Biological, Behavioral, Environmental and Clinical Characteristics of Vitiligo Patients at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala, Sri Lanka- Descriptive cross-sectional study

Biological, Behavioral, Environmental and Clinical Characteristics of Vitiligo Patients at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala, Sri Lanka- Descriptive cross-sectional study | medRxiv /* */ /* */ <!-- <!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0];var j=d.createElement(s);var dl=l!='dataLayer'?'&l='+l:'';j.src='//www.googletagmanager.com/gtm.js?id='+i+dl;j.type='text/javascript';j.async=true;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-P4HH5NV'); Skip to main content Home About Submit ALERTS / RSS Search for this keyword Advanced Search Biological, Behavioral, Environmental and Clinical Characteristics of Vitiligo Patients at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Yakkala, Sri Lanka- Descriptive cross-sectional study View ORCID Profile Fathima Shazmin Hazari doi: https://doi.org/10.1101/2025.08.24.25334308 Fathima Shazmin Hazari a Faculty of Graduate Studies, University of Kelaniya , Sri Lanka Find this author on Google Scholar Find this author on PubMed Search for this author on this site ORCID record for Fathima Shazmin Hazari For correspondence: fathimashein{at}gmail.com Abstract Full Text Info/History Metrics Data/Code Preview PDF Abstract Background Vitiligo is a complex skin disorder with multifactorial etiology, including genetic, environmental, and behavioral factors. In Sri Lanka, data on the epidemiology and characteristics of Vitiligo patients, particularly in Ayurvedic clinical settings, remain limited. Objectives This study aimed to explore the biological, behavioral, environmental, and clinical characteristics of vitiligo patients receiving Ayurvedic treatment at the Gampaha Wickramarachchi Ayurveda Teaching Hospital, Sri Lanka, and to examine associations with comorbid conditions. Methods A total of 108 patients with clinically diagnosed Vitiligo were consecutively recruited. Data on socio-demographic, behavioral, environmental, and clinical variables were collected using a structured interviewer-administered questionnaire. Descriptive statistics and correlation analyses were performed to identify key patterns and associations. Results The majority of patients were female (60.9%) with a mean age of 44 years, and 17.3% reported a family history of Vitiligo. Most resided in the Western Province, exhibited dietary imbalances, and reported behavioral factors such as low exercise and betel chewing. Localized vitiligo types predominated, with common lesions on upper and lower limbs. Comorbid dermatological allergies and systemic conditions were frequent, with hyperlipidemia significantly correlated with Vitiligo type (p = 0.041). Other comorbidities showed no significant association. Conclusions This study provides important local epidemiological data, revealing a multifactorial profile of Vitiligo patients in an Ayurvedic setting. The significant link between hyperlipidemia and Vitiligo suggests potential metabolic involvement. Integration of traditional and biomedical approaches may enhance patient management. Larger, multi-center studies are needed to validate and extend these findings. This study used a structured interviewer-administered questionnaire, enhancing data completeness and consistency. Consecutive recruitment of participants minimized selection bias within the clinic population. Data collection included a comprehensive range of biological, behavioral, environmental, and clinical variables for a holistic understanding. The single-center, cross-sectional design limits causal inference and may affect the generalizability of findings to broader populations. Self-reported behavioral and environmental data may be subject to recall bias, which could impact accuracy. Introduction Vitiligo is a chronic, acquired skin disorder characterized by the progressive loss of skin pigmentation due to the destruction of melanocytes 1 . This is actuated through complicated and multifactorial pathways that include genetic susceptibility, autoimmune responses, oxidative stress and environmental triggers 2 . Clinically, the condition manifests in well-defined areas of white patches or lesions on the body; thus, it may be accompanied by itching and burning sensation 3 . The condition can develop in young age, with a substantial number of cases initiated at age 20 or below 4 . Multiple