Patient-Reported Outcomes Reveal Distinct Sinonasal Phenotype in Vitiligo-Associated Chronic Rhinosinusitis

Introduction: Vitiligo is a chronic, T1-skewed autoimmune depigmentation disorder associated with substantial psychosocial burden and a range of immune-mediated comorbidities. Chronic rhinosinusitis (CRS) is a heterogeneous inflammatory condition whose clinical expression is shaped by underlying immune endotype and systemic comorbidity. While CRS prevalence is elevated in patients with vitiligo, the impact of vitiligo on CRS phenotype and symptom burden has not been characterized. This study evaluated whether CRS in patients with vitiligo exhibits a distinct clinical profile compared with CRS alone. Methods: In this retrospective study, 13 patients with comorbid vitiligo and CRS were compared to 137 patients with CRS without nasal polyps and 49 with CRS with nasal polyps, both without autoimmune comorbidity. CRS severity was assessed using the Sino-Nasal Outcome Test (SNOT-22), Lund-Mackay Score (LMS), Lund-Kennedy Score (LKS), serum IgE, absolute eosinophil count, and nasal polyp presence. Results: Demographics were similar across groups. Objective disease burden was greatest in CRS with nasal polyps. Despite carrying intermediate LMS and LKS scores, vitiligo-associated CRS demonstrated the highest total SNOT-22 scores (p = 0.04), with significant elevations in need to blow the nose, sneezing, ear fullness, ear pain, dizziness, facial pain, fatigue, and sleep quality. Conclusions: Vitiligo confers a distinct CRS phenotype characterized by disproportionately elevated subjective symptom burden relative to objective disease severity. This discordance may reflect systemic neuroimmune amplification driven by vitiligo's T1 dominant cytokine environment, underscoring the importance of patient reported outcomes and multidisciplinary management in this population.