Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis

Varikasuvu, Seshadri Reddy; Aloori, Sowjanya; Varshney, Saurabh; Bhongir, Aparna Varma

doi:10.1016/j.abd.2020.10.002

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Original Article • An. Bras. Dermatol. 96 (3) • May-Jun 2021 • https://doi.org/10.1016/j.abd.2020.10.002 copy

Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis^☆☆ ☆☆ Study conducted at the All India Institute of Medical Sciences, Deoghar, Jharkhand, India.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

The serum Vitamin D status in patients with vitiligo is ambiguous when compared to controls. A systematic review and updated meta-analysis were conducted to evaluate the association between Vitamin D and vitiligo.

Methods:

Relevant studies were identified by searching PubMed and other databases. The random effects model was used to obtain standardized mean differences and pooled correlation coefficients. Meta-regression and sub-group analyses were conducted to explore heterogeneity. The presence of publication bias and the study robustness were tested using funnel plot and sensitivity analyses, respectively.

Results:

This meta-analysis finally included 31 studies. Compared with controls, vitiligo patients showed significantly decreased serum Vitamin D levels (standardized mean difference = −1.03; p < 0.0001). The sub-group analysis showed that vitiligo patients with indoor/urban work had a significantly lower Vitamin D level when compared to their outdoor/rural counterparts (standardized mean differences = −0.45; p = 0.03). The sensitivity analysis indicated that no single study had a significant influence on the overall outcome, suggesting the robustness of this meta-analysis.

Study limitations:

Varied sample sizes and heterogeneous study populations from different countries are the limitations of this study. However, the between-study heterogeneity has been addressed by the random-effects model with meta-regression and sensitivity analyses.

Conclusions:

This meta-analysis showed significantly decreased Vitamin D level in vitiligo, and its association with indoor/outdoor type of work of vitiligo patients. This study highlights the need to assess Vitamin D status for improving its level in vitiligo.