risk factors including genetic predisposition, immune dysfunction, sun exposure, chemical or physical trauma, and lifestyle influences contribute to its onset and progression of Vitiligo, although the precise causes often remain unclear 5 , 6 , 7 The fact that limited improvement occurs in response to therapy and the time consumed in such re-pigmentation further exacerbate the psychological impact of the disease, often forcing patients to conceal their Vitiligo lesions to improve their confidence and self-esteem 8 , 9 . Such psychosocial burdens can significantly affect the daily functioning, interpersonal relationships, and treatment-seeking behavior in affected individuals 10 , 11 Although extensive research on the biological, behavioral, and environmental factors of Vitiligo abounds, most of the findings are context-specific and centered on populations outside South Asia 12 , 13 . This constrains the external validity of such studies to various contexts such as Sri Lanka 14 . Moreover, there is a notable absence of research focusing on the epidemiological and clinical characteristics of Vitiligo patients within the Sri Lankan healthcare context, particularly in an Ayurvedic medical setting. The Gampaha Wickramarachchi Ayurveda Teaching Hospital in Yakkala, Sri Lanka, is one of the foremost educational and clinical institutions of traditional medicine under the University of Indigenous Medicine 15. It has combined both Ayurvedic and conventional ways of treating Vitiligo, providing it with a unique environment to explore Vitiligo in both biomedical and indigenous concepts. This descriptive cross-sectional study is appropriate for documenting the prevalence, characteristic demographic distribution, and clinical manifestations patients of Vitiligo at Gampaha Wickramarachchi Ayurveda Teaching Hospital. This study aimed to describe the biological, behavioral, environmental, and clinical characteristics, of patients with Vitiligo. It also attempted to investigate the relationships between comorbid conditions, and Vitiligo patch distribution. These features are more comprehensible to allow the designing of patient-centered managerial approaches and preventive measures. Furthermore, early identification of potential complications and comorbidities may improve clinical outcomes and quality of life for Vitiligo patients. Methods Study Design and Setting The research was a descriptive cross-sectional study that lasted (April-July 2025) at the Skin Clinic of Gampaha Wickramarachchi Ayurveda Teaching Hospital, in Yakkala, Sri Lanka. Key outcomes and exposures, predictors, possible confounders, and impact modifiers had been defined before data were collected. Vitiligo was clinically diagnosed according to the standard diagnostic criteria through a clinical examination concurred by the researcher in collaboration with the in-charge consultant at the Skin Clinic. Certain behavioral and environmental factors which include: diet, residence, working conditions, educational level, smoking and exposure to sun were measured using a structured questionnaire which the researcher conducted. Comorbidity was checked by examining medical records where possible. All participants were interviewed using the same standardized questionnaire, ensuring consistency in measurement methods To reduce potential selection bias, all eligible patients attending the clinic during the study period who met the inclusion criteria were consecutively invited to participate. Interviewer administered questionnaires were useful in minimizing information bias as there was the capacity to clarify with the participants. Recall bias was recognized as a limitation due to reliance on self-reported behavioral data. Study Population and Sampling Clinically diagnosed patients with Vitiligo, aged between 15 to 80 years, both sexes, and patients with second attempt treatment and were started on Ayurvedic medicine were recruited according to predefined inclusion criteria. Pregnant, lactating women and individuals unwilling to participate were excluded. The required sample size (n = 108) was computed based on a 95% confidence level, 5% margin of error, and adjustment for the finite population. Quantitative data represented by age and the duration of the disease were treated both as continuous variables and as categories defined by clinical relevant (age groups: 15-24, 25-34,35-44, >44 years). Groupings were chosen to facilitate meaningful comparisons and align with similar Vitiligo