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Eleftheriadou V, Delattre C, Chetty-Mhlanga S, Lee C, Girardat-Rotar L, Khan I, Mathew A, Thompson AR. Burden of disease and treatment patterns in patients with vitiligo: findings from a national longitudinal retrospective study in the UK. Br J Dermatol 2024; 191:216-224. [PMID: 38534198 DOI: 10.1093/bjd/ljae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND UK studies examining vitiligo burden and vitiligo-related healthcare resource utilization (HCRU) are lacking. OBJECTIVE To describe the incidence and prevalence of vitiligo, the demographic and clinical characteristics of patients with vitiligo, vitiligo burden, HCRU, incidence of mental health comorbidities and management strategies, including treatment patterns. METHODS This retrospective study used UK Clinical Practice Research Datalink and Hospital Episode Statistics databases to analyse patients with vitiligo from 1 January 2010 to 31 December 2021. RESULTS Among 17 239 incident patients, mean incidence of vitiligo was 0.16 (2010-2021) per 1000 person-years [PY; range 0.10 (2020-COVID-19) to 0.19 (2010/2013/2018)]; among 66 217 prevalent patients, prevalence increased from 0.21% (2010) to 0.38% (2021). The most common comorbidities recorded after vitiligo diagnosis were diabetes (19.4%), eczema (8.9%), thyroid disease (7.5%) and rheumatoid arthritis (6.9%). Mental health diagnoses recorded at any time included depression and/or anxiety (24.6%), depression (18.5%), anxiety (16.0%) and sleep disturbance (12.7%), and recorded after vitiligo diagnosis in 6.4%, 4.4%, 5.5% and 3.9%, respectively. Mental health comorbidities were more common in White (e.g. depression and/or anxiety 29.0%) than in Black (18.8%) and Asian (16.1%) patients. In adolescents, depression and/or anxiety was most commonly diagnosed after a vitiligo diagnosis than before (7.4% vs. 1.8%). Healthcare resources were used most frequently in the first year after vitiligo diagnosis (incident cohort), typically dermatology-related outpatient appointments (101.9/100 PY) and general practitioner consultations (97.9/100 PY). In the year after diagnosis, 60.8% of incident patients did not receive vitiligo-related treatment (i.e. topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids or phototherapy), increasing to 82.0% the next year; median time from diagnosis to first treatment was 34.0 months (95% confidence interval 31.6-36.4). Antidepressants and/or anxiolytics were recorded for 16.7% of incident patients in the year after diagnosis. In 2019, 85.0% of prevalent patients did not receive vitiligo-related treatments. CONCLUSION Most patients were not on vitiligo-related treatments within a year of diagnosis, with the time to first treatment exceeding 2 years, suggesting that vitiligo may be dismissed as unimportant. New effective treatments, early initiation and psychological intervention and support are needed to reduce the vitiligo burden on patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew R Thompson
- Cardiff and Vale University Health Board and Cardiff University, South Wales Clinical Psychology Training Programme, Cardiff, UK
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Kim IW, Park WJ, Yun HY, Kim DS. Methylsulfonylmethane promotes melanogenesis via activation of JNK in Mel-Ab cells. Int J Cosmet Sci 2024. [PMID: 38924609 DOI: 10.1111/ics.12988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Methylsulfonylmethane (MSM), which contains organic sulphur, has been used for a long time as a medicinal ingredient because of its benefits to human health. MSM is reported to be protective against certain skin disorders, but it is unknown whether it affects melanin synthesis. Therefore, in our current research, we examined the possibility of MSM controlling the production of melanin in Mel-Ab melanocytes. METHODS In Mel-Ab cells, melanin contents and tyrosinase activities were assessed and quantified. The expression of microphthalmia-associated transcription factor (MITF) and tyrosinase was evaluated using western blot analysis, while MSM-induced signalling pathways were investigated. RESULTS The MSM treatment significantly resulted in a dose-dependent increase in melanin production. Furthermore, MSM elevated melanin-related proteins, including MITF and tyrosinase. However, the rate-limiting enzyme of melanin production, tyrosinase, was not directly influenced by it. Therefore, we investigated potential melanogenesis-related signalling pathways that may have been triggered by MSM. Our findings showed that MSM did not influence the signalling pathways associated with glycogen synthase kinase 3β, cAMP response-element binding protein, extracellular signal-regulated kinase, or p38 mitogen-activated protein kinase. However, MSM phosphorylated c-Jun N-terminal kinases/stress-activated protein kinase (JNK/SAPK), which is known to induce melanogenesis. SP600125, a specific JNK inhibitor, inhibited MSM-induced melanogenesis. CONCLUSION Taken together, our study indicates that MSM induces melanin synthesis and may serve as a therapeutic option for hypopigmentary skin disorders such as vitiligo.
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Affiliation(s)
- In Wook Kim
- Department of Biochemistry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Woo-Jae Park
- Department of Biochemistry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hye-Young Yun
- Department of Biochemistry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Dong-Seok Kim
- Department of Biochemistry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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Rosmarin D, Lofland JH, Marwaha S, Piercy J, Anderson P, Liu J. Patient Burden of Nonsegmental Vitiligo: A US Real-World Survey of Dermatologists and Their Patients. Dermatol Ther (Heidelb) 2024; 14:1531-1546. [PMID: 38753072 PMCID: PMC11169217 DOI: 10.1007/s13555-024-01165-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/10/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Vitiligo is a chronic autoimmune disease characterized by destruction of melanocytes, leading to skin depigmentation. Vitiligo can have a high quality-of-life burden and profound impact on psychosocial well-being. The objectives of this study were to describe the self-reported patient burden among patients with nonsegmental vitiligo with ≤ 10% affected body surface area, summarize the physician-reported psychosocial and psychological impact of vitiligo on patient lives, and describe disease characteristics and treatment history, goals, and satisfaction. METHODS Data were drawn from the Adelphi Vitiligo Disease Specific Programme™, a real-world, cross-sectional survey with retrospective data collection of physicians and patients with vitiligo, collected in the United States between October 2021 and April 2022. Separate surveys for dermatologists and patients contained questions on clinical and demographic characteristics of patients with vitiligo and burden of vitiligo. Treatment history, goals, and satisfaction were assessed together with the impact of vitiligo on quality of life. RESULTS Sixty-one dermatologists provided data for 326 patients with ≤ 10% affected body surface area (adults, n = 221; adolescents, n = 105); 90 of those patients also responded to the survey. The most common treatments were topical corticosteroids, topical calcineurin inhibitors, and narrow-band ultraviolet-B phototherapy, with the main treatment goal being repigmentation. Physician-reported treatment satisfaction was 56%; 25% of patients reported frustration with treatment options. Physicians reported impact of vitiligo on everyday life in 46% of patients. Patients reported 12.7% overall work impairment; mean scores for Hospital Anxiety and Depression Scale anxiety and depression domains were 3.5 and 2.2, respectively, and mean Vitiligo-specific Quality of Life index score was 26.9. Patients with facial involvement experienced higher burden than those without. CONCLUSION A high patient burden was reported by dermatologists and their patients with vitiligo who had ≤ 10% affected body surface area, including psychosocial and psychological consequences. These findings highlight an unmet need in the treatment of vitiligo.
