo were studied in order to understand this disease more clearly.

Materials and Methods

Search Strategy

We conducted a systematic search of scientific databases, including EMBASE, PubMed, the Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang database and Weipu database to find relevant papers published from inception to May 2016. The search medical subject heading (MeSH) terms and keywords were “vitiligo” OR “leucoderma” AND “prevalence” OR “epidemiology”. In addition, a manual search was supplemented by verifying a secondary review of the reference lists of key publications to confirm additional relevant citations.

Inclusion and Exclusion Criteria

The criteria of included studies were as follows: (1) had sufficient information to estimate the pooled prevalence of vitiligo; (2) population-based, community-based or hospital-based; (3) published in either English or Chinese language.

The exclusion criteria of studies were: (1) irrelevant to vitiligo; (2) irrelevant to our topic; (3) review; (4) duplicate data.

Data Extraction

The whole potentially relevant information from the included studies was independently reviewed by two investigators (Yuhui Zhang, Meihui Shi) using a standardized form which was designed in advance. When there was a disagreement about whether selecting articles should be resolved for analysis or not, a third investigator (Yunfei Cai) made the final decision. The following information was extracted from each suitable study: first author’s name, years of publication, country, survey age, gender of the participants, survey year, total sample size, numbers of vitiligo and prevalence rate.

Data Analysis

All statistical analyses were made using Stata software (version 12.0; Stata Corporation, College Station, Texas, USA) and the meta package was used to produce the pooled estimates, forest plots and publication bias assessment. Initially, the pooled prevalence estimates of vitiligo and 95% confidence intervals (CIs) were calculated assuming a fixed-effect model when significant heterogeneity was absent (P>0.1, I2<50%). If significant heterogeneity was present (P<0.1, I2>50%), a random-effect model was selected. To determine possible causes of heterogeneity, subgroup analyses were conducted by areas, years of publication, gender, and age. The areas covered Asia (India, China, Saudi Arabia, Sri Lanka, Turkey, Nepal, Iran, Korea, Kuwait, Thailand, Japan, Jordan), Africa (Tanzania, Egypt, Mali, Mozambique, Nigeria, Congo), America (USA, Brazil, Mexico, West Indies), Europe (Denmark, Sweden, Italy, Germany, Romania, France), Oceania (Australia) and Atlantic (Faroe Islands). For publication years, studies were grouped into eight periods, including 1 period before 80s and 7 periods after 80s with an interval of 5 years. For subgroup analysis according to age, it was grouped into four sections with an interval of 20 years. Publication bias was assessed by visually inspecting funnel plots and applying Egger’s tests to evaluate sources of variability. For all tests, P value < 0.1 was considered to be statistically significant.

Results

Literature search

A total of 1731 titles and/or abstracts of relevant studies were retrieved, and 1586 papers were removed due to irrelevance or review. The full-texts of remaining 145 papers were further reviewed, and 42 papers were excluded because of duplication and not providing sufficient information. Finally, 103 studies met the inclusion criteria and were included in this meta-analysis [6–108]. The flow chart of study selection process was shown in Fig 1.

Fig 1. Flow diagram of the study selection process.

Fig 1

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Flow diagram of the study selection process.

Study characteristics

Of the 103 studies, 82 were population- or community-based studies and 22 were hospital-based studies. The countries were Faroe Islands, India, Denmark, USA, Australia, Sweden, Brazil, China, Italy, Germany, Tanzania, Saudi Arabia, Romania, Sri Lanka, Egypt, France, Turkey, Mali, Mozambique, Nepal, Iran, Korea, Mexico, Kuwait, West Indies, Thailand, Nigeria, Japan, Congo, Jordan and the areas covered Asia, Africa, America, Europe, Oceania and Atlantic. The years of publication ranged from 1964 to 2015. The sample size of included studies ranged from 102 to 50593516. The prevalence of vitiligo ranged from 0.004% to 9.98%. The characteristics of included studies were summarized in Table 1.

Table 1. Characteristics of studies on the prevalence of vitiligo.