studies. Data Collection Data were collected using a structured, interviewer-administered questionnaire including three main sections: (1) socio-demographic information, which included biological (e.g., age, gender, religion), environmental (e.g., residence, marital status, employment, family system, exposure to environmental triggers), and behavioral determinants (e.g., psychiatric history, diet, bowel movements, sleep patterns, habits related to the disorder); (2) disease-related characteristics, encompassing comorbidities and details of lesions; and (3) clinical determinants related to vitiligo and associated health conditions. Ethical Considerations Ethical approval was obtained from the Ethics Review Committee, Faculty of Medicine, University of Kelaniya, Ragama, Sri lanka. (Ref: P/127/09/2024). Written informed consent was obtained from all participants after explaining the study purpose, procedures, and voluntary nature of participation. Data Analysis Statistical analysis was done through SPSS with descriptive statistics, independent-sample t-test, and one way ANOVA, as appropriate. Statistical test assumptions were verified and p<0.05 was adopted as a significance level. Possible confounding factors were discussed through the calculation of all the percentages of biological, behavioral, environmental and clinical determinants. Correlation analysis was done to target specifically the extent to which the comorbid diseases are associated with varied Vitiligo. There were very few missing data which were filled using list wise deletion. Sensitivity analysis was not performed because the study was of descriptive nature and because of completeness of the data. Patient and Public Involvement Patients were involved in the design of the research through consultation meetings. Their feedback helped shape the research questions and patient information materials. They were engaged throughout the study to advice on recruitment strategies and dissemination plans. Results There were 120 patients who were screened at the beginning of the study period. Among them, 12 were excluded. Thus, 108 patients with clinically diagnosed Vitiligo were included. The non-participation was due to reasons such as e.g., refusal, pregnancy, and incomplete data. Biological characteristics The majority were female (60.9%), with the average age of 44 years, Most participants were Buddhist (82%) and 8.7 percent had documented history of psychiatry ( Table 1 ). View this table: View inline View popup Download powerpoint Table 1. Biological characteristic features of individuals with Vitiligo Environmental and Behavioral Characteristics Most participants resided in the Western Province (82.6%), were married (78%), and lived in nuclear families (56%). Over half (52%) had completed secondary education. Occupationally, the majority were housewives (17.4%) and office workers (13%). Environmental triggers included animal bites (22.7%), rat urine contamination (4.3%), cosmetic/medication allergies (25.9%), chemical exposures (4.3%), and sunlight (8.7%) ( Table 2 ). Behavioral patterns included imbalanced diets (69.5%), low water intake (78.3%), Of these, 60.9% had mostly healthy bowel motions and mostly normal sleep (73.9%). Exercise (17.4%) and chewing betel (17.4%) were listed under the patients’ behaviors ( Table 3 ). View this table: View inline View popup Download powerpoint Table 2. Environmental characteristic features of individuals with Vitiligo View this table: View inline View popup Table 3. Behavioral characteristic features of individuals with Vitiligo View this table: View inline View popup Table 4. Clinical characteristic of individuals with Vitiligo View this table: View inline View popup Download powerpoint Table 5. Significant Correlation between other disease and types of Vitiligo patches Clinical Characteristics According to the results, 39.1% of the patients had been diagnosed with a condition that had lasted more than three years. The body types with the highest and lowest percentages of Vitiligo involvement were mucosal (4.3%) and local types (39.1%) ( figure1 ). Upper limb (65.1%), lower limb (52.1), lips (43.4%) were the body parts most involved, while the entire body and face were the least involved and gradually onset. Wounds accounted for 17.4% before appear white patches, followed by itching. Family history (17.3%) within the family (13%) and 4.3% were related generation. The majority of them had other dermatological conditions