Beyond Pigmentation: Interplay of Metabolic Profile, Carotid Intima—Media Thickness, and Fatty Liver in Vitiligo: An Age‐ and Sex‐Matched Case‐Control Study

Background and Aims Vitiligo shares inflammatory and metabolic pathways with cardiovascular and hepatic steatosis. Carotid intima–media thickness (IMT) is an established marker of early subclinical atherosclerosis, whereas non‐alcoholic fatty liver disease (NAFLD) reflects hepatic involvement in chronic inflammatory and metabolic dysregulation. This study aimed to evaluate subclinical vascular and hepatic changes in patients with vitiligo and to explore their associations with disease characteristics and metabolic parameters. Methods In this age‐ and sex‐matched case‐control study, adults with mild vitiligo (Vitiligo Area Severity Index [VASI] < 5%) and no metabolic syndrome were compared with healthy controls. Participants underwent carotid duplex ultrasonography to assess common carotid IMT and atherosclerotic plaques, liver ultrasonography for steatosis grading, and laboratory testing, including lipid profile (total cholesterol, low‐density lipoprotein [LDL], high‐density lipoprotein [HDL], and triglycerides [TG]), fasting blood glucose (FBS), and body mass index (BMI). Disease duration and VASI score were also assessed. Results A total of 46 participants (23 patients with vitiligo and 23 healthy controls) completed all assessments. Common carotid IMT measurements and liver ultrasound findings were comparable between groups. However, abnormal HDL levels were more frequent among patients with vitiligo (69.6% vs. 39.1%, p = 0.03). Greater disease severity, measured by VASI score, and higher BMI were independently associated with increased right carotid IMT ( p = 0.01, 0.02, respectively). Exploratory interaction analyses demonstrated significant sex‐dependent associations of HDL, triglycerides, and fatty liver status with carotid IMT. Post hoc analyses identified higher carotid IMT among male patients with abnormal HDL. Conclusion Selected subgroups of patients with vitiligo, particularly men with HDL metabolic abnormalities, may exhibit differences in subclinical carotid atherosclerosis. Disease severity and BMI may also contribute to the vascular risk. Although exploratory, these findings warrant further investigation of cardiovascular and hepatic risk profiles in selected patients with vitiligo.