First Author Publication Year Country Survey Age (years) Survey Year Sample (N) Vitiligo (n) Prevalence
Population or community-based studies
Lomholt G [6] 1964 Faroe Islands all - 10984 7 0.06%
Mehta NR [7] 1973 India all 1971~1972 9065 138 1.52%
Howitz J [8] 1977 Denmark all 1971~1972 47033 179 0.38%
Johnson MT [9] 1978 USA 1~74 1971~1974 20749 102 0.49%
Quirk CJ [10] 1979 Australia adults - 1037 12 1.16%
Larsson PA [11] 1980 Sweden 12~17 - 8298 33 0.40%
Weismann K [12] 1980 Denmark 55~106 - 584 7 1.20%
Bechelli LM [13] 1981 Brazil 6~16 1974~1975 9955 4 0.04%
Zhou YH [14] 1985 China all 1985 13390 1 0.01%
Das SK [15] 1985 India ≥3 1978~1982 15685 72 0.46%
Montagnani A [16] 1985 Italy 1month~12years 1979~1982 1273 12 0.94%
Nanda A [17] 1989 India ≤6 weeks 1986 310 1 0.32%
Schallreuter KU [18] 1991 Germany 14~86 1989 350 2 0.57%
Xue SQ [19] 1994 China 42~60 1992 5683 72 1.27%
Cellini A [20] 1994 Italy 23~79 1990~1992 526 2 0.38%
Wang WX [21] 1994 China all 1984~1985 316379 294 0.09%
Gibbs S [22] 1996 Tanzania all - 1114 3 0.27%
Guan JC [23] 1997 China 15~20 1997 2206 1 0.05%
Bhatia V [24] 1997 India 0~14 1988~1989 666 4 0.60%
Kubeyinje EP [25] 1997 Saudi Arabia 18~45 1991~1995 1520 5 0.33%
Ren XL [26] 1998 China - - 155000 15 0.01%
Sun TQ [27] 1999 China 1~79 1996 78021 93 0.12%
Liao WQ [28] 1999 China - 1997 3560 4 0.11%
Popescu R [29] 1999 Romania 6~12 1995 1114 3 0.27%
Perera A [30] 2000 Sri Lanka all 1997 1806 22 1.22%
Ling WJ [31] 2001 China - 1999~2000 102 1 0.98%
Xie PL [32] 2001 China 0~7 - 23052 1 0.004%
Che DF [33] 2001 China - 1998~1999 3160 2 0.06%
Sun ZX [34] 2001 China 0~7 1999~2000 10804 2 0.02%
Zhang JQ [35] 2002 China 21~51 1999 641 3 0.47%
Zhang BX [36] 2002 China 17~31 1998~2000 3761 7 0.19%
Chen XQ [37] 2002 China - 2001 11389 5 0.04%
Prahalad S [38] 2002 USA - - 496 2 0.40%
Yang XQ [39] 2002 China 16~24 2001~2002 2188 20 0.91%
El-Serag HB [40] 2002 USA 59.8113.41 1992~1999 136816 130 0.10%
Dogra S [41] 2003 India 6~14 2001 12586 272 2.16%
Abdel-Hafez K [42] 2003 Egypt all 1994~1996 8008 98 1.22%
Xu YY [43] 2003 China all - 156461 279 0.18%
Li PH [44] 2003 China all 2002 13953 3 0.02%
Wolkenstein P [45] 2003 France all 2002 18137 51 0.28%
Zeng YH [46] 2004 China 6~12 2002 17542 6 0.03%
Feng D [47] 2004 China 17~58 2000 853 4 0.47%
Xu HZ [48] 2004 China 20~97 - 2195 1 0.05%
Zhao Y [49] 2004 China 18~24 2002 2116 1 0.05%
Naldi L [50] 2004 Italy ≥45 2003 3660 26 0.71%
Tuncel AA [51] 2005 Turkey 14~25 - 682 2 0.29%
Lin T [52] 2005 China 18~46 2004 385 1 0.26%
Faye O [53] 2005 Mali <15 2001 1729 4 0.23%
Wang TL [54] 2006 China 17.4~23.8 2004 34166 35 0.10%
Song WF [55] 2006 China - 2005 3920 2 0.05%
Ai JZ [56] 2006 China 7~16 - 21794 3 0.01%
Al-Saeed WY [57] 2006 Saudi Arabia 6~17 2003 2239 8 0.36%