such as mosquito bite allergy (30%), imitation jewelry allergy (21.7%), and food allergy (8.6%), and they were medicated for rheumatoid arthritis (21.7%), hyperlipidemia, wheezing, hypertension, wheezing (25.8%), and thyroxin for hypothyroidism (4.3%). Most (43.5%) had previously received western therapy before attending the clinic. Download figure Open in new tab Figure 1. Types of Vitiligo Download figure Open in new tab Figure 2. body sites Missing Data Missing data were minimal; for all key variables, the number of participants with missing information was less than 5%. Variables with missing data are indicated in the corresponding tables. Associations with comorbid The analysis of correlations between selected clinical factors, in patients with Vitiligo, regarding comorbid conditions, only hyperlipidemia showed a significant correlation with Vitiligo type (p = 0.041), whereas rheumatoid arthritis (p = 0.306), wheezing (p = 0.784), and hypertension (p = 0.246) were not significantly associated. Confidence intervals were not calculated due to the descriptive nature of the analysis. Discussion This study explored the characteristics into biological, behavioral, environmental, and clinical aspects of 108 Vitiligo patients that visited the n Ayurvedic skin clinic in Sri Lanka, which would complement the existing system in the country that gap in local epidemiological data 16 , 17 . Consistent with prior research, females comprised the majority, and nearly half were over 44 years old. The prevalence of family history and psychiatric conditions are consistent with global evidence emphasizing genetic and psychosocial influences on Vitiligo 18 , 19 , 20 , 21 . Environmental factors such as residence primarily in the Western Province reflect the hospital’s location, while occupational, behavioral, and Ayurvedic concepts provide additional context for disease triggers 22 , 23 , 24 . Behavioral findings revealed prevalent dietary imbalances, poor hydration, and lifestyle habits with low exercise and betel chewing which has been identified to exacerbate oxidative stress and immune suppression associated with Vitiligo progression 25 , 26 , 27 , 28 . Clinical presentations varied in localized to mucosal types with common lesion sites consistent with literature, though some site patterns differed 29 , 30 . Associations with comorbid dermatological allergies and systemic conditions were noted, with hyperlipidemia demonstrating significant correlation with Vitiligo type and emphasizing an apparent metabolic factor in the pathogenesis of the disease 31 , 32 , 33 , 34 . The single center study design also forms a limitation to this study as it may constitute a challenge to generalizability to other populations outside the clinic. Although the factors of selection bias were criticized as limited by consecutive recruitment, the factors of the bias of recall potentially existed due to self-reported behavioral data. The descriptive cross-sectional nature precludes causal inference, and missing data were minimal but not zero, handled via list wise deletion. Multiplicity of analyses was addressed through conducting the analysis on defined variables but sensitivity analyses were not applied Interpretation of findings should consider these limitations alongside existing evidence. The predominance of the female population and family history is suggestive of genetics and psychosocial factors towards the cause of Vitiligo in this population. Behavioral and environmental factors underscore the multifactorial nature of the disease and the potential role of Ayurveda-specific contributors. The significant correlation between hyperlipidemia and Vitiligo types justifies for integrating metabolic monitoring in patient management and further research on lipid metabolism’s role in Vitiligo. The results have relevant implications for public health and clinical practice in Sri Lanka, specifically in integrating traditional Ayurvedic perspectives with biomedical approaches. While the single-center setting limits broad extrapolation, findings contribute valuable local epidemiological data.. In further studies, multi-site longitudinal design with larger samples enhances generalizability and explores causal pathways, including metabolic and psychosocial mechanisms influencing vitiligo. Additionally, public awareness campaigns are essential to dispel myths and superstitions surrounding vitiligo Conclusion This study provides valuable insights into the