Association of serum cortisol and dehydroepiandrosterone sulfate (DHEAS) levels with psychological stress in patients with vitiligo

Ahmet Gürpinar,Cengiz Kiliç,Ayşen Karaduman,Sibel Doğan Günaydin

doi:10.3906/sag-1812-84

Abstract

Background/aimVitiligo is a depigmentation disorder that leads to serious psychological burden in patients, who are frequently reported to have depression and anxiety. The aim of this study was to investigate the association between stress-related hormone levels and psychological stress in vitiligo. Materials and methodsIn this study 46 vitiligo patients and 46 controls were enrolled; their cortisol, dehydroepiandrosterone sulfate (DHEAS), and cortisol/DHEAS levels were measured. Psychological burden was assessed by the Beck Depression Inventory and Perceived Stress Scale. ResultsPatients and controls did not differ in terms of cortisol, DHEAS, or cortisol/DHEAS. Patients had higher perceived stress than controls but did not differ in terms of depression scores. Correlation analyses revealed that cortisol/DHEAS correlated positively with perceived stress (P = 0.009, r = 0.272). The correlation between cortisol/DHEAS and perceived stress was stronger in the patient group (P = 0.013, r = 0.363) and close to zero among controls. In regression analyses, lower depression and higher perceived stress were shown to predict cortisol/DHEAS values. ConclusionVitiligo patients significantly differed from the healthy population in terms of hormones and psychological distress. There was also an association between perceived stress and cortisol/DHEAS ratio in vitiligo. Abnormality of hormonal response to distress lowers DHEAS, which is known for its antioxidant properties, a possible mechanism for vitiligo development. Another important finding is the significance of using the composite variable cortisol/DHEAS, which seems to be more sensitive to distress than each of its components. We suggest its use in future studies on psychological distress–hormone relationships.

Highlights

Stress and hormones are known to be closely related, and recent studies show that, in addition to cortisol, the major stress hormone dehydroepiandrosterone sulfate (DHEAS) may play a role in stress [1,2]
Another important finding is the significance of using the composite variable cortisol/DHEAS, which seems to be more sensitive to distress than each of its components
We suggest its use in future studies on psychological distress–hormone relationships

Summary

Introduction

Stress and hormones are known to be closely related, and recent studies show that, in addition to cortisol, the major stress hormone dehydroepiandrosterone sulfate (DHEAS) may play a role in stress [1,2]. One of the most popular pathogenetic mechanisms suggested for the pathophysiology of vitiligo is oxidative stress and hydrogen peroxide accumulation, leading to damage in melanocytes in the epidermis [3,4]. The cosmetic disfigurement is known to lead to serious psychological burdens in patients with vitiligo, who are frequently reported to have depression and anxiety disorders, which may in part be caused by stigmatization of the disease [5,6,7]. Based on the existing literature, we sought to investigate the association between stress-related hormone levels (serum cortisol and DHEAS) and psychological stress measures in vitiligo patients. DHEAS levels were not evaluated in vitiligo before. The relationship between hormone levels and clinical subtypes of vitiligo was evaluated. We will find differences in stress-related hormone levels (i.e. cortisol and DHEAS) between vitiligo patients and controls Our hypotheses were as follows: 1. We will find differences in stress-related hormone levels (i.e. cortisol and DHEAS) between vitiligo patients and controls

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