Lu T [58] 2007 China all 2002~2003 42833 40 0.09%
Zhao G [59] 2007 China 18~44 2006 324 3 0.93%
Xu CY [60] 2007 China - 2007 4725 3 0.06%
Chhaganlal K [61] 2007 Mozambique 0~82 3-month period 780 1 0.13%
El-Essawi D [62] 2007 USA 20~80 - 194 3 1.55%
Chen GY [63] 2008 China 6~11 2005 3273 3 0.09%
Birlea SA [64] 2008 Romania all 2001~2006 2021 3 0.15%
Walker SL [65] 2008 Nepal 12 days~80 years - 878 8 0.91%
Zhao G [66] 2009 China 22~57 2007~2008 255 1 0.39%
Zhu LB [67] 2009 China all 2007~2008 6593 2 0.03%
Komba EV [68] 2010 Tanzania 6~19 - 420 3 0.71%
Liu XH [69] 2010 China - 2007 1670 1 0.06%
Li YF [70] 2010 China 18~53 2008 1078 3 0.28%
Ingordo V [71] 2011 Italy 18 2001~2004 34740 60 0.17%
Pei GD [72] 2011 China 18~94 - 2341 22 0.94%
Wang RL [73] 2012 China 12~20 2008~2009 7747 37 0.48%
Yamamah GA [74] 2012 Egypt ≤18 2008~2009 2194 4 0.18%
Liu Q [75] 2013 China 12~80 - 2719 21 0.77%
Wang XY [76] 2013 China all - 17345 122 0.70%
Yang YS [77] 2013 China 17~21 - 1525 2 0.13%
Pang XW [78] 2013 China 18~39 2011 473 3 0.63%
Chen JZ [79] 2013 China 17~21 - 2957 2 0.07%
Zhu XW [80] 2014 China 18~93 2012 3993 2 0.05%
Shao ZQ [81] 2014 China - 2011 986 1 0.10%
El-Khateeb EA [82] 2014 Egypt 6~12 2011~2012 6162 4 0.06%
Reddy J [83] 2014 India all - 22037 160 0.73%
Afkhami-Ardekani M [84] 2014 Iran 10~98 2011 1100 20 1.82%
Lee H [85] 2015 Korea all 2009~2011 50593516 63467 0.13%
Chen YT [86] 2015 China all 1997~2011 23254688 14883 0.06%
Liu TH [87] 2015 China 17~43 2014 1347 2 0.15%
Hospital-based studies
Ruiz-Maldonado R [88] 1977 Mexico 0~18 1971~1975 10000 260 2.60%
Anand IS [89] 1998 India 0~12 1994 400 8 2.00%
Nanda A [90] 1999 Kuwait 0~12 1992~1996 10000 149 1.49%
Boisseau-Garsaud AM [91] 2000 West Indies 1~96 1995~1996 2077 7 0.34%
Wisuthsarewong W [92] 2000 Thailand 0~12 - 2361 97 4.11%
Yang XQ [93] 2001 China 15~78 1990~2000 735 6 0.82%
Li GP [94] 2003 China - 2001~2002 7796 72 0.92%
Ogunbiyi AO [95] 2004 Nigeria - 1994~1998 1091 51 4.67%
Onayemi O [96] 2005 Nigeria all 1999~2001 2611 25 0.96%
Nnoruka EN [97] 2005 Nigeria 0~73 1999~2001 2871 91 3.17%
Yang QY [98] 2007 China 60~93 2005~2006 599 2 0.33%
El-Essawi D [62] 2007 USA 20~80 - 207 5 2.42%
Tamer E [99] 2008 Turkey 0~16 2004~2006 6300 91 1.44%
Taylor A [100] 2008 USA ≥12 - 140 1 0.71%
Ayanlowo O [101] 2009 Nigeria - 2003~2006 6645 186 2.80%
Poojary SA [102] 2011 India - 2002~2008 33252 204 0.61%
Furue M [103] 2011 Japan all 2007~2008 67448 1134 1.68%
Muteba Baseke C [104] 2011 Congo all 2000~2010 14195 204 1.44%
Zhang LJ [105] 2012 China 8~76 2009~2011 1439 13 0.90%
Al-Refu K [106] 2012 Jordan 0~12 2-year period 2000 71 3.55%
Kumar S [107] 2014 India all 2012 443 44 9.98%
Su WL [108] 2014 China ≥60 2011~2013 1094 2 0.18%
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The results of pooled meta-analysis

