Vitiligo Disease Duration Linked to Depression Severity

Emotional distress, including anxiety, depression, and stress, is prevalent among patients with vitiligo, often exacerbating disease perception and treatment adherence.¹ While physical activity (PA) is known to mitigate psychological symptoms in many chronic diseases, its effect in vitiligo has remained unclear. The 2025 cross-sectional study by Aryanian et al in Health Science Reports provides the first systematic evaluation of the relationship between PA and psychological health in this population.²

Study Design and Population

Eighty-five vitiligo patients aged 15 years and older were recruited from Yahya Nejad Hospital in Babol, Iran (April 2023–March 2024). Individuals with psychiatric comorbidities, psychotropic medication use, or physical limitations affecting PA were excluded. Standardized validated Persian versions of the Depression, Anxiety and Stress Scale–21 (DASS-21) and the International Physical Activity Questionnaire (IPAQ) were employed to quantify psychological symptoms and PA levels, respectively. Disease severity was assessed via the Vitiligo Area Scoring Index (VASI).

Key Findings

Psychological distress was strikingly common: 58% of patients reported stress, 55% depression, and 49% anxiety. The distribution of PA levels showed 26% low, 43% moderate, and 31% high activity.

No statistically significant associations were found between PA levels and any of the psychological measures:

• Stress: r = 0.164, p = 0.13
• Anxiety: r = 0.002, p > 0.99
• Depression: r = 0.036, p = 0.74

Anxiety correlated weakly but significantly with disease severity (r = 0.23, p = 0.04*), and longer disease duration (>5 years) was associated with higher depression scores (p = 0.03*). PA levels were significantly higher among males (p = 0.02*), whereas other demographic and clinical variables, including age, BMI, education, and lesion visibility, were not associated with PA or psychological outcomes.

Clinical Interpretation

Despite well-established antidepressant and anxiolytic effects of exercise in the general population, this study found no measurable protective role of PA against psychological symptoms in vitiligo. The authors propose that vitiligo’s psychosocial burden, rooted in visibility, stigma, and altered self-image, may operate through pathways less responsive to the mood-stabilizing effects of physical activity. Additionally, autoimmune and oxidative stress mechanisms intrinsic to vitiligo could contribute to neuroinflammatory processes associated with mood disorders, possibly dampening PA’s expected benefit.

These findings suggest that general lifestyle modification alone is insufficient for addressing the psychological sequelae of vitiligo. Clinicians should consider routine psychological screening and integrate mental health interventions, such as cognitive-behavioral therapy, support groups, or pharmacotherapy, into comprehensive vitiligo management. Addressing depression and anxiety is clinically relevant not only for quality of life but also because these comorbidities can negatively affect treatment adherence and therapeutic response.

Context with Existing Literature

Prior studies in other dermatologic conditions, including psoriasis and alopecia areata, have shown improvements in mood and disease outcomes with structured exercise interventions. However, cross-sectional data in vitiligo remain inconsistent. Cultural factors, stigma, and avoidance of public exercise settings may further blunt potential psychosocial benefits. This underscores the need for interventional trials exploring structured, supportive exercise environments and longer-term behavioral programs.

Limitations and Future Directions

The study’s cross-sectional design precludes causal inference. The modest sample size and reliance on self-reported measures (DASS-21, IPAQ) introduce recall bias. Future longitudinal and randomized controlled studies should examine whether supervised or group-based exercise interventions—potentially integrated with psychotherapy—can improve psychological outcomes and even influence disease stability through immunomodulatory mechanisms.

Clinical Takeaway

Patients with vitiligo experience substantial psychological morbidity independent of physical activity levels. While promoting physical health remains essential, clinicians should adopt a multidisciplinary approach that includes dermatologic, psychological, and social support to optimize patient outcomes.

References

1. Salama AH, Alnemr L, Khan AR, Alfakeer H, Aleem Z, Ali-Alkhateeb M. Unveiling the unseen struggles: A comprehensive review of vitiligo's psychological, social, and quality of life impacts. Cureus. 2023;15(9):e45030. Published 2023 Sep 11. doi:10.7759/cureus.45030
2. Aryanian Z, Asgari E, Shirzadian A, Ahangar HG, Heidari S, Massoodi A, Babaie H. Physical activity and psychological health in vitiligo patients: A cross-sectional study on depression, anxiety, and stress. Health Sci Rep. 2025 Oct 3;8(10):e71317. doi: 10.1002/hsr2.71317.