International Journal of Clinical Dermatology

2020; 3(2): 19-21

http://www.sciencepublishinggroup.com/j/ijcd
doi: 10.11648/j.ijcd.20200302.11

Serum Vitamin B12 and Folic Acid in Vitiligo Patients:

A Case Control Study
Nadia Abdalhafid El Sherif1, *, Salwa Abdalsalam El-Dibany2, Azza El Saddiek Hussein Greiw3
1
Dermatology Department, Faculty of Medicine, Benghazi University, Benghazi, Libya
2
Dermatology Department, Omar El-Mukhtar University, Al-Beida, Libya
3
Department of Family and Community Medicine, Benghazi University, Benghazi, Libya

Email address:
*
Corresponding author

To cite this article:

Nadia Abdalhafid El Sherif, Salwa Abdalsalam El-Dibany, Azza El Saddiek Hussein Greiw. Serum Vitamin B12 and Folic Acid in Vitiligo
Patients: A Case Control Study. International Journal of Clinical Dermatology. Vol. 3, No. 2, 2020, pp. 19-21.
doi: 10.11648/j.ijcd.20200302.11

Received: August 14, 2020; Accepted: August 24, 2020; Published: September 16, 2020

Abstract: Background: Vitiligo is an autoimmune disease characterized by the destruction of melanocytes by immune
mechanisms. The role of vitamin B12 and folate in melanin synthesis has been well recognized. Aim of the study: To evaluate
the serum levels of vitamin B12 and folate in Libyan patients with vitiligo vulgaris. Patients and Methods: Blood samples for
haemoglobin (Hb) level, mean corpuscular volume (MCV), serum levels of Vitamin B12 and folate were obtained from 50
patients with vitiligo vulgaris and 50 age and sex-matched healthy controls at Dermatology Department of Eljumhoria Hospital
in Benghazi, Libya. Results: 50 patients with vitiligo vulgaris, with mean of age 34±6 years, 34% had active disease. Blood Hb
level was non-significantly lower in 26% vitiligo patients as compared to 16% control subjects (P=0.064). A significant
difference was observed regarding the MCV level which was lower in vitiligo patients in comparison to that of control subjects
(P=0.03). 38% of vitiligo patients have microcytic anemia (P=0.142). None of the patients has macrocytic anemia. Female
patients were found to have significantly lower Hb and lower MCV than males (P=.000). Serum vitamin B12 and folate were
lower in patients than control subjects and this difference was statistically significant (P=.05, P=0.001). There was no
significant correlation between serum levels of vitamin B12 and folate with sex, age, family history, duration and activity of
the disease ( P >0.05). Conclusions: Decreased levels of serum vitamin B12 and folate are significantly prevalent in vitiligo
patients, and screening vitiligo patients for vitamin B12 and folate deficiency may be warranted.
Keywords: Vitiligo, Serum, Vitamin B12, Folate

folate in vitiligo have been reported, though results are still

1. Introduction conflicting [4]. The aim of the present study to assess whether
Vitiligo is an acquired disorder characterized by there were significantly higher frequencies of Hb, iron, vitamin
depigmented macules and patches that result from the B12, and folic acid deficiencies in vitiligo patients.
destruction of melanocytes [1]. The precise aetiology of
vitiligo is still unknown, but the major hypotheses state that 2. Methods
stress, accumulation of toxic compounds, infection,
autoimmunity and mutations can all contribute to its 2.1. Patients and Control Subjects
etiopathogenesis [1, 2]. Increased frequencies of autoimmune Fifty vitiligo patients and 50 age and sex-matched healthy
disorders, such as autoimmune thyroid disease, pernicious subjects attending OPD of Dermatology Department, El-
anaemia, and Addison disease have been detected in patients Jumhoria Teaching Hospital, in Benghazi, Libya participated
with vitiligo [3]. Vitamin B12 and folate both are important in in the present study. All patients had vitiligo vulgaris, based on
melanin synthesis through many enzymatic pathway clinical and wood lamp examination. Exclusion criteria
activations. Studies on the blood levels of vitamin B12 and included pregnancy or lactation, taking mineral supplements or
20 Nadia Abdalhafid El Sherif et al.: Serum Vitamin B12 And Folic Acid in Vitiligo Patients: a Case Control Study