KEYWORDS
Meta-analysis; Vitamin D; Vitiligo; 25-hydroxyvitamin D 2

Study/ Country (study period) (REF)	Study type/SKT	Vitiligo				Controls		Matching	Vitamin D									NOS
		N (M/F)	Age	Type	DD	N (M/F)	Age (y)		Sample/Method	Units (change)	Vit-D	Vitiligo (n)			Controls (n)
		N (M/F)	Age	Type	DD	N (M/F)	Age (y)		Sample/Method	Units (change)	Vit-D	Def	In-Suf	Suf	Def	In-Suf	Suf
Aly et al., 2017/Egypt (Nov-Dec 2015)⁵5 Aly D, Mohammed F, Sayed K, Gawdat H, Mashaly H, Abdel Hay R, et al. Is There a Relation between Vitamin D and Interleukin-17 in Vitiligo? A Cross-Sectional Study. Dermatology. 2018;233:413-8.	Cross-sectional/III, IV	30 (9/21)	30.23	Nonsegmental; Vulgaris Acrofacial Focal	5.83y	40 (19/21)	35.38	Age, sex	Serum/ELISA	ng/mL (SL)	(<10, 10-30, ≥30 ng/mL)	5	25	0	0	34	6	8
Amon et al., 2018/US (Jul 2015-Jun 2016)⁶6 Amon U, Baier L, Yaguboglu R, Ennis M, Holick MF, Amon J. Serum 25 hydroxyvitamin D levels in patients with skin diseases including psoriasis, infections, and atopic dermatitis. Dermatoendocrinology. 2018;10:e1442159.	Retrospective/NC	113 (57/56)	38.2	NC	NA	71 (17/54)	49.2	NC	Serum/ELISA	ng/mL (SL)	(≤20 ng/mL, NA, NA)	46	NA	NA	1	NA	NA	5
Beheshti et al., 2014/Iran (Mar-Jun 2012)³⁷37 Beheshti A, Ghadami H, Barikani A, Haj Manouchehri F. Assessment of vitamin D plasma levels in patients with Vitiligo Vulgaris. Acta Med Iran. 2014;52:609-14.	Cross-sectional/III, IV	100 (42/58)	28.7	Vulgaris	5y	No control group			Serum/EIA	nmoL/L	(<25, 25-47, 47.7-144 nmoL/L)	NA	NA	NA	NA	NA	NA	5
Cerman et al., 2014/Turkey (Nov 2012-Mar 2013)⁷7 Cerman AA, Sarikaya Solak S, Kivanc Altunay I. Vitamin D deficiency in alopecia areata. Br J Dermatol. 2014;170:1299-304.	Cross-sectional/NC	44 (27/17)	33.64	NA	60.55m	58 (34/24)	32.55	Age, sex, BMI	Serum/LCMS	ng/mL (SL)	(≤20 ng/mL, NA, NA)	31	NA	NA	19	NA	NA	8
Deepthi & Geetharani 2018/India (Dec16-May 17)⁸8 Deepthi V. A study on the correlation of serum cholecalciferol level and vitiligo in patients attending Government Rajaji Hospital, Madurai. [thesis]. Tamilnadu (IN): The Tamil Nadu Dr MGRMedical University; 2018.	Dissertation/III, IV	120 (59/61)	37.6	Segmental, Vulgaris, universal, focal, acrofacial	≤5 to ≥21 y	60 (29/31)	36.2	Age, sex	Serum/ELISA	ng/mL (SL)	(≤20, 20-30, >30 ng/mL)	70	28	22	22	12	26	6
Doss et al., 2015/Egypt (Jun-Sep 2013)⁹9 Doss RW, El-Rifaie AA, Gohary YM, Rashed LA. Vitamin D receptor expression in vitiligo. Indian J Dermatol. 2015;60:544-8.	Case-control/ IV	30 (20/10)	32.5	Universal Generalized Localized	58.4 m	30 (16/14)	28.0	Age, sex	Serum/ELISA	ng/mL (SL)	(≤20, 20-30, ≥30 ng/mL)	8	12	10	0	1	29	7
El-Hanbuli et al., 2018/Egypt (Jun-Sep 2016)¹⁰10 El-Hanbuli HM, Dawoud NM, Mahmoud RH. Narrow-band UVB effects on cutaneous vitamin D receptor expression and serum 25-hydroxyvitamin D in generalized vitiligo. Photodermatol Photoimmunol Photomed. 2018;34:175-83.	Case-control/ IV	30 (16/14)	29.53	NA	14.87 m	30 (16/14)	29.53	Age, sex, skin type	Serum/ELISA	ng/mL (SL)	(<12, 12-20, >20 ng/mL)	20	8	2	0	0	30	7
Farag et al., 2018/Egypt (Mar-Jun 2016)¹¹11 Farag AGA, Haggag MM, Muharram NM, Mahfouz R, Elnaidany NF, Abd El Ghany HM. Is Vitamin D a participant in narrow-band ultraviolet B-induced pigmentation in patients with vitiligo? J Egypt Women’s Dermatologic Soc. 2018;15:30-4.	Case-control/III, IV	50 (18/32)	28.76	Acrofacial Generalized	3.5y	25 (10/15)	28.16	Age, sex, skin type	Serum/ELISA	nmoL/L (SL)	(<25, 25-74, ≥75 nmoL/L)	40	10	0	0	23	2	6
Firjani 2019/Egypt¹²12 Amer AM, Khater EMG, Marei AM, Firjani BAA. Evaluation of Serum Level of 25-Hydroxy Vitamin D in Vitiligo Patients. Zagazig Univ Med J. 2019;25:935-40.	Case-control/NC	21	NA	NA	NA	21	NA	Age, sex	Serum/NC	ng/mL (SL)	NA	NA	NA	NA	NA	NA	NA	4
Hassan et al., 2019/India¹³13 Hassan I, Bhat YJ, Majid S, Sajad P, Rasool F, Malik RA, et al. Association of Vitamin D Receptor Gene Polymorphisms and Serum 25-Hydroxy Vitamin D Levels in Vitiligo - A Case-control Study. Indian Dermatol Online. 2019;10:131-8.	Case-control/NC	100 (39/61)	28.66	NC	3.81y	100 (40/60)	NA	Age, sex	Plasma/CLIA	ng/mL (SL)	(<20, 20-30, ≥30 ng/mL)	75	15	10	19	35	46	7
