Abstract
INTRODUCTION: Vitiligo is an autoimmune condition that causes depigmented skin patches, often leading to challenges such as stigma, bullying, and poor self-esteem in pediatric populations. These challenges may contribute to psychiatric comorbidities and impaired quality of life (QoL). Pediatric-specific data remain limited. OBJECTIVES: To synthesize current evidence on psychiatric comorbidities and QoL outcomes in pediatric vitiligo and identify factors associated with increased psychosocial burden. METHODS: PubMed, Embase, and MEDLINE were systematically searched through March 15, 2025, for primary English-language studies involving patients aged 0-18 years with vitiligo and validated psychiatric or QoL outcomes. Study quality was assessed using Oxford Centre for Evidence-Based Medicine Levels of Evidence. Meta-analyses were performed where possible, with 95% confidence intervals and I (2) for heterogeneity. Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation framework. RESULTS: Fourteen studies (n = 1576) were included. Pooled means for depression (CDI: 9.93) and anxiety scores (STAI-State: 37.07; STAI-Trait: 38.27) did not exceed thresholds for probable clinical diagnosis, though heterogeneity was considerable. Pooled means for QoL burden (CDLQI: 3.00; PedsQL: 80.55) suggested mild-to-moderate QoL impairment. Multiple individual comparative studies reported greater psychiatric symptom burden and higher prevalence of depression and anxiety among vitiligo patients versus controls. Subgroup findings from selected studies also suggested worse QoL in adolescents and those with extensive or visible lesions. CONCLUSIONS: Pediatric vitiligo is associated with elevated psychiatric comorbidity prevalence, symptom burden, and mild-to-moderate QoL impairment among included studies. These findings highlight the need for clinicians to integrate psychosocial assessment into routine care. Current evidence further emphasizes incorporating routine mental health screening and multidisciplinary support into pediatric dermatology practice for children with vitiligo, although conclusions are restricted by limited and heterogeneous data.