Serum homocysteine, folate, and vitamin B12 levels in patients with vitiligo and their potential roles as disease activity biomarkers: A systematic review and meta-analysis

Tsung Yu Tsai, Che Yuan Kuo, Yu-Chen Huang

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Background: Hyperhomocysteinemia and folate and vitamin B12 deficiencies have been reported in patients with vitiligo. Investigating the role of these conditions might shed light on the pathogenesis of vitiligo. Objective: To perform a systematic review and meta-analysis of studies assessing serum homocysteine, folate, and vitamin B12 levels in vitiligo patients. Methods: Online databases were searched on May 15, 2018, to identify studies comparing serum homocysteine, folate, and vitamin B12 levels between patients with vitiligo and controls. A random effects model was used. Results: Twenty-two studies involving a total of 1448 patients with vitiligo were included. Patients with vitiligo had significantly higher serum homocysteine levels (standardized mean difference [SMD] 0.550, 95% confidence interval [CI] 0.262-0.838; I2 87.3%) and lower vitamin B12 levels (SMD −0.430, 95% CI −0.738 to −0.121; I2 85.3%) than controls. Serum folate levels were not significantly different between the 2 groups (SMD –0.240, 95% CI –0.592 to 0.111; I2 85.5%). A subgroup analysis revealed that these findings correlated with disease activity. Limitations: The included studies were heterogeneous. Serum homocysteine levels could be influenced by various factors. Conclusion: Patients with vitiligo have higher serum homocysteine levels and lower vitamin B12 levels than individuals without vitiligo.

Original languageEnglish
JournalJournal of the American Academy of Dermatology
Publication statusAccepted/In press - Jan 1 2018



  • folate
  • homocysteine
  • hyperhomocysteinemia
  • vitamin B
  • vitiligo

ASJC Scopus subject areas

  • Dermatology

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