Ibrahim et al., 2018/Egypt (Dec 2015-Dec 2016)¹⁴14 Ibrahim H, El Taieb M, El Gamel Z, El Saied AR. Effect of narrow-band ultraviolet B on the serum of 25-hydroxyvitamin D in vitiligo patients. J Cosmet Dermatol. 2018;17:911-6.	Case-control/ III, IV	80 (40/40)	34.27	NC	NA	20 (10/10)	35.20	Age, sex	Serum/ELISA	nmoL/L (SL)	(<10, 10-29, >30 ng/mL)	NA	NA	NA	NA	NA	NA	7
Karagün et al., 2016/Turkey (Dec 2013-Mar 2014)¹⁵15 Karagün E, Ergin C, Baysak S, Erden G, Aktaş H, Ekiz Ö. The role of serum Vitamin D levels in vitiligo. Postepy Dermatol Alergol. 2016;33:300-2.	Case-control/ NC	50 (28/22)	30.96	Generalized	2-25y	47 (30/17)	31.45	Age, sex, skin type	Serum/NC	ng/mL (ND)	NA	NA	NA	NA	NA	NA	NA	6
Khodair et al., 2019/Egypt (Mar-Jun 2018)¹⁶16 Khodair HA, Amer AW, Samir H, Al A. Assessment of serum vitamin D level before and after narrowband therapy in vitiligo. Egypt J Hosp Med. 2019;74:310-7.	Cross-sectional/II-V	30 (6/24)	30.7	Localized Generalized	4.5 y	30 (10/20)	30.3	Age, sex	Serum/ELISA	ng/mL (SL)	NA	0	22	8	0	11	19	6
Khurrum et al., 2016/Saudi Arabia (Jan 2011-Dec 2012)¹⁷17 Khurrum H, AlGhamdi KM. The relationship between the serum level of Vitamin D and vitiligo: A controlled study on 300 subjects. J Cutan Med Surg. 2016;20:139-45.	Case-control/NC	150 (90/60)	30.6	Generalized Acral Focal	8m	150 (76/74)	30.7	Age, sex	Serum/CLIA	ng/mL (ND)	(<10, 10-30, ≥30 ng/mL)	137	0	13	136	0	14	8
Liu et al., 2014/China¹⁸18 Liu cheng-gang A, Jian-biao LI, Shao-quan SUN, Li-mei SHI, Su-qin C, Mei-cai ZHU. Detection of serum 25-hydroxy vitamin D3 in patients with vitiligo. J Navy Med. 2014;35:122-4.	Case-control/NC	86	19-56	NA	NC	30	19-56	Age, sex	Serum/ELISA	nmoL/L (ND)	(<25, 25-47.6, 47.4-250 nmoL/L)	32	44	10	5	19	6	6
Ochoa-Ramírez et al., 2019/Mexico¹⁹19 Ochoa-Ramírez LA, Díaz-Camacho SP, Becerra-Loaiza DS, Verdugo-Nieto L, Muñoz-Estrada VF, Servín-Vázquez LA, et al. Catalase but not vitamin D receptor gene polymorphisms are associated with nonsegmental vitiligo in Northwestern Mexicans. Int J Dermatol. 2019;58:1264-9.	Case-control/NC	173 (81/92)	18-45	Disseminated (generalized, universal), Localized (focal, acrofacial).	NA	184	NA	Age, sex	Serum/ELISA	ng/mL (SL)	NA	NA	NA	NA	NA	NA	NA	6
Omidian & Asadian 2018/Iran (Apr 2015-Mar 2016)²⁰20 Omidian M, Asadian T. Evaluation of serum vitamin D levels in patients with vitiligo undergoing NBUVB (narrowband UV-B) therapy. Jundishapur J Nat Pharm Prod. 2018;13:e65045.	Clinical trial/NC	30 (12/18)	36.93	Generalized	NA	30 (11/19)	32.03	Age, sex	Serum/ECL	nmoL/L (SL)	(≤10, 10-29, 30-100 nmoL/L)	14	13	3	18	10	2	7
Pillai & Dinachandran 2019/India (Jan-Apr 2018)²¹21 Dinachandran A, Pillai RT. A Study to assess the association of vitamin D (serum 25 hydroxy vitamin D3) and vitiligo. IP Indian J Clin Exp Dermatol. 2019;5:6-8.	Case-control/NC	50 (27/23)	30.96	Generalized	2-25y	50 (30/20)	31.45	Age, sex, skin type	Serum/NC	ng/mL (ND)	NA	NA	NA	NA	NA	NA	NA	7
Prakash & Karthikeyan 2017/India (Oct 2014-May 2016)²²22 Prakash D, Karthikeyan K. A case control study of vitamin D levels in patients with vitiligo. Int J Res Dermatol. 2017;3:103.	Case-control/V	45 (26/19)	43.78	Vulgaris Acrofacial Focal	51.04 m	45	NA	Age, sex	Serum/ELISA	ng/mL (ND)	(<20, 20-30, >30 ng/mL)	23	22	0	21	21	3	6
Ramalingam & Tang 2018/ Malaysia (Jul-Dec 2014)²³23 Ramalingam R, Tang MM. 25-hydroxyvitamin D Level among Vitiligo Patients in Malaysia. J Endocrinol Diabetes Obes. 2018;6:1112.	Cross-sectional/I-IV	93 (46/47)	40.43	Non-segmental	3y	87 (43/44)	39.95	Age, sex, race, BMI	Serum/NC	ng/mL (ND)	(≤20, 20-30, >30 ng/mL)	37	29	27	42	23	22	7
Saleh et al., 2013/Egypt (Apr-Jun 2011)²⁴24 Saleh HMA, Abdel Fattah NSA, Hamza HTMM. Evaluation of serum 25-hydroxyvitamin D levels in vitiligo patients with and without autoimmune diseases. Photodermatol Photoimmunol Photomed. 2013;29:34-40.	Case-control/III-IV	40 (18/22)	34.1	Nonsegmental	3.5 y	40 (18/22)	34.2	Age, sex, skin type, Vit-D intake	Serum/RIA	ng/mL (SL)	(≤20, 20-30, ≥30 ng/mL)	39	0	1	5	2	33	7