biological, behavioral, environmental, and clinical characteristics of the patients with Vitiligo in an Ayurvedic clinical setting in Sri Lanka. The results highlight a predominance of female patients, significant genetic as well as psychosocial factors, and lifestyle that may affect the progression of the disease. The observed association between hyperlipidemia and Vitiligo type which indicates the presence of a possible metabolic aspect warranting further investigation. Despite limitations related to the single-center design and cross-sectional nature, the results emphasize the importance of integrating traditional and biomedical approaches for holistic patient management. Future research with larger, multi-site cohorts is needed to confirm these findings and explore causal mechanisms. Data Availability The data that support the findings of this study are from the corresponding author upon reasonable request Author contributions F.S Hazari-Conceptualization, Validation, Formal analysis, Writing – Original Draft. Funding none Competing interests None declared. Patient consent for publication Not applicable Data availability The data that support the findings of this study are from the corresponding author upon reasonable request. Declaration of Generative AI and AI-assisted technologies in the writing processes During the preparation of this work the authors used Perplexity in order to assist with English writing and language refinement. After using this tool, the authors reviewed and edited the content as needed and take full responsibility for the content of the publication. Download figure Open in new tab Acknowledgements I would like to express my thanks to the director of the Gampaha Wickramarachchi Ayurveda Teaching Hospital in Yakkala, Sri Lanka, for her care in allowing me to conduct my study in the skin clinic. Reference 1. ↵ Boissy RE , Manga P. On the etiology of contact/occupational vitiligo . Pigment Cell Res . 2004 ; 17 ( 3 ): 208 – 214 . OpenUrl CrossRef PubMed Web of Science 2. ↵ Jin Y , Mailloux CM , Gowan K , Riccardi SL , LaBerge G , Bennett DC , et al. NALP1 in vitiligo-associated multiple autoimmune disease . N Engl J Med . 2007 Mar 29; 356 ( 13 ): 1216 – 25 . OpenUrl CrossRef PubMed Web of Science 3. ↵ Dridhbala C , editor. Charaka Samhita. Chaukhambha Sanskrit Series; Varanasi, India . 4. ↵ Lee AY , Kim NH , Choi WI , Youm YH . Less keratinocyte derived factors related to more keratinocyte apoptosis in depigmented than normally pigmented suction-blistered epidermis may cause passive melanocyte death in vitiligo . J Invest Dermatol 2005 ; 124 : 976 – 983 . OpenUrl CrossRef PubMed 5. ↵ Le Poole IC , Das PK , van den Wijngaard RM , Bos JD , Westerhof W. Review of the etiopathomechanism of vitiligo: a convergence theory . Exp Dermatol . 1993 Jun ; 2 ( 3 ): 145 – 153 . OpenUrl CrossRef PubMed 6. ↵ Kemp EH , Waterman EA , Weetman AP . Autoimmune aspects of vitiligo . Autoimmunity . 2001 ; 34 ( 2 ): 65 – 77 . OpenUrl PubMed 7. ↵ Hu Z , Wang T. Beyond skin white spots: Vitiligo and associated comorbidities . Front Med (Lausanne) . 2023 Feb 23; 10 : 1072837 . doi: 10.3389/fmed.2023.1072837 . OpenUrl CrossRef PubMed 8. ↵ Silpa-Archa N , Pruksaeakanan C , Angkoolpakdeekul N , et al. Relationship between depression and quality of life among vitiligo patients: A self-assessment questionnaire-based study . Clin Cosmet Investig Dermatol . 2020 ; 13 : 511 – 520 . doi: 10.2147/CCID.S265349 . PMID: 32801827 . OpenUrl CrossRef PubMed 9. ↵ Bae JM , Lee SC , Kim TH , Yeom SD , Shin JH , Lee WJ , et al. Factors affecting quality of life in patients with vitiligo: A nationwide study . Br J Dermatol . 2018 Jan ; 178 ( 1 ): 238 – 244 . doi: 10.1111/bjd.15560 . OpenUrl CrossRef PubMed 10. Aradhya S , Manjunath K , Kasturi Somaiah S. Quality-of-life and psychosocial impact of vitiligo in Indian patients . Pigment Int . 2015 ; 2 ( 1 ): 28 – 33 . doi: 10.4103/2349-5847.159392 . OpenUrl CrossRef 11. ↵ Amer AA , Gao XH . Quality of life in patients with vitiligo: An analysis of the dermatology life quality index outcome over the past two decades . Int J Dermatol . 2016 Jun ; 55 ( 6 ): 608 – 14 . doi: 10.1111/ijd.13198 . OpenUrl CrossRef PubMed 12. ↵ Boissy RE , Manga P. On the etiology of contact/occupational vitiligo . Pigment Cell Res . 2004 ; 17 : 208 – 214 . doi: 10.1111/j.1600-0749.2004.00147.x OpenUrl CrossRef PubMed Web of Science 13. ↵ James SL , Abate D , Abate KH , et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017 . Lancet . 