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Affiliation(s)
- David Rosmarin
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | | | | | | | - Jinan Liu
- Incyte Corporation, 1801 Augustine Cut-Off, Wilmington, DE, 19803, USA.
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Wu W, Wang X, He K, Li C, Li S. From mice to men: An assessment of preclinical model systems for the study of vitiligo. Clin Immunol 2024; 262:110171. [PMID: 38462156 DOI: 10.1016/j.clim.2024.110171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/21/2024] [Accepted: 02/16/2024] [Indexed: 03/12/2024]
Abstract
Vitiligo is an autoimmune skin disease of multiple etiology, for which there is no complete cure. This chronic depigmentation is characterized by epidermal melanocyte loss, and causes disfigurement and significant psychosocial distress. Mouse models have been extensively employed to further our understanding of complex disease mechanisms in vitiligo, as well as to provide a preclinical platform for clinical interventional research on potential treatment strategies in humans. The current mouse models can be categorized into three groups: spontaneous mouse models, induced mouse models, and transgenic mice. Despite their limitations, these models allow us to understand the pathology processes of vitiligo at molecule, cell, tissue, organ, and system levels, and have been used to test prospective drugs. In this review, we comprehensively evaluate existing murine systems of vitiligo and elucidate their respective characteristics, aiming to offer a panorama for researchers to select the appropriate mouse models for their study.
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Affiliation(s)
- Wei Wu
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China
| | - Xinju Wang
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China
| | - Kaiqiao He
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China
| | - Chunying Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China.
| | - Shuli Li
- Department of Dermatology, Xijing Hospital, Fourth Military Medical University, No. 127 Changlexi Road, Xi'an 710032, Shaanxi, China.
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Augustin M, Gewiss C, Ben-Anaya N, Böhm M. [Quality of life, disease burden and healthcare need of patients with vitiligo]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:404-411. [PMID: 38466405 PMCID: PMC11065915 DOI: 10.1007/s00105-024-05312-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND With a prevalence of 0.5-2%, vitiligo is one of the most common skin disorders worldwide with loss of pigment. The skin disease has a disfiguring, often stigmatising character and is often associated with psychosocial distress. OBJECTIVE To provide an overview of the psychosocial impairment, disease burden and resulting health care needs of patients with vitiligo. MATERIALS AND METHODS Narrative review based on a literature search in PubMed for the years 1996-2022 on disease burden, quality of life and stigmatization is provided. RESULTS The search yielded 175 relevant original papers including clinical studies, meta-analyses and systematic reviews (n = 65) for the search period. A large number of studies document that vitiligo is associated with considerable psychosocial stress and relevant losses in quality of life. Problem areas particularly concern stigmatisation, sexual dysfunction, anxiety, reduced self-esteem and problems at work. The observed increased levels of anxiety and depression correlate with the severity and activity of vitiligo. Often, comorbidity also contributes to reduced self-esteem and social isolation. These factors determine a high need for care in a relevant proportion of those affected. CONCLUSION Vitiligo is not primarily a cosmetic problem, but a disease requiring treatment according to the World Health Organisation's definition of health as physical, mental and social well-being. The benefits of treatment options are to be measured by their effects on patient-reported outcomes.
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Affiliation(s)
- Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 42, 20246, Hamburg, Deutschland.
| | - Caroline Gewiss
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 42, 20246, Hamburg, Deutschland
| | - Nesrine Ben-Anaya
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Martinistr. 42, 20246, Hamburg, Deutschland
| | - Markus Böhm
- Klinik für Hautkrankheiten, Universitätsklinikum Münster, Münster, Deutschland
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Fakih A, Tannous R, Lajnef M, Seneschal J, Andreu N, Tran VT, Ezzedine K. Stigma in vitiligo: associated factors and severity strata of the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) score. Br J Dermatol 2024; 190:712-717. [PMID: 38234050 DOI: 10.1093/bjd/ljae020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed. OBJECTIVES To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) for patients with vitiligo. METHODS We conducted a cross-sectional study in ComPaRe Vitiligo, an e-cohort of adult patients with vitiligo. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata for the PUSH-D. RESULTS In total, 318 patients participated (mean age 49.7 years; 73.9% women). Fitzpatrick skin phototype IV-VI, severe facial involvement (high Self-Assessment Vitiligo Extent Score of the face) and depression (high Patient Health Questionnaire-9 score) were positively -associated with a higher stigmatization score, although this association was weak [r = 0.24 (P < 0.001) and r = 0.30 (P < 0.001), respectively]. PUSH-D cutoff values that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23 (κ = 0.622, 95% confidence interval 0.53-0.71). CONCLUSIONS Our study is the first to use a skin-specific stigmatization tool to assess stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.
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Affiliation(s)
- Ali Fakih
- Department of Dermatology, Hôpital Nord, Centre Hospitalier Universitaire, Université Jean Monnet, Saint Etienne, France
| | - Rim Tannous
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Mohamed Lajnef
- Inserm U955 IMRB, Translational Neuropsychiatry Laboratory and Paris-Est Créteil University, Créteil, France
| | - Julien Seneschal
- Department of Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, Bordeaux, France
| | - Nicolas Andreu
- Department of Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, Bordeaux, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Centre de Recherche Épidémiologie et Statistiques (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
- EpidermE, Université Paris-Est Créteil (UPEC), Créteil, France
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Ezzedine K, Soliman AM, Li C, Camp HS, Pandya AG. Economic Burden among Patients with Vitiligo in the United States: A Retrospective Database Claims Study. J Invest Dermatol 2024; 144:540-546.e1. [PMID: 37739338 DOI: 10.1016/j.jid.2023.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/24/2023]
Abstract
Patients with vitiligo incur direct and indirect costs associated with their condition; however, data regarding the economic burden of vitiligo are scarce and outdated. In this retrospective cohort analysis of the Merative MarketScan Commercial Database, healthcare costs and healthcare resource utilization (HCRU) were evaluated among United States patients with vitiligo. Patients with vitiligo were matched (1:2) with individuals without vitiligo (controls) between January 2007 and December 2021. Outcomes included all-cause and vitiligo-related costs (2021 dollars) and all-cause HCRU, including mental health-related HCRU, during a 1-year postindex period. Subgroup analyses were completed for patients on vitiligo treatments with systemic effects (such as phototherapy and oral steroids) or a new mental health diagnosis. The analysis was focused solely on direct costs. Baseline demographics were well-balanced between matched vitiligo (49,512) and control (99,024) cohorts. Patients with vitiligo incurred significantly higher all-cause ($15,551 vs $7735) and vitiligo-related ($3490 vs $54) costs than controls (P < .0001). All-cause and mental health-related HCRU were also significantly higher among patients with vitiligo (P < .0001). Differences in all-cause and vitiligo-related healthcare costs remained significantly higher in patients on treatments with systemic effects/mental health diagnoses than in controls (P < .0001). Taken together, healthcare costs and HCRU were significantly higher among patients with vitiligo than among controls.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, Université Paris-Est Créteil (UPEC), Créteil, France; Epidemiology in Dermatology and Evaluation of Therapeutics (EpiDermE) - EA 7379, Université Paris-Est Créteil (UPEC), Créteil, France.
