Vitiligo and Depression in Western versus South Asian Countries: Cultural Background Should Be Considered.

Abstract

Reported psychosocial outcomes in vitiligo vary considerably across geographic and cultural contexts, yet no comprehensive review has compared these differences. In this study, we aimed to review the psychological and social impact of vitiligo, with a comparative focus on South Asia and Western countries. In this review, Western countries were defined as Europe, the United States, Canada, and Australia, whereas South Asian countries included India, Pakistan, Bangladesh, Sri Lanka, and Nepal. This narrative review was conducted using PubMed, Scopus, Web of Science, and PsycINFO, including English- and French-language publications from 2000 to 2025. Evidence was categorized across 5 thematic domains: (i) psychological outcomes, (ii) social consequences, (iii) skin phototype and visibility, (iv) health system and policy factors, and (v) cultural and religious frameworks. Psychiatric morbidity was highest in South Asian populations, with depression and anxiety rates reaching up to 60%, compared with 15-30% in European cohorts and 20-30% in North American and Australian samples. Stigma in India was exacerbated by cultural beliefs related to contagion, impurity, karma, and dietary taboos, especially among individuals with darker skin phototypes. Western patients more often reported issues related to self-image and social withdrawal but faced fewer institutional or interpersonal barriers. Future research should prioritize longitudinal and community-based studies to inform interventions that shift vitiligo from a socially disabling condition to a manageable chronic difference.