Based on the results of random-effects method, the prevalence of vitiligo from population- or community-based studies was 0.2% (95%CI: 0.1%–0.2%) and from hospital-based studies was 1.8% (95%CI: 1.4%–2.1%). The forest plots of vitiligo prevalence were shown in Figs 2 and 3.

Fig 2. Forest plot of prevalence from population- or community-based studies.

Fig 2

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Forest plot of prevalence of vitiligo from population- or community-based studies from 1964 to 2015.

Fig 3. Forest plot of prevalence from hospital-based studies.

Fig 3

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Forest plot of prevalence of vitiligo from hospital-based studies from 1977 to 2014.

The subgroup analyses of population- or community-based studies (Table 2)

Table 2. Prevalence of vitiligo stratified by different factors.

Stratified factors No. of Studies Prevalence rate Lower limit Upper limit Heterogeneity I2 (%) P from test of heterogeneity Model
Population or community-based studies
Area
Asia 57 0.001 0.001 0.002 99.50% 0 Random
Africa 7 0.004 0.001 0.007 93.10% 0 Random
America 5 0.002 0.001 0.004 94.80% 0 Random
Europe 11 0.004 0.002 0.005 83.90% 0 Random
Oceania 1 0.012 0.005 0.018 - - Random
Atlantic 1 0.001 0 0.001 - - Random
Years
1964~1980 7 0.006 0.004 0.009 97.30% 0 Random
1981~1985 4 0.002 0.001 0.003 96.20% 0 Random
1986~1990 1 0.003 -0.003 0.009 - - Random
1991~1995 4 0.006 -0.001 0.013 95.40% 0 Random
1996~2000 9 0.001 0.001 0.002 93.00% 0 Random
2001~2005 23 0.002 0.002 0.003 97.10% 0 Random
2006~2010 17 0.001 0 0.001 77.90% 0 Random
2011~2015 17 0.002 0.002 0.002 99.80% 0 Random
Gender
male 30 0.002 0.002 0.003 94.10% 0 Random
female 18 0.005 0.004 0.006 95.00% 0 Random
Age
0~19 26 0.002 0.002 0.003 95.80% 0 Random
20~39 8 0.002 0.001 0.003 83.30% 0 Random
40~59 7 0.004 0.003 0.006 90.20% 0 Random
≥60 7 0.007 0.003 0.01 95.30% 0 Random
Hospital-based studies
Area
Asia 13 0.016 0.011 0.02 97.50% 0 Random
Africa 5 0.025 0.016 0.034 95.70% 0 Random
America 4 0.015 -0.001 0.031 97.60% 0 Random
Years
1964~1980 1 0.026 0.023 0.029 - - Random
1996~2000 4 0.019 0.007 0.031 97.10% 0 Random
2001~2005 5 0.02 0.01 0.029 94.70% 0 Random
2006~2010 5 0.015 0.005 0.025 94.10% 0 Random
2011~2015 7 0.016 0.01 0.022 98.50% 0 Random
Gender
male 4 0.011 0.005 0.017 94.20% 0 Random
female 4 0.013 0.007 0.02 94.60% 0 Random
Age
0~19 7 0.024 0.018 0.029 93.00% 0 Random
20~39 1 0.014 0.012 0.016 - - Random
40~59 1 0.015 0.013 0.017 - - Random
≥60 3 0.008 -0.005 0.02 98.50% 0 Random
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The vitiligo prevalence of different areas were 0.1% (0.1%, 0.2%) in Asia, 0.4% (0.1%, 0.7%) in Africa, 0.2% (0.1%, 0.4%) in America, 0.4% (0.2%, 0.5%) in Europe, 1.2% (0.5%, 1.8%) in Oceania (only one study) and 0.1% (0%, 0.1%) in Atlantic, respectively.