Saniee et al., 2019/Iran (Spring and summer 2017)²⁵25 Saniee S. Zinc, vitamin D and TSH levels in vitiligo patients. Erciyes Med J. 2019;41:13-5.	case control/III-IV	98 (50/48)	30.06	NC	34.65m	98 (53/45)	29.45	Age, sex	Serum/ELISA	ng/mL (ND)	(<10, 10-30, >30 ng/mL)	17	53	28	17	46	35	6
Sanjay & Raval 2019/India (1 yr period)²⁶26 Sanjay B, Raval S. Clinical significance of serum vitamin d level in patients of vitiligo at tertiary care centre, Surat, India. Int J Sci Res. 2019;9:52-3.	Cross sectional/NC	25 (15/10)	23.0	Focal Generalized Acrofacial Mucosal	NA	25 (16/9)	24.12	Age, sex	Serum/ECL	ng/mL (ND)	NA	NA	NA	NA	NA	NA	NA	4
Sehrawat et al., 2014/India²⁷27 Sehrawat M, Arora TC, Chauhan A, Kar HK, Poonia A, Jairath V. Correlation of Vitamin D Levels with Pigmentation in Vitiligo Patients Treated with NBUVB Therapy. ISRN Dermatol. 2014;2014:1-6.	Clinical study/IV-V	30 (10/20)	31.33	Generalized	10.47y	30 (10/20)	NA	Age, sex	Serum/ELISA	nmoL/L (SL)	(<25, 25-74, 75-250 nmoL/L)	24	6	0	3	27	0	6
Shalaby et al., 2017/Egypt (Dec 2014-Jun 2016)³⁴34 Shalaby MES, Ibrahim SM, Shorbagy MSE, Ahmed RAE. Evaluation of serum level of 25-hydroxy vitamin D in vitiligo patients. Gulf J Dermatology Venereol. 2017;24:45-9.	Case-control/NC	40 (30/10)	28.70	Non-segmental	4.7y	40 (25/15)	32.95	Age, sex	Serum/ELISA	nmoL/L (SL)	(<10, 10-30, >30 ng/mL)	8	22	10	0	4	36	6
Sobeih et al., 2016/Egypt (Jul-Dec 2013)²⁸28 Sobeih S, Mashaly HM, Gawdat H, Amr K, Hamid MFA, Shaalan E. Evaluation of the correlation between serum levels of vitamin D and vitamin D receptor gene polymorphisms in an Egyptian population. Int J Dermatol. 2016;55:1329-35.	Case-control/ III-V	75	31.5	Vulgaris Acrofacial Segmental	5.5 y	75	NA	Age, sex	Serum/ELISA	ng/mL (SL)	NA	NA	NA	NA	NA	NA	NA	5
Srirama 2016/India (4 m period)²⁹29 Srirama L. A Case Control Study: Evaluation of Serum Vitamin D Levels and Vitamin B12 Levels in Vitiligo. J Med Sci Clin Res. 2016;4:10331-6.	Case-control/NC	30 (11/19)	43.9	Clinical	2-5y	30 (11/19)	49.8	Age, sex	Serum/CLIA	ng/mL (SL)	(<20, 20-30, >30 ng/mL)	NA	NA	NA	NA	NA	NA	5
Takci et al., 2015/Turkey (Winter: Nov 2011-Feb 2012)³⁰30 Takci Z, Tekin Ö, Ertuğrul DT, Karadağ AS, Akin KO. A case-control study: Evaluation of vitamin D metabolism in patients with vitiligo. Turkish J Med Sci. 2015;45:837-41.	Case-control/II, III	44 (24/20)	34.5	Vulgaris Generalized Localized	38.8m	43 (10/33)	33.0	Age, sex, skin type	Plasma/RIA	ng/mL (SL)	(<20, 20-30, >30 ng/mL)	32	NA	NA	13	NA	NA	7
Ustun et al., 2014/Turkey (b/w 2010-2011)³¹31 Ustun I, Seraslan G, Gokce C, Motor S, Can Y, Ugur Inan M, et al. Investigation of vitamin D levels in patients with vitiligo vulgaris. Acta Dermatovenerol Croat. 2014;22:110-3.	Cross-sectional/II, III	25 (13/12)	33.9	Vulgaris	5.36y	41 (20/21)	34.7	Age, sex, skin type	Serum/CLIA	ng/mL (ND)	(<20, 21-29, 30-100 ng/mL)	20	5	0	34	6	1	8
Watabe et al., 2018/Japan (Sep 2015-Jan 2016)³²32 Watabe A, Yamasaki K, Asano M, Kanbayashi Y, Nasu-Tamabuchi M, Terui H, et al. Efficacy of oral cholecalciferol on rhododendrol-induced vitiligo: A blinded randomized clinical trial. J Dermatol. 2018;45:456-62.	RCT/III, IV	45	50.89	Vulgaris	NC	45	Age matched	Age	Serum/ NC	ng/mL (SL)	(<20, 20-30, >30 ng/mL)	30	12	3	17	20	8	8
Xu et al., 2012/China (Mar-May 2011)³³33 Xu X, Fu WW, Wu WY. Serum 25-Hydroxyvitamin D Deficiency in Chinese Patients with Vitiligo: A Case-Control Study. PLoS One. 2012;7:e52778.	Case-control/NC	171 (80/91)	34.1	Segmental, Non-segmental; generalized, universal, focal, halo nevi	NC	93	34.6	Age, sex	Serum/NC	nmol/L (ND)	(<25, 25-75, >75 nmoL/L)	57	114	0	57	36	0	7
Xu et al., 2012/China (Sep-Oct 2010)³³33 Xu X, Fu WW, Wu WY. Serum 25-Hydroxyvitamin D Deficiency in Chinese Patients with Vitiligo: A Case-Control Study. PLoS One. 2012;7:e52778.	Case-control/NC	30	NA	Segmental, Non-segmental; generalized, universal, focal, halo nevi	NC	20	NA	Age, sex	Serum/NC	nmol/L (ND)	(<25, 25-75, >75 nmoL/L)	3	27	0	2	18	0	7