receiving any medication, metabolic or systemic disorders and Table 2. Mean of serum levels of hemoglobin, MCV, vitamin B12 and folate
skin problems other than vitiligo. A complete history was taken in vitiligo patients and control subjects.
from each patient, which included the demographic data, Vitiligo patients Control subjects
Serum level P value
medical and drug history, duration of vitiligo, and familial Mean ± SD Mean ± SD
history of vitiligo. Laboratory tests were recommended from Hemoglobin (g/dl) 12 ±2 12.7±2 .064
both patients and control subjects, which comprised complete MCV† (fl) 34.9±6.4 37.9±7 .030*
blood count, Folate and Vitamin B12 levels. Vitiligo patients Folate (ng/ml) 7.3±4 9.5±5 .019*
were divided into two groups as active and stable according to Vitamin B12 (pg/ml) 284±100 370±136 .001*
the progression of the disease in the last three months. Signed *P value <0.05 significant, †MCV mean corpuscular volume.
consent was obtained from all patients and subjects after
explaining the nature of the study to them and the manuscript Table 3. Correlation between the gender of the patients and other variables.
is according to the declaration of Helsinki. Gender: Mean ±SD P value
Hemoglobin (g/dl) M: 13.5±1.4 F: 10.7±.7 .000*
2.2. Statistical Analysis
MCV (fl) M: 39.2±6 F: 30.6±4 .000*
All statistical analyses were performed using SPSS Folate (ng/ml) M: 7.5±4 F: 7±4 .614
software for Windows (Version 16.0). Results are presented Vitamin B12 (pg/ml) M: 261±86 F: 306±109 .105
as mean and standard deviations for continuous variables and *P value <0.05 significant.
as a number (%) for categorical variables. Comparisons
between the patients and the control group were done by t- Table 4. Correlation between the activity of the disease and other variables.
test. P values <0.05 were considered significant. Serum level Active disease Non-active disease P value
Hemoglobin (g/dl) 11.7±1.5 12.2±2 .365
3. Results Folate (ng/ml) 8.5±4 6.7±4 .137
Vitamin B12 (pg/ml) 283±100 285±102 .960
A total of 50 vitiligo patients and 50 age and sex-
matched healthy subjects were enrolled in this study.
Table 1 show the demographic data of the patients and
4. Discussion
control subjects under study. Serum vitamin B12 and Vitiligo is an acquired, idiopathic, and in the majority
folate were lower in patients than control subjects and this of cases, a progressive, unpredictable skin disease [2]. Its
difference was statistically significant. A significant aetiology is still unclear, however, several hypotheses
difference was observed regarding the mean of MCV level have been proposed these include; the autoimmunity;
in vitiligo patients in comparison to that of control auto-destruction of melanocytes and the neural hypothesis
subjects (Table 2). Blood haemoglobin level was non [3].
significantly lower in 26% vitiligo patients as compared to The autoimmune aetiology of vitiligo is the most widely
16% control subjects (P=.064). 38% of vitiligo patients accepted, Alkhateeb et al. reported at least 30% of patients
have microcytic anemia (P=0.142). Female patients were with vitiligo to be affected with at least one additional
found to have lower haemoglobin and lower mean MCV autoimmune disorder like; thyroid diseases, Pernicious
than males and this difference statistically significant. No anaemia, Addison's disease and alopecia areata [5]. Folic
significant difference between male and female patients acid and vitamin B12 require each other in biological
regarding folate and vitamin B12 serum levels (Table 3). reactions. Vitamin B12 is needed for the reduction of folic
There was no significant correlation between blood Hb and acid to tetrahydrofolic acid which is prerequisite for
the serum levels of folate and vitamin B12 with the activity participation of folic acid in enzymatic reactions [6].
of the disease (Table 4). Blood haemoglobin, MCV, vitamin Vitamin B12 acts as a coenzyme in the folate-dependent
B12 and Folate levels did not show significant difference synthesis of pyrimidines and purines [7]. Moreover, it has
according to age, family history and duration of vitiligo. also been suggested that folate may play a role in the
melanin synthesis through the enzymatic hydroxylation of
Table 1. The demographic data of vitiligo patients under study.
phenylalanine to tyrosine, and through the activity of its
Demographic data Vitiligo patients Control subjects P value components; pteridine, para-aminobenzoic acid, and also
Age mean±SD yrs 34 ±6 yrs 32.2±9 yrs .235 through vitamin B12-dependent formation of methionine [7,
Sex 8].
Female 26 (52%) 27 (54%) .902 Although statistically insignificant, a quarter of the
Male 24 (48%) 23 (46%)
patients under study had microcytic anaemia, in the
Duration yrs ±SD † 10.5±9 yrs NA*
agreement of previous studies [9, 10], however, Gonul et al
Activity of disease
Active 17 (34%)
reported a lower prevalence (9.9%) of anaemia in vitiligo
NA* patients [11]. Vitiligo patients have been reported to be more
Stable 33 (66%)
susceptible to develop celiac disease, an autoimmune
*NA: None applicable †SD: standard deviation. disorder known to be associated with iron deficiency [12].
 International Journal of Clinical Dermatology 2020; 3(2): 19-21 21

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