When stratified by publication years, the prevalence of vitiligo was 0.6% (0.4%, 0.9%) before the 80s. It decreased to 0.2%~0.3% in the 80s. The prevalence rebounded to 0.6% (-0.1%, 1.3%) in the first half of 90s. After that, the prevalence drastically decreased and maintained at a low level of 0.1%~0.2%.

The subgroup analysis stratified by gender showed that vitiligo attacked 0.2% (0.2%, 0.3%) males in contrast to 0.5% (0.4%, 0.6%) females.

Pooled prevalence of age-groups in 0~19 years, 20~39 years, 40~59 years and ≥60 years were 0.2% (0.2%, 0.3%), 0.2% (0.1%, 0.3%), 0.4% (0.3%, 0.6%) and 0.7% (0.3%, 1.0%), respectively. The prevalence in the ≥60 years age-group was the highest of the four age categories, and the prevalence of vitiligo increased with age gradually.

The subgroup analyses of hospital-based studies (Table 2)

With regard to hospital-based studies, the prevalence of vitiligo was as high as 2.5% (1.6%, 3.4%) of Africa, compared with 1.6% (1.1%, 2.0%) of Asia and 1.5% (-0.1%, 3.1%) of America.

Before the 80s, the prevalence of vitiligo was 2.6% (2.3%, 2.9%). The data of the 80s and the first half of 90s were not available. The prevalence of the latter half of 90s and the first 5 years of 21st century were 1.9% (0.7%, 3.1%) and 2.0% (1.0%, 2.9%), respectively. In recent 10 years, the prevalence has decreased to 1.5%~1.6%. It has showed a decreased trend from 60s till now.

The prevalence of males was 1.1% (0.5%, 1.7%) in contrast to 1.3% (0.7%, 2.0%) of females.

The prevalence of age-groups in 0~19 years, 20~39 years, 40~59 years and ≥60 years were 2.4% (1.8%, 2.9%), 1.4% (1.2%, 1.6%), 1.5% (1.3%, 1.7%) and 0.8% (-0.5%, 2.0%), respectively. The highest prevalence was observed in 0~19 years and the overall prevalence showed a gradually decreased trend with age increment.

Publication Bias

There was significant publication bias in population- or community-based studies (t = 2.31, P = 0.026), while no significant publication bias existed in hospital-based studies (t = 0.47, P = 0.643). The funnel plot of publication bias was shown in Fig 4.

Fig 4. Funnel plot assessing publication bias: (a) population- or community-based published studies; (b) hospital-based published studies.

Fig 4

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Funnel plot assessing publication bias in the prevalence of vitiligo from: (a) 82 population- or community-based published studies; (b) 22 hospital-based published studies.

Discussion

To our knowledge, this is the first meta-analysis examining the prevalence of vitiligo. The results of this study showed that the pooled prevalence of 82 population- or community-based studies was 0.2% and of 22 hospital-based studies was 1.8%. The latter data derived from hospital-based surveys was obviously high.

Although vitiligo occurs worldwide, it is known that the reported prevalence of vitiligo is various. Prevalence distributions might differ in areas. In the included population- or community-based studies, the lowest prevalence was in Asia and Atlantic, the second-highest in Africa and in Europe, and the highest in Oceania. But only 1 study was included, the result of Oceania was not definite. In hospital-based studies, prevalence was the lowest in America and the highest in Africa. So we could draw a common conclusion from the two types of studies that Africa had a high prevalence of vitiligo. These results were in accordance with previous studies that vitiligo frequently occurred in darker-skinned individuals [109]. However, differences did exist in various reports. We suspect the differences that vitiligo is more prevalent in some geographic areas may result from the following factors. Firstly, different skin types and ethnic groups may play important roles in the discrepancy of the prevalence among different areas. Environmental conditions as well as genetic factors may solely or synergistically contribute to the various prevalence distribution in different geographic areas [7]. Secondly, the populations in many surveys were ethnically and culturally diverse such as the survey in USA. Several generations of immigrants or various population's lifestyles in this region might contribute to these differences. Thirdly, unbalanced number of included studies in geographic regions might compromise accurate and sufficient information for heterogeneity. Studies were extremely more conducted in Asia, while only 1 study was conducted in Oceania or Atlantic. Lastly, small amounts of participants in some included studies may contribute to imprecise estimates.