| | - Ahmed M Soliman
- Health Economics and Outcomes Research Strategy Team, AbbVie, North Chicago, Illinois, USA
| | - Chao Li
- Health Economics and Outcomes Research Strategy Team, AbbVie, North Chicago, Illinois, USA
| | - Heidi S Camp
- Immunology Clinical Development, AbbVie, North Chicago, Illinois, USA
| | - Amit G Pandya
- Department of Dermatology, Palo Alto Foundation Medical Group, Sunnyvale, California, USA; Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Raheel MFS, Snoubar Y, Mosbah WS. Being female with vitiligo disease in traditional societies within North Africa. Biopsychosoc Med 2024; 18:1. [PMID: 38200533 PMCID: PMC10777494 DOI: 10.1186/s13030-024-00299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
This study aims to assess the influence of vitiligo illness on the quality of life of female individuals residing in Ajdabiya, Libya. Through this investigation, we aim to enhance our comprehension of the potential impact of cultural norms and conventional gender roles on managing and caring for skin disorders within a North African society. Over a 20-week period, 65 female participants diagnosed with vitiligo were recruited. The participants' quality of life was assessed using the Skindex-16 scale. This validated tool measures the impact of skin disease on several aspects of an individual's life, including physical, emotional, and social well-being. The findings of this study indicate that the quality of life of women with vitiligo significantly differed with age, social and functional status, and economic status. However, the illness profoundly impacted patients' lives emotionally, with clear consequences, including diminished emotional satisfaction and reduced social participation. The results of this study highlight the negative effects that vitiligo disease can have on women's quality of life within traditional Libyan society. This investigation also indicates that cultural norms and traditional gender patterns may contribute to these effects.
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Affiliation(s)
| | - Yaser Snoubar
- Department of Social Sciences, College of Arts and Sciences, Qatar University, Doha, 2713, Qatar.
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Wang Y, Yao T, Lin Y, Ye L, Li S, Gao Y, Wu J. Exploring genetic associations between vitiligo and mental disorders using Mendelian randomization. Exp Dermatol 2024; 33:e14979. [PMID: 37975615 DOI: 10.1111/exd.14979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/10/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023]
Abstract
Although a large number of existing studies have confirmed that people with vitiligo are prone to mental disorders, these observational studies may be subject to confounding factors and reverse causality, so the true causal relationship is inconclusive. We conducted a bidirectional Mendelian randomization (MR) analysis to assess the causality between vitiligo and mental disorders, namely depression, anxiety, insomnia, schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD). Summary statistics from large available genome-wide association study (GWAS) datasets for generalized vitiligo (n = 44 266), depression (n = 173 005), anxiety (n = 17 310), insomnia (n = 386 988), schizophrenia (n = 130 644), bipolar disorder (n = 413 466), OCD (n = 9725) and ADHD (n = 225 534) were utilized. Inverse-variance weighted (IVW), MR-Egger and weighted median were employed to estimate causal effects. Sensitivity analysis and MR Pleiotropy Residual Sum and Outliers (MR PRESSO) were conducted to assess heterogeneity and pleiotropy, ensuring the robustness of the results. Additionally, we corrected for estimating bias that might be brought on by sample overlap using MRlap. In our findings, none of the rigorous bidirectional MR analyses uncovered a significant causal association. Even after applying the MRlap correction, the effect sizes remained statistically nonsignificant, thereby reinforcing the conclusions drawn via IVW. In summary, our genetic-level investigation did not reveal a causal link between generalized vitiligo and mental disorders.
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Affiliation(s)
- Yingwei Wang
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tao Yao
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yunlu Lin
- Department of Cardiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lili Ye
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shuting Li
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Gao
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jianming Wu
- Department of Dermatology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
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Fekete L, Iantovics LB, Fekete GL. Exploratory axis factoring for identifying the self-esteem latent factors and their correlation with the life quality of persons suffering from vitiligo. Front Psychol 2023; 14:1200713. [PMID: 38162970 PMCID: PMC10757324 DOI: 10.3389/fpsyg.2023.1200713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/24/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Our research aimed to measure the importance of self-esteem in assessing the disease burden in patients with vitiligo, which, according to our knowledge, had not been studied earlier. The purpose of this research study was to expand the state of knowledge regarding the influence of vitiligo on the quality of patients' life, with a particular focus on their self-esteem. We have formulated the following two hypotheses which include H1: two latent factors characterize the self-esteem of patients with vitiligo; H2: the self-esteem of the patients with Vitiligo is correlated with their life quality, by influencing it to a high degree. Methods We have used two validated questionnaires called Rosenberg (Q1), for the evaluation of self-esteem (for proving H1), and Dermatology Life Quality Index (DLQI) (Q2), to measure the health-related quality of life of patients (for proving H2). Both questionnaires with 10 questions were applied to the same set of 114 carefully selected patients with no missing values to questions. An in-depth statistical and reliability analysis was performed on the outcomes provided by Q1, applying a scale and subscale reliability analysis, using the Cronbach's alpha reliability indicator (Cα). An exploratory analysis called Principal Axis Factoring (PAF) with Oblimin with Kaiser Normalization rotation was applied to prove H1, verifying the assumptions regarding the average variance extracted (AVE) and convergent and discriminant validity (CDV). A scale reliability analysis of outcomes provided by Q2 was performed for proving H2, by calculating Cα. Additionally, a nonparametric correlation analysis was performed, by calculating the Spearman r correlation coefficient between the Rosenberg index and DLQI index, and the 95% confidence interval (CI). Results Based on the provided data, the value of Cα obtained in Q1 was 0.84. As a result of applying PAF on Q1, H1 has been proven and two latent factors of self-esteem have been extracted. These factors were named competence (eigenvalue = 4.126; 41.258% of total variance explained) and value (eigenvalue = 1.857; 18.57% of total variance explained). For the two subscales determined by the two factors, we have obtained the Cα values of 0.848 and 0.8, all indicating good reliability. For testing H2, on Q2 data we obtained Cα = 0.914. The Spearman correlation coefficient r = -0.734 (p < 0.0001), between the self-esteem questionnaire evaluation result and the life-quality index result indicated the existence of a strong negative correlation, which is significant according to 95% CI [-0.81, -0.63]. Discussion The study focused on analyzing the self-esteem of patients with vitiligo. In addition, the psychometric properties of the Q1 questionnaire were analyzed and Q1 proved to have good internal consistency. PAF indicated a two-factorial structure, with factors called competence and value, proving H1, with a moderate correlation of 0.427 between the two latent constructs. The competence factor includes motivation, self-efficacy, initiative, and persistence in action. The value factor is much more complex, indicating a feeling, a personal evaluation, or a positive or negative attitude toward one's person, which better captures the entire phenomenology of self-esteem. The statistical analysis of the results provided by the self-esteem questionnaire included questions that proved to be internally consistent. The AVE and CDV assumptions were met. Q2 was proved to have excellent scale reliability. H2 proved a statistically significant strong negative correlation between the Rosenberg score and DLQI score.
