American Academy of Pediatrics – Section on Dermatology

View all recommendations from this society

Released January 27, 2021

Do not routinely order laboratory tests for associated autoimmune diseases in patients with vitiligo in the absence of signs and/or symptoms of the diseases in question.

Vitiligo is a depigmenting disorder believed to have an autoimmune origin. It is well-established that patients with nonsegmental vitiligo have
an increased risk of other autoimmune conditions, with subclinical hypothyroidism being the most common. There is also a higher risk of having
antithyroid antibodies (TPOs). Other autoimmune conditions have been associated with vitiligo but less commonly.

Recognizing the risk of associated autoimmune conditions has led physicians to screen patients with vitiligo for other diseases. There is no convincing
evidence that extensive workups in the absence of specific clinical suspicion improves outcomes for patients and may in fact beget additional costs
and harms. Although many studies suggest ordering these tests, it is based largely on the increased cosegregation of vitiligo and thyroid disease and
not on improved outcomes from having identified an abnormal laboratory test result. Therefore, thyroid function testing including screening for thyroid
autoimmunity or hypothyroidism is only indicated for clinical findings such as goiter, slow growth and hypothyroid symptoms, or a strong family history
of thyroid disease


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

Members of the American Academy of Pediatrics Section on Dermatology submitted the top 5 topics for Choosing Wisely items based on a review of the literature and expert opinion of the most common dermatologic problems seen in primary care pediatrics. The list was then peer reviewed and approved by more than a dozen relevant AAP Committees, Councils and Sections. The AAP Executive Committee and Board of Directors granted final approval of the list.

AAP’s disclosure and conflict of interest policy can be found at www.aap.org.

Sources

Alvarez Casano M, Lopez Siguero JP. Review of the natural course of subclinical hypothyroidism and study of its costs. Endocrinol Diabetes Nutr. 2019;66(9):550-554

Gawkrodger DJ, Ormerod AD, Shaw L, et al. Guideline for the diagnosis and management of vitiligo. Br J Dermatol. 2008;159(5):1052-1076

Gill L, Zarbo A, Isedeh P, Jacobsen G, Lim H, Hamzavi I. Comorbid autoimmune diseases in patients with vitiligo: a cross-sectional study. J Am Acad Dermatol. 2016;74(2):295-302

Sawicki J, Siddha S, Rosen C. Vitiligo and associated autoimmune disease: retrospective review of 300 patients. J Cutan Med Surg. 2012;16(4):261-266

Yuan J, Sun C, Jiang S, et al. The prevalence of thyroid disorders in patients with vitiligo: a systematic review and meta-analysis. Front Endocrinol. 2019;9:1-13