In general, the prevalence of vitiligo showed a relatively decreased trend with increase in the times. Especially, it has remained at a low level in recent two decades in both population- or community-based studies and hospital-based studies. The association between vitiligo and its autoimmune diseases, such as autoimmune thyroid diseases, psoriasis, pernicious anemia, Addison’s disease et al has been frequently described in the literatures. As vitiligo may accompany with other diseases or disorders, we assume that the decreasing prevalence may be beneficial from development of diagnostic tools or improvement of screening programs or therapeutic methods of vitiligo-related diseases or disorders. The prevalence went up to 0.6% in the first half of 90s in population- or community-based studies. We found there was a literature written by Xue SQ about skin diseases of workers and technical personnel in Taigang company. The prevalence of vitiligo of this community population reached 1.27%, higher than other papers in this period. Chemical elements or decolorization may result in the increase of patients with vitiligo. The exact etiology and pathogenesis of vitiligo have not been completely unraveled. It involves a series of known and unknown environmental factors or immunological factors acting over time.

Our results also demonstrated that the pooled prevalence of vitiligo was slightly higher in females than in males, both for the population- or community-based studies (0.5% compared with 0.2%) and the hospital-based studies (1.3% compared with 1.1%). This result was different from previous literatures, which revealed that male and female patients were affected equally by vitiligo [4, 58, 110] or men were more affected than women [111]. Women usually incline to concern about pigmentation changes of their skin and the impact on their social life, and women may be more diligent in seeking treatment. This could be a possible reason for the greater number of female patients in this study [112].

Besides, this study revealed that the prevalence of vitiligo increased with age in population- or community-based studies, increasing gradually from 0.2% in the 0~19 years age-group to 0.7% in the ≥ 60 years age-group. Similar results have been found in some previous studies [8, 58]. The increase possibly correlates to a cumulative effect, because vitiligo is a long-lasting disease and is life-long in most patients. However, in hospital-based studies, the prevalence in the 0~19 years age-group was higher than that in the ≥ 60 years age-group. Youngers may occupy more important position in the family and parents will take them to see a doctor as soon as they find the children’s conditions. In contrast, some elderly patients do not pay greater awareness of their appearance and will not see doctors unless necessary.

Despite we have conducted a comprehensive searching of the epidemiology of vitiligo, several limitations should be considered in this meta-analysis. The available publications/studies were from 31 countries. The data of unavailable countries are required to reflect the wide variation. Some characteristics of the patients, such as clinical types, site or age of onset, risk factors, etc., were not included in the subgroup analyses. These might exert an important influence on the prevalence of vitiligo. Another possible limitation of this study was related to publication bias. The result from Egger’s test showed an evidence of publication bias in population- or community-based studies. It may result from unbalanced number of studies and year of publications. For example, the number of included studies of 2001~2005 was 23, in contrast, the number of 1986~1990 was only 1. Finally, some included studies had noted methodological flaws, especially related to selection and recruitment of samples. Special subjects, such as soldiers, teachers, miners and other professional workers, participating in the investigations could not be representative of other samples. Control group with other diseases such as diabetes was also selected in some studies. As a result, the estimates of prevalence may have been influenced in unpredictable ways and need continuous perfectibility for verifying our conclusion.

In conclusion, we investigated a worldwide prevalence of vitiligo with population- or community-based and hospital-based data. A relatively high prevalence of vitiligo was found in Africa area and in female patients. The prevalence has maintained at a low level in recent years. It showed an inverse trend with age increment in the two types of studies. The current study provided a basic result for further studies. Future researches should be done to find key factors that contribute to the prevalence.

Supporting Information

S1 File. Figure legends.

(DOCX)

Click here for additional data file. (12.8KB, docx)
S1 Table. PRISMA 2009 checklist.

(DOC)

Click here for additional data file. (54.5KB, doc)

Data Availability

All relevant data are within the paper and its Supporting Information files.

Funding Statement

This work was supported by the Vitiligo Research Foundation - VRF11102015/1.

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