2018 Nov 10; 392 ( 10159 ): 1789 – 858 . OpenUrl CrossRef PubMed 14. ↵ Katti A , et al. Vitiligo: Etiopathogenesis, clinical variants, and treatment modalities . Indian Dermatol Online J . 2024 ; 15 ( 3 ): 218 – 228 . doi: 10.4103/idoj.idoj_407_23 . OpenUrl CrossRef PubMed 15. Gampaha Wickramarachchi University of Indigenous Medicine . ( 2025 ). Gampaha Wickramarachchi Ayurveda Teaching Hospital . Available http://gwu.ac.lk/ at: (Accessed August 2025 ). 16. ↵ Aghaei S , Amiri R , Haj-saeedi L , et al. Epidemiological and clinical characteristics of vitiligo: A cross-sectional study . International Journal of Dermatology . 2018 ; 57 ( 7 ): 844 – 850 . doi: 10.1111/ijd.14004 OpenUrl CrossRef 17. ↵ Perera A , Atukorale DN , Sivayogan S , Ariyaratne VS , Karunaratne LA . Prevalence of skin diseases in suburban Sri Lanka . Ceylon Med J . 2000 Sep ; 45 ( 3 ): 123 – 8 . doi: 10.4038/cmj.v45i3.8112 . OpenUrl CrossRef PubMed 18. ↵ Allen GE . Biological determinism . In: Encyclopedia Britannica [Internet] . 2018 Sep 25 [cited 2025 Aug 22 ]. Available from: https://www.britannica.com/topic/biological-determinism 19. ↵ Gopal KVT , Rama Rao GR , Kumar YHK , Appa Rao MV , Vasudev P , Srikant S. Vitiligo: a part of a systemic autoimmune process . Indian J Dermatol Venereol Leprol . 2007 May -Jun; 73 ( 3 ): 162 – 165 . OpenUrl CrossRef PubMed 20. ↵ Spritz RA , Andersen GH . Genetics of vitiligo . Dermatol Clin . 2017 Apr ; 35 ( 2 ): 245 – 255 . doi: 10.1016/j.det.2016.11.013 . OpenUrl CrossRef PubMed 21. ↵ Radtke MA , Schäfer I , Gajur A , Langenbruch A , Augustin M. Willingness-to-pay and quality of life in patients with vitiligo . Br J Dermatol . 2009 Jul ; 161 ( 1 ): 134 – 139 . OpenUrl PubMed 22. ↵ Kumarasinghe SPW . The changing pattern of hospital attendance for skin disease in Sri Lanka . Ceylon J Med Sci . 1992 ; 35 ( 2 ): 29 – 34 https://dl.nsf.gov.lk/handle/1/7082 OpenUrl 23. ↵ Jayasinghe DM . Charmaroga Nidana Cikitsa Sangrahaya . Department of Ayurveda, Sri Lanka ; 1990 . p. 13 – 14 , 35-36. 24. ↵ Sharma PV , editor and translator. Charaka Samhita, Chikitsa Sthana 7/173-176 . Chaukhambha Orientalia; Varanasi, India ; 1981 . 25. ↵ Hamada R , Funasaka Y , Saeki H , Serizawa N , Hagino T , Yano Y , Mitsui H , Kanda N. Dietary habits in adult Japanese patients with vitiligo . J Dermatol . 2024 Apr ; 51 ( 4 ): 491 – 508 . doi: 10.1111/1346-8138.17163 . OpenUrl CrossRef PubMed 26. ↵ London Dermatology Centre . Vitiligo causes, treatment, and management . 2025 . Available from: https://www.londondermatologycentre.co.uk/skin-conditions/vitiligo/ (Accessed Aug 22, 2025 ). 27. ↵ Bolognia JL , Pawelek JM . Biology of hypopigmentation . J Am Acad Dermatol . 1988 Feb ; 19 ( 2 Pt 1): 217 – 255 . OpenUrl CrossRef PubMed Web of Science 28. ↵ Li XS , Tang XY , Su W , Li X. Vitexin protects melanocytes from oxidative stress via activating MAPK-Nrf2/ARE pathway . Immunopharmacol Immunotoxicol . 2020 ; 42 ( 6 ): 594 – 603 . doi: 10.1080/08923973.2020.1835952 . OpenUrl CrossRef PubMed 29. ↵ Shah KN , Mehta HH , Shah RJ , Vora RV , Dave JB . Clinico-epidemiological profile of vitiligo: a study of 143 patients from Gujarat, India . Int J Dermatol . 2008 Apr ; 47 ( 4 ): 390 – 3 . doi: 10.1111/j.1365-4632.2007.03588.x . OpenUrl CrossRef PubMed 30. ↵ MedlinePlus. Vitiligo . 2021 . Available from: https://medlineplus.gov/ [Cited D2025 Aug 22 ] 31. ↵ Alikhan A , Felsten LM , Daly M , Petronic-Rosic V. Vitiligo: A comprehensive overview . Part I. J Am Acad Dermatol . 2011 Mar ; 65 ( 3 ): 473 – 491 . doi: 10.1016/j.jaad.2010.11.061 . OpenUrl CrossRef PubMed 32. ↵ Ezzedine K , Eleftheriadou V , Whitton M , van Geel N. Vitiligo . Lancet . 2015 Jan 3; 386 ( 9988 ): 74 – 84 . doi: 10.1016/S0140-6736(14)60763-7 . OpenUrl CrossRef PubMed 33. ↵ Taneja K , Taneja J , Kaur C , Patel S , Haldar D. Lipid risk factors in vitiligo: homocysteine the connecting link? Clin Lab . 2020 Oct 1; 66 ( 10 ). doi: 10.7754/Clin.Lab.2020.200120 . OpenUrl CrossRef 34. ↵ Liang X , Guo F , Zhang M , Wang C , Lin N , Liu L , Chen Y , Liu F , Du Y , Li L , Li X. Risk factors for cardiovascular diseases in patients with vitiligo: an analysis of current evidence . Ann Med . 2024 Dec ; 56 ( 1 ): 2326297 . doi: 10.1080/07853890.2024.2326297 . OpenUrl CrossRef PubMed View the discussion thread. Back to top Previous Next Posted August 27, 2025. Download PDF Data/Code Email Thank you for your interest in spreading the word about medRxiv. 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