Familial Versus Non-Familial Vitiligo: Clinical Features, Anatomical Distribution, and Autoimmune Comorbidity from a Southern Taiwan Hospital

<i>Background and Objectives</i>: Familial clustering and autoimmune multimorbidity are frequently observed in vitiligo. However, the clinical implications of a positive family history across generations remain unclear. In this study, a positive family history was defined as having at least one affected parent or grandparent. <i>Materials and Methods</i>: We retrospectively reviewed the electronic medical records of 972 adults with vitiligo who attended the rheumatology division in a regional teaching hospital in southern Taiwan between 2006 and 2022. Demographic characteristics, family history, clinical features, and autoimmune comorbidities were extracted from electronic medical records. Associations between family history and clinical parameters were assessed using logistic regression analyses adjusted for age and sex. <i>Results</i>: A total of 157 patients (16.2%) reported a family history, more often through parents than grandparents; maternal history was more common than paternal. Compared with those without a family history, affected families showed significantly younger age at diagnosis and a higher prevalence of lower-limb involvement. In adjusted models, family history was associated with greater odds of lower-limb involvement (adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI] 1.22-2.58) and lower odds of eyebrow/eyelash depigmentation (aOR 0.39, 95% CI 0.16-0.92). Hashimoto thyroiditis was more frequent among familial cases (aOR 7.56, 95% CI 1.23-46.65). In sex-stratified analyses, associations were stronger in females, notably for lower-limb involvement (aOR 1.87), axillary depigmentation (aOR 2.33), and Hashimoto thyroiditis (aOR 11.27). <i>Conclusions</i>: Familial vitiligo shows earlier onset, distinct anatomical patterns, and increased thyroid autoimmunity, supporting systematic family-history assessment and targeted thyroid screening.