Subgroup	N of studies	I² (%)	SMD	95% CI	Overall effect (Z)	p-value
Overall	31	95	-1.03	-1.35; -0.71	6.22	<0.00001
Country
Egypt	10	94	-2.46	-3.21; -1.70	6.39	<0.00001
Non-Egypt	21	90	-0.43	-0.69; -0.17	3.22	0.001
Germany	1	NA	-1.80	-2.15; -1.45	10.09	<0.00001
China	3	0	-0.14	-0.34; 0.06	1.34	0.18
India	7	88	-0.63	-1.08; -0.17	2.70	0.007
Iran	2	56	0.12	-0.30; 0.55	0.56	0.57
Japan	1	NA	-0.63	-1.05; -0.20	2.91	0.004
Malaysia	1	NA	0.07	-0.23; 0.36	0.45	0.65
Mexico	1	NA	0.65	-1.13; -0.17	2.64	0.008
Saudi Arabia	1	NA	0.17	-0.06; 0.40	1.47	0.14
Turkey	4	77	-0.39	-0.84; 0.06	1.71	0.09
Method
ELISA	15	95	-1.72	-2.27; -1.16	6.04	<0.00001
Non-ELISA	9	94	-0.54	-1.09; 0.02	1.91	0.06
CL	6	94	-0.20	-0.86; 0.46	0.59	0.56
RIA	2	94	-1.42	-2.86; 0.02	1.93	0.05
LCMS	1	NA	-0.86	-1.27; -0.45	4.11	<0.0001
NA/NC	7	66	-0.26	-0.52; -0.00	1.98	0.05
Vitiligo
Type A vs. B	4	10	-0.08	-0.41; 0.25	0.48	0.63
Type A vs. C	5	37	0.37	-0.11; 0.86	1.51	0.13
Type B vs. C	3	22	0.22	-0.53; 0.96	0.57	0.57
Male vs. Female	11	80	0.24	-0.09; 0.56	1.43	0.15
Active vs. Stable	4	41	0.18	-0.21; 0.57	0.92	0.36
SKT-III vs. IV	4	48	-0.20	-0.64; 0.24	0.91	0.36
VFH-Positive vs. Negative	5	26	0.15	-0.16; 0.46	0.93	0.35
AIC-Positive vs. Negative	5	64	0.04	-0.48; 0.56	0.15	0.88
Indoor vs. Outdoor	3	68	-0.57	-1.15; 0.01	1.94	0.05
Indoor vs. Outdoor & U/R	4	60	-0.45	-0.86; -0.04	2.17	0.03
Journal Article Indexed
PubMed/MEDLINE	18	96	-1.37	-1.86; -0.88	5.47	<0.00001
Non-PubMed/MEDLINE	13	90	-0.59	-0.96; -0.23	3.16	0.002