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Affiliation(s)
- Laszlo Fekete
- Doctoral School, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Laszlo Barna Iantovics
- Department of Electrical Engineering and Information Technology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
| | - Gyula Laszlo Fekete
- Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, Romania
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Ahmed A, Eleftheriadou V. Global VALIANT study: 'lifting the lid' on disappointment and frustration with the lack of effective treatment for vitiligo. Br J Dermatol 2023; 189:e99-e102. [PMID: 37705206 DOI: 10.1093/bjd/ljad336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/03/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023]
Affiliation(s)
- Alia Ahmed
- Frimley Health NHS Foundation Trust, Frimley
- Barts Health NHS Trust, London
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Zhang X, Naz AF, Jiang L, Fu C, Huang J, Liang Y, Zhu L, Zhang F, Chen J, Lei L, Zeng Q. Disease Awareness and Treatment Preferences in Vitiligo: A Cross-sectional Study in China. Acta Derm Venereol 2023; 103:adv11643. [PMID: 37787420 PMCID: PMC10561102 DOI: 10.2340/actadv.v103.11643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/15/2023] [Indexed: 10/04/2023] Open
Abstract
In China, there is a lack of data regarding the awareness and treatment preferences among patients with vitiligo and their families. To address this gap, a cross-sectional questionnaire-based study was conducted to investigate disease awareness and treatment preferences in Chinese patients with vitiligo. The study also evaluated willingness to pay, using 2 standardized items, and assessed quality of life, using the Dermatology Life Quality Index (DLQI) score. Data from 307 patients with vitiligo (59.3% women, mean age 28.98 years, range 2-73 years) were analysed. Of these patients, 44.7% had insufficient knowledge of vitiligo, particularly those from rural areas or with low levels of education. Mean DLQI total score was 4.86 (5.24 for women and 4.30 for men). Among the most accepted treatments were topical drugs, phototherapy, and systemic therapy. Patients were relatively conservative about the duration and cost of treatment, with only 27.7% willing to pay more than 10,000 Chinese yuan renminbi (CNY) for complete disease remission. High level of education, high income, skin lesions in specific areas, and skin transplantation therapy predicted higher willingness to pay. Insufficient knowledge was associated with a higher burden of disease. In order to reduce the disease burden and improve treatment adherence it is crucial to enhance disease awareness and take into account patient preferences.
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Affiliation(s)
- Xiaolin Zhang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Adnan Falak Naz
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Ling Jiang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Chuhan Fu
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Jinhua Huang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Yixuan Liang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Lu Zhu
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Fan Zhang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Jing Chen
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Li Lei
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China.
| | - Qinghai Zeng
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China.
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Ezzedine K, Soliman AM, Li C, Camp HS, Pandya AG. Comorbidity Burden Among Patients with Vitiligo in the United States: A Large-Scale Retrospective Claims Database Analysis. Dermatol Ther (Heidelb) 2023; 13:2265-2277. [PMID: 37668899 PMCID: PMC10539259 DOI: 10.1007/s13555-023-01001-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/02/2023] [Indexed: 09/06/2023] Open
Abstract
INTRODUCTION Vitiligo is often associated with comorbid conditions that may increase economic burden and affect patients' health-related quality of life. No large-scale study has been published to date using claims databases to evaluate the burden of comorbidities among patients with vitiligo. Herein, we evaluate the comorbidity burden among patients diagnosed with vitiligo from the US. METHODS This retrospective cohort analysis used the Merative MarketScan Commercial Database. Eligible patients were diagnosed with vitiligo between January 2008 and December 2020 and matched 1:4 (vitiligo:control) with control subjects with no diagnosis of vitiligo between January 2007 and December 2021. Study outcomes were the incidence of comorbidities after matching, adjusted hazard ratios of comorbidity incidence among patients with vitiligo relative to matched control subjects, and time to comorbidity diagnosis or incidence. RESULTS Baseline demographics were well balanced between matched vitiligo (n = 13,687) and control cohorts (n = 54,748). Incidence rates of comorbidities were higher among patients compared with control subjects (psychiatric, 28.4% vs 22.8%; autoimmune, 13.4% vs 5.1%; and non-autoimmune, 10.0% vs 7.0%). The most common psychiatric and autoimmune comorbidities in patients with vitiligo compared with control subjects included anxiety (14.3% vs 11.0%, respectively), sleep disturbance (9.1% vs 7.1%), depression (8.0% vs 6.3%), atopic dermatitis (3.1% vs 1.1%), psoriasis (2.7% vs 0.6%), and linear morphea (1.5% vs 0.1%). The risk of developing any psychiatric (hazard ratio 1.31; P < 0.01), autoimmune (hazard ratio 2.77; P < 0.01), or non-autoimmune (hazard ratio 1.45; P < 0.01) comorbidity was significantly higher among patients with vitiligo. Time to diagnosis of most vitiligo comorbidities was 1-3 years, although linear morphea was diagnosed at < 1 year. CONCLUSION Results of this retrospective analysis demonstrated that patients were much more likely to be diagnosed with autoimmune or psychiatric comorbidities following a vitiligo diagnosis, which likely contributed to increased economic burden and lower quality of life.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, AP-HP, Henri Mondor University Hospital, UPEC, 51 Avenue de Lattre de Tassignv, 94000, Créteil, France.
- EA 7379 EpiDermE, Université Paris-Est Créteil (UPEC), Créteil, France.
| | | | - Chao Li
- AbbVie Inc., North Chicago, IL, USA
| | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Vitiligo Treatments: Review of Current Therapeutic Modalities and JAK Inhibitors. Am J Clin Dermatol 2023; 24:165-186. [PMID: 36715849 DOI: 10.1007/s40257-022-00752-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 01/31/2023]
Abstract
Vitiligo is a chronic autoimmune disease characterized by loss of pigment of the skin, affecting 0.5-2% of the population worldwide. It can have a significant impact on patients' quality of life. In recent years, there has been significant progress in our understanding of the pathogenesis of vitiligo. It is believed that vitiligo develops due to a complex combination of genetics, oxidative stress, inflammation, and environmental triggers. Conventional treatments include camouflage, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy, and surgical procedures, with the treatment regimen dependent on the patient's preferences and characteristics. With increased understanding of the importance of the Janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway in the pathogenesis of vitiligo, treatment has expanded to include the first US FDA-approved cream to repigment patients with vitiligo. This review summarizes our understanding of the major mechanisms involved in the pathogenesis of vitiligo and its most common available treatments.
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Beyzaee AM, Goldust M, Patil A, Rokni GR, Beyzaee S. The role of cytokines and vitamin D in vitiligo pathogenesis. J Cosmet Dermatol 2022; 21:6314-6325. [PMID: 35871394 DOI: 10.1111/jocd.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 12/27/2022]
Abstract
Vitiligo is a pigment-related disease with a global prevalence of 0.2% to 1.8% associated with considerable burden on quality of life. The treatment is still a challenge because of relapses and/or incomplete re-pigmentation. Although the exact cause is still unclear, its pathogenesis seems to be justifiable with the autoimmune theory, supported by the results of clinical research. In this narrative review, we aimed to summarize the evidence related to cytokines and vitiligo development. This review is consisted of English articles published in PubMed and Google Scholar concerning levels of inflammatory mediators, especially interleukins, in vitiligo patients over the last 20 years. References of relevant articles were also considered for review. Crucial role of dysregulated levels of interleukins and their synergistic function to each other, in the onset or progression of the disease is evident. The theory of autoimmune vitiligo is reinforced by the results of the studies in the literature, due to the association of pathogenesis with increased secretion of pro-inflammatory mediators and reduction of anti-inflammatory mediators. Decreased vitamin D levels may have a considerable role in vitiligo development by affecting Th1- and Th17-related immune responses. Cytokines play an important role in the pathogenesis or progression of the disease. Moreover, we believe that decreased vitamin D level has a considerable role in vitiligo development by affecting Th1- and Th17-related immune responses.
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Affiliation(s)
| | - Mohamad Goldust
- Department of Dermatology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Anant Patil
- Department of Pharmacology, Dr. DY Patil Medical College, Navi Mumbai, India
| | - Ghasem Rahmatpour Rokni
- Department of Dermatology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samira Beyzaee
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Thompson AR, Eleftheriadou V, Nesnas J. The mental health associations of vitiligo: UK population-based cohort study. BJPsych Open 2022; 8:e190. [PMID: 36268886 PMCID: PMC9634603 DOI: 10.1192/bjo.2022.591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Vitiligo is an acquired, autoimmune depigmenting skin disorder that may affect psychological well-being. AIMS To determine the risk and impact of psychological comorbidity in people with new-onset vitiligo. METHOD We conducted a retrospective observational study, using UK general practice data (2004-2020). Adults diagnosed with vitiligo (n = 7224) were matched 1:4 with controls (n = 28 880). Associations within 2 years of diagnosis were assessed for psychological conditions: recurrent depressive disorder (RDD), depressive episodes, non-phobia-related anxiety disorder, social phobia, adjustment disorder, substance misuse, self-harm and suicide attempts. Healthcare utilisation, time off work and unemployment within 1 year were compared in those with and without a mental health condition at vitiligo diagnosis. RESULTS At diagnosis, people with vitiligo had a similar prevalence of mental health conditions as controls, except for anxiety disorder (cases 7.9%, controls 7.0%; P = 0.014). Incident RDD and anxiety disorder were more common in people with vitiligo (RDD: adjusted hazard ratio (aHR) 1.25, 95% CI 1.01-1.55; anxiety disorder: aHR 1.23, 95% CI 1.00-1.51). Risk was highest in Black and minority ethnic individuals (RDD: aHR 1.72, 95% CI 1.06-2.79; depressive episodes: aHR 1.56, 95% CI 1.03-2.37). No association was found with other mental health conditions. People with vitiligo and psychological comorbidity had more primary care encounters, more time off workand higher unemployment. CONCLUSIONS People with vitiligo have a higher incidence of RDD and anxiety disorder than controls, and this risk increase may be greatest in Black and minority ethnic populations.
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Affiliation(s)
- Andrew R Thompson
- South Wales Clinical Psychology Training Programme, Department of Psychology, Cardiff University, Wales, UK
| | | | - John Nesnas
- Inflammation and Immunology, Medical Dermatology, Pfizer Ltd, UK
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17
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Picardo M, Huggins R, Jones H, Marino R, Ogunsola M, Seneschal J. The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes. J Eur Acad Dermatol Venereol 2022; 36:1507-1523. [PMID: 35366355 PMCID: PMC9790455 DOI: 10.1111/jdv.18129] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/04/2022] [Indexed: 12/30/2022]
Abstract
Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.
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Affiliation(s)
- M. Picardo
- San Gallicano Dermatological Institute IRCCSRomeItaly
| | | | - H. Jones
- Incyte CorporationWilmingtonDEUSA
| | | | | | - J. Seneschal
- Department of Dermatology and Pediatric DermatologyNational Reference Center for Rare Skin DisordersHôpital Saint‐AndréCNRS, UMR‐5164, ImmunoConCept, F‐33000BordeauxFrance
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18
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Ning X, Zhang Y, Wang W, Yan H, Xia Y. Evaluation of the Behavioral and Psychological Symptoms in Patients with Vitiligo in China. Psychol Res Behav Manag 2022; 15:2107-2116. [PMID: 35979226 PMCID: PMC9377344 DOI: 10.2147/prbm.s370445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Vitiligo is a common, acquired depigmenting disorder. The pathogenesis is not clear, neuropsychological factors may be involved. Vitiligo will affect the individual’s physical and psychological health, leading to different levels of psychological behavior problems. However, there are few research on psychological symptoms in patients with vitiligo in China. Methods Adult patients with vitiligo were selected in convenient sampling method from March 2019 to November 2019 from the dermatology clinic. They were evaluated by the DLQI (Dermatology Life Quality Index), SCL-90 (Symptom Checklist-90), SADS (Social Avoidance and Distress Scale) and MCMQ (Medical Coping Modes Questionnaire). Results The DLQI score was 7.56 ± 6.11, which was in the third level. The SCL-90 score of patients with vitiligo was 136.44 ± 39.19, significantly higher than the Chinese norms (P < 0.05), and it mainly manifested as interpersonal sensitivity, depression, anxiety and phobia, which may be affected by the patient’s gender, marital status, severity of disease, stage and location of skin lesions. The total score of SADS in patients was 10.30 ± 6.38. The total score and scores in all dimensions of SADS were significantly higher than the Chinese norms (all P < 0.05), which were related with the patient’s gender, educational attainment, severity, type and stage of skin lesions. For MCMQ, the facing score was significantly lower than the Chinese norms (P < 0.05), and the avoiding and yielding scores were significantly higher than the Chinese norms (all P < 0.05). Conclusion In China, vitiligo affects the patient’s quality of life to varying degrees, resulting in a series of psychological and behavioral problems. We should actively concern and improve the psychological health status and behavior of patients, and multidisciplinary treatment strategies and education about vitiligo should be given to the patients.
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Affiliation(s)
- Xiaoying Ning
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yanfei Zhang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Wei Wang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Huling Yan
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yumin Xia
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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Do Bú EA, Santos VMD, Lima KS, Pereira CR, Alexandre MESD, Bezerra VADS. Neuroticism, stress, and rumination in anxiety and depression of people with Vitiligo: An explanatory model. Acta Psychol (Amst) 2022; 227:103613. [PMID: 35569205 DOI: 10.1016/j.actpsy.2022.103613] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022] Open
Abstract
Psychological impacts of Vitiligo have been demonstrated, and associations of the skin disease with anxiety and depression disorders have already been shown. However, it is still unclear the role of individuals' personality factors, such as neuroticism, stress, and rumination, as well as sociodemographic characteristics of people with Vitiligo in such disorders. We conducted a study in a community sample of individuals with Vitiligo (N = 324) aiming to test the hypothesis that neuroticism, stress, and rumination are subjacent to these individuals' anxiety and depression symptomatology. We also explored whether individuals' gender might favor the onset or worsening of the psychological consequences of such disorders. Results showed that the relationship between neuroticism, anxiety and depression was mediated by stress and rumination (brooding), being this effect moderated by the participants' gender. Specifically, women's reflection and stress seemed to be important mechanisms to predict their anxiety and depression symptoms, whereas brooding predicts such disorders' symptomatology in men with Vitiligo. These findings may guide future research and clinical interventions for this population, for which it is necessary to consider the psychological consequences of the disease and not just its physiological aspects.
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Affiliation(s)
- Emerson Araújo Do Bú
- Institute of Social Sciences, University of Lisbon, Lisbon, Portugal; Faculty of Psychology, University of Lisbon, Lisbon, Portugal.
| | | | | | - Cicero Roberto Pereira
- Institute of Social Sciences, University of Lisbon, Lisbon, Portugal; Federal University of Paraíba, João Pessoa, Paraíba, Brazil
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20
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Bibeau K, Pandya AG, Ezzedine K, Jones H, Gao J, Lindley A, Harris JE. Vitiligo Prevalence and Quality of Life Among Adults in Europe, Japan, and the United States. J Eur Acad Dermatol Venereol 2022; 36:1831-1844. [PMID: 35611638 PMCID: PMC9544885 DOI: 10.1111/jdv.18257] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background Vitiligo, an autoimmune disorder characterised by skin depigmentation, is associated with reduced quality of life (QoL). Vitiligo may be under‐reported, in part because of misconceptions that it is a cosmetic disease. Objectives This survey sought to characterise vitiligo prevalence and explore the relationship between sociodemographic and clinical characteristics with QoL in a population‐based, multinational study. Methods Participants aged ≥18 years were recruited via an online panel in Europe, Japan and the USA to answer questions regarding skin disorders they may have experienced. Those reporting vitiligo (diagnosed or undiagnosed) or vitiligo signs (experiencing loss of skin colour but unaware of vitiligo and not diagnosed) were included in the analyses of vitiligo prevalence. Participants who self‐reported physician‐diagnosed vitiligo were given a broader survey to characterise disease progression, management and QoL (as measured with the Vitiligo‐specific QoL [VitiQoL] instrument). Results The total estimated vitiligo prevalence among 35 694 survey participants (Europe, n = 18 785; USA, n = 8517; Japan, n = 8392) was 1.3% (diagnosed, 0.6%; undiagnosed, 0.4%; vitiligo signs, 0.3%). Among 219 patients formally diagnosed with vitiligo (Europe, n = 150; USA, n = 48; Japan, n = 21), total VitiQoL scores were associated with age (P = 0.00017), disease extent (P < 0.0001), disease progression (P < 0.0001), disease management (P < 0.0001) and time since diagnosis (P = 0.0015). Behaviour scores varied based on skin phototype (P = 0.024) and ethnicity (P = 0.048). Higher total VitiQoL scores were reported in patients with head lesions (P = 0.027) and those with head and hand and/or wrist lesions (P = 0.018). Substantial high concern (rated 8–10 on an 11‐point Likert scale) for lesions was found across all body areas and varied with geographical region. Conclusions The vitiligo prevalence rate may be higher than previously reported, with a substantial proportion attributed to people who have not received a formal diagnosis. Among formally diagnosed patients with vitiligo, QoL was most severely impacted by more progressive and higher extent of disease.
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Affiliation(s)
- K Bibeau
- Incyte Corporation, Wilmington, DE, USA
| | - A G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris, France
| | - H Jones
- Incyte Corporation, Wilmington, DE, USA
| | - J Gao
- Incyte Corporation, Wilmington, DE, USA
| | - A Lindley
- Incyte Corporation, Wilmington, DE, USA
| | - J E Harris
- University of Massachusetts Medical School, Worcester, MA, USA
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21
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Wu X, Jin S, Yang Y, Lu X, Dai X, Xu Z, Zhang C, Xiang LF. Altered expression of ferroptosis markers and iron metabolism reveals a potential role of ferroptosis in vitiligo. Pigment Cell Melanoma Res 2022; 35:328-341. [PMID: 35218147 DOI: 10.1111/pcmr.13032] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 01/02/2022] [Accepted: 02/16/2022] [Indexed: 12/14/2022]
Abstract
Oxidative stress is one of the triggering factors for vitiligo, which leads to melanocyte (MC) destruction in vitiligo lesions. Ferroptosis, which is characterized by iron-dependent increase in oxidative stress and lipid peroxidation, has been widely explored in numerous diseases, whereas whether ferroptosis plays a role in MC loss of vitiligo remains to be elucidated. Quantitative real-time PCR and western blot analysis were used to determine the expression of ferroptosis markers in vitiligo patients. Immunonephelometry and electrochemiluminescence were performed to analyze iron status. Reactive oxygen species (ROS), Fe2+ , and lipid ROS were assessed by flow cytometry. The expression of ferroptosis markers was significantly altered in the epidermis of vitiligo patients. Iron deficiency was revealed in the blood of patients. Erastin reduced cell viability and led to oxidative stress, iron overload as well as lipid peroxide accumulation in human epidermal MCs in vitro. Altered expression of ferroptosis markers and inhibition of melanin synthesis in MCs were induced by erastin, which was attenuated by N-acetyl-L-cysteine (NAC) pretreatment or post-treatment in vitro. In conclusion, ferroptosis might take place during the process of vitiligo. Erastin could induce ferroptosis in human epidermal MCs and NAC could protect MCs from ferroptosis in vitro.
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Affiliation(s)
- Xiuyi Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Shanglin Jin
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yiwen Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoli Lu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaoxi Dai
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhongyi Xu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Leihong Flora Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
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22
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Leighton P, Chalmers JR, Batchelor JM, Rogers A, Perways A, Haines RH, Meakin GD, White J, Ravenscroft JC, Sach TH, Santer M, Whitton ME, Eleftheriadou V, Thomas KS. Prescribing and using vitiligo treatments - lessons from a nested Process Evaluation within the HI-Light Vitiligo Randomised Controlled Trial. Clin Exp Dermatol 2022; 47:1480-1489. [PMID: 35340044 PMCID: PMC9544377 DOI: 10.1111/ced.15193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/20/2022] [Accepted: 03/23/2022] [Indexed: 12/01/2022]
Abstract
Background The HI‐Light Trial demonstrated that for active, limited vitiligo, combination treatment with potent topical corticosteroid (TCS) and handheld narrowband ultraviolet B offers a better treatment response than potent TCS alone. However, it is unclear how to implement these findings. Aim We sought to answer three questions: (i) Can combination treatment be used safely and effectively by people with vitiligo?; (ii) Should combination treatment be made available as routine clinical care?; and (iii) Can combination treatment be integrated within current healthcare provision? Methods This was a mixed‐methods process evaluation, including semi‐structured interviews with a purposive sample of trial participants, structured interviews with commissioners, and an online survey and focus groups with trial staff. Transcripts were coded by framework analysis, with thematic development by multiple researchers. Results Participants found individual treatments easy to use, but the combination treatment was complicated and required nurse support. Both participants and site investigators felt that combination treatment should be made available, although commissioners were less certain. There was support for the development of services offering combination treatment, although this might not be prioritized above treatment for other conditions. A ‘mixed economy’ model was suggested, involving patients purchasing their own devices, although concerns regarding the safe use of treatments mean that training, monitoring and ongoing support are essential. The need for medical physics support may mean that a regional service is more practical. Conclusion Combination treatment should be made available for people seeking treatment for vitiligo, but services require partnership with medical physics and ongoing training and support for patients.
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Affiliation(s)
- Paul Leighton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Jonathan M Batchelor
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | - Andy Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Akram Perways
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Rachel H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, UK
| | - Garry D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, UK
| | - Jennifer White
- Nottingham Clinical Trials Unit, University of Nottingham, UK
| | - Jane C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tracey H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Maxine E Whitton
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
| | | | - Kim S Thomas
- Centre of Evidence Based Dermatology, School of Medicine, University of Nottingham, UK
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23
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Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, Pandya AG. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol 2021; 22:757-774. [PMID: 34554406 PMCID: PMC8566637 DOI: 10.1007/s40257-021-00631-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration PROSPERO (CRD42020162223). Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00631-6.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, Paris, France.
| | | | | | | | | | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Mountain View, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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24
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Manohar H, Madegowda RK, Seshadri SP. Addressing Emotional Issues in an Adolescent with Vitiligo and Early Child Sexual Abuse-Therapeutic Challenges. Indian J Psychol Med 2021; 43:442-445. [PMID: 34584311 PMCID: PMC8450727 DOI: 10.1177/02537176211000772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic medical conditions in children and adolescents have a significant impact on development and quality of life. Children with vitiligo experience depression, anxiety and guilt, body image concerns, and conflicts of acceptance-rejection among peers. Understanding issues of relevance through a developmental perspective is pivotal. Here, we report the experiences of working with an adolescent who presented with depressive symptoms, mood dysregulation, and self-harm, in the background of vitiligo and child sexual abuse. We describe the unique therapeutic challenges, focusing on the interplay between depressive psychopathology, childhood trauma, and normative adolescent development. Therapeutic strategies for patient-centered psychological interventions are discussed. The therapy processes focused on a narrative approach, with the active involvement of the family.
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Affiliation(s)
- Harshini Manohar
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rajendra Kiragasur Madegowda
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Shekhar P Seshadri
- Dept. of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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25
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Eleftheriadou V, Atkar R, Batchelor J, McDonald B, Novakovic L, Patel JV, Ravenscroft J, Rush E, Shah D, Shah R, Shaw L, Thompson AR, Hashme M, Exton LS, Mohd Mustapa MF, Manounah L. British Association of Dermatologists guidelines for the management of people with vitiligo 2021. Br J Dermatol 2021; 186:18-29. [PMID: 34160061 DOI: 10.1111/bjd.20596] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- V Eleftheriadou
- Queen Elizabeth Hospital, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - R Atkar
- Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - J Batchelor
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, NG7 2NR, UK
| | - B McDonald
- The Royal London Hospital, Whitechapel Road, Whitechapel, London, E1 1FR, UK
| | - L Novakovic
- Queen Elizabeth Hospital, Department of Dermatology, Lewisham and Greenwich NHS Trust, London, SE18 4QH, UK.,St John's Institute of Dermatology, Department of Photodermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | | | | | - E Rush
- Patient representative.,Vitiligo Support UK, London, UK
| | - D Shah
- Amersham Hospital, Amersham, HP7 0JD, UK
| | - R Shah
- Central & North West London NHS Trust, London, NW1 2PL, UK.,British Psychological Society, Leicester, LE1 7DR, UK
| | - L Shaw
- Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - A R Thompson
- British Psychological Society, Leicester, LE1 7DR, UK.,South Wales Clinical Psychology Training, Cardiff University, Cardiff, CF10 3AT, UK
| | - M Hashme
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - L S Exton
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - M F Mohd Mustapa
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
| | - L Manounah
- British Association of Dermatologists, Willan House, London, W1T 5HQ, UK
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26
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Mohr N, Petersen J, Kirsten N, Augustin M. Epidemiology of Vitiligo - A Dual Population-Based Approach. Clin Epidemiol 2021; 13:373-382. [PMID: 34079380 PMCID: PMC8165096 DOI: 10.2147/clep.s304155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background Most epidemiological data on vitiligo refer to selected environments or focus on the prevalence of comorbidity unrelated to the population. Objective Aim of the study was to gain robust representative prevalence data on vitiligo and on associated dermatologic comorbidity in the German adult population. Methods A dual population-based approach was applied with 1) primary data obtained between 2004 and 2014 from dermatological exams in the general working population; 2) claims data from a large German statutory health insurance, reference year 2010. Results In the working cohort (N = 121,783; 57% male; mean age 43 years), the prevalence of vitiligo was 0.77% (0.84% in men; 0.67% in women). In the claims data (N = 1,619,678; 38% male; mean age 46 years), prevalence was 0.17% (0.14% in men; 0.18% in women). In the working cohort, vitiligo was significantly more common in people with fair skin type, ephelides and port-wine stains and less common in people with acne and solar lentigines. In the claims data, vitiligo was associated with a variety of skin conditions, eg, atopic dermatitis, psoriasis and alopecia areata. Conclusion The resulting discrepancy of claims vs primary data between 0.17% and 0.77% indicates the most probable spectrum of vitiligo prevalence in Germany. It is more frequently observed in clinical exams than recorded in claims data, indicating a marked proportion of people seeking no medical help. Such nonattendance may result from the fact that many treatment options do not provide satisfying benefits to the patients.
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Affiliation(s)
- Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jana Petersen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Natalia Kirsten
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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27
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Sanei-Dehkordi A, Soleimani-Ahmadi M, Zare M, Jaberhashemi SA. Risk factors associated with scabies infestation among primary schoolchildren in a low socio-economic area in southeast of Iran. BMC Pediatr 2021; 21:249. [PMID: 34034686 PMCID: PMC8145826 DOI: 10.1186/s12887-021-02721-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 05/19/2021] [Indexed: 01/10/2023] Open
Abstract
Background Scabies is a neglected tropical disease caused by the mite Sarcoptes scabiei that burrows under the skin. It is a major health problem in tropical areas, largely affecting children. Scabies is common and highly contagious and in schoolchildren spreads quite rapidly, due to overcrowding and close contact within the schools. This study aimed to determine the risk factors associated with scabies infestation among primary schoolchildren in Bashagard County, one of the low socio-economic areas in southeast of Iran. Methods To conduct this community-based, descriptive, and cross-sectional study, four primary schools were randomly selected in the Bashagard County. All students in these schools were selected and examined for scabies. Clinical examination and sociodemographic profile of students were assessed using a pre-tested structured questionnaire. Chi-square test, and binary logistic regression were used to analyse the factors associated with scabies infestation by SPSS version 21 software. Results Out of 480 studied schoolchildren, 15 cases of scabies with a prevalence of 3.1 % were observed. The frequency of infestation in males was 1.6 % and it was 4.7 % in females. Independent factors associated with a high risk of scabies infestation in unadjusted analysis were being student of grade 5–6 (cOR = 13.12, 95 % CI 2.92–58.89, p = 0.0001), low educational level of father (cOR = 4.37, 95 % CI 0.97–19.59, p = 0.036), low educational level of mother (cOR = 4.14, 95 % CI 1.92–18.57, p = 0.045), joblessness of father (cOR = 14.77, 95 % CI 4.97–43.89, p = 0.0001), employment of mother (cOR = 5.28, 95 % CI 1.38–20.16, p = 0.007), large family size (cOR = 3.34, 95 % CI 1.05–10.64, p = 0.031), use of shared articles (cOR = 33.37, 95 % CI 10.82–102.90, p = 0.0001), and absence of bathroom in the house (cOR = 11.77, 95 % CI 2.16–63.94, p = 0.0001). Conclusions Results of this study confirmed that scabies is still one of the most important health problems in the primary schools of the Bashagard County. Low socioeconomic status and personal hygiene of the schoolchildren were the most important factors influencing the prevalence of scabies. Improvement of socioeconomic conditions and implementation of appropriate educational programs and active surveillance system to quickly detect and treat scabies cases are necessary in order to reduce the prevalence of scabies in schoolchildren in this area.
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Affiliation(s)
- Alireza Sanei-Dehkordi
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Bandar Abbas, Iran
| | - Moussa Soleimani-Ahmadi
- Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Bandar Abbas, Iran. .,Department of Medical Entomology and Vector Control, Faculty of Health, Hormozgan University of Medical Sciences, P.O. Box: 79145-3838, Bandar Abbas, Iran.
| | - Mehdi Zare
- Department of Occupational Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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28
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Meta-Analytic Review of High Anxiety Comorbidity among Patients with Vitiligo. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6663646. [PMID: 34055993 PMCID: PMC8147524 DOI: 10.1155/2021/6663646] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
Background Vitiligo is a disfiguring skin disease with profound psychosocial impacts, such as anxiety, but the reported effect sizes of associations vary. We aimed to conduct a meta-analysis to quantify the strength of association between anxiety and vitiligo and to estimate the prevalence of anxiety among individuals with vitiligo. Methods A systematic literature search was performed in five online databases (MEDLINE, Embase, Web of Science, Cochrane Library, and PsycINFO) from inception until March 20, 2020. All of the eligible studies were comprehensively reviewed, and all of the available data were analyzed according to our predefined criteria. Results Twenty-one studies involving 3259 patients in 11 countries were included in this meta-analysis. Compared with the healthy control group, patients with vitiligo often had concomitant anxiety (OR = 6.14 [95% CI: 3.35–11.24], I2 = 30.1%). The pooled prevalence of anxiety in female patients was significantly higher than that in males (OR = 2.24 [95% CI: 1.31–3.84], I2 = 0.0%). Subgroup analysis showed that the pooled prevalence of clinical anxiety disorder and anxiety symptoms was 12% (95% CI: 7%–16%, I2 = 76.3%) and 34% (95% CI: 21%–46%, I2 = 94.7%), respectively. No publication bias has been detected by Begg's funnel plot and Egger's test. Conclusion Patients with vitiligo have high anxiety comorbidity, with female predominance. Dermatologists and psychiatrists should be vigilant to the presence of anxiety, apply appropriate interventions to reduce the psychological impacts in a timely manner, and thus promote recovery in vitiligo patients. However, due to some objective limitations (poor information about the OR and diversity in assessment tools among included studies), findings should be interpreted with caution.
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29
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Hung CT, Huang HH, Wang CK, Chung CH, Tsao CH, Chien WC, Wang WM. Pregnancy outcomes in women with vitiligo: A Taiwanese nationwide cohort study. PLoS One 2021; 16:e0248651. [PMID: 33750961 PMCID: PMC7984608 DOI: 10.1371/journal.pone.0248651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/02/2021] [Indexed: 12/27/2022] Open
Abstract
Vitiligo is perceived as an autoimmune skin disease. Previous studies showed conflicting data about vitiligo and pregnancy outcomes. To delineate the associations between vitiligo and the pregnancy outcomes, we used the National Health Insurance Research Database of Taiwan to conduct a retrospective cohort study from January 1, 2000 to December 31, 2015. This study population was composed of 1,096 women with vitiligo and 4,384 women without vitiligo, who were all matched according to age, comorbidity, and index year. Compared with the non-vitiligo controls, women with vitiligo had a higher risk of abortion (aHR 1.158, 95% confidence interval (CI) 1.095–1.258, P < .001). Perinatal events, such as preterm delivery, pre-eclampsia/eclampsia, gestational diabetes mellitus, stillbirth, and intrauterine growth retardation, were not different between both groups (aHR 1.065, 95% CI 0.817–1.157, P = .413). To determine if systemic treatment before conception decreases the risk of abortion, we assessed the medical history of pregnant women with vitiligo 1 year before pregnancy. Patients who were treated with oral medications had a lower risk of abortion than those who were not (aHR: 0.675, 95% CI: 0.482–0.809, P < .001). Our study indicates that there is a higher risk of abortion in pregnant women with vitiligo and the control of disease activity with systemic treatment before conception could improve pregnancy outcomes.
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Affiliation(s)
- Chih-Tsung Hung
- Department of Dermatology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
| | - Hsin-Hui Huang
- Department of Obstetrics and Gynecology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
| | - Chun-Kai Wang
- Department of Obstetrics and Gynecology, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Department of Microbiology & Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- * E-mail: (WC); (WW)
| | - Wei-Ming Wang
- Department of Dermatology, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
- National Defense Medical Center, Graduate Institute of Medical Sciences, Taipei, Taiwan
- * E-mail: (WC); (WW)
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30
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Bergqvist C, Ezzedine K. Vitiligo: A focus on pathogenesis and its therapeutic implications. J Dermatol 2021; 48:252-270. [DOI: 10.1111/1346-8138.15743] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Christina Bergqvist
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
| | - Khaled Ezzedine
- Department of Dermatology AP‐HP Henri Mondor University Hospital UPEC Créteil France
- EA 7379 EpidermE Université Paris‐Est Créteil, UPEC Créteil France
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31
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Leung AKC, Lam JM, Leong KF, Hon KL. Vitiligo: An Updated Narrative Review. Curr Pediatr Rev 2021; 17:76-91. [PMID: 33302860 DOI: 10.2174/1573396316666201210125858] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/26/2020] [Accepted: 10/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Vitiligo is a relatively common acquired pigmentation disorder that can cause significant psychological stress and stigmatism. OBJECTIVE This article aims to familiarize physicians with the clinical manifestations, evaluation, diagnosis, and management of vitiligo. METHODS A Pubmed search was conducted in Clinical Queries using the key term "vitiligo". The search included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English language. The information retrieved from the above search was used in the