Variables	Coefficients	95% CI	SE	p-value
Total n	0.004	-0.003; 0.012	0.004	0.253
Vitiligo n	0.003	-0.009; 0.016	0.006	0.612
Controls n	0.015	-0.001; 0.031	0.008	0.059
Vitiligo-Male	0.009	-0.015; 0.034	0.013	0.468
Vitiligo-Female	0.007	-0.018; 0.032	0.013	0.593
Vitiligo-M/F Ratio	0.030	-0.073; 0.134	0.053	0.566
Controls -Male	0.038	0.001; 0.075	0.019	0.044
Controls -Female	0.031	-0.007; 0.068	0.019	0.107
Controls -M/F Ratio	0.030	-0.073; 0.134	0.053	0.566
Vitiligo-Age	0.042	-0.056; 0.140	0.050	0.405
Controls-Age	0.012	-0.105; 0.130	0.060	0.837
Disease duration	-0.021	-0.261; 0.219	0.122	0.863
Year	-0.086	-0.313; 0.140	0.116	0.455
Country	0.194	0.041; 0.347	0.078	0.013
Method	-0.450	-1.206; 0.306	0.386	0.243
NOS	-0.166	-0.756; 0.425	0.301	0.583

Vit-D correlation with	Studies	n	I² (%)	r	95% CI	Z	p
Age	6	317	86.92	-0.144	-0.438-0.178	-0.874	0.38
DD	7	342	4.97	0.061	-0.052-0.173	1.057	0.29
BSA	4	202	0.00	0.135	-0.006-0.271	1.876	0.06
VASI	5	220	82.68	-0.197	-0.494-0.142	-1.143	0.25

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[1] * Corresponding author. E-mail: lifeschemistry@live.com (S.R. Varikasuvu).

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Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis☆☆ ☆☆ Study conducted at the All India Institute of Medical Sciences, Deoghar, Jharkhand, India.

Abstract

Background:

Methods:

Results:

Study limitations:

Conclusions:

Decreased circulatory levels of Vitamin D in Vitiligo (ViViD Study): a meta-analysis^☆☆ ☆☆ Study conducted at the All India Institute of Medical Sciences, Deoghar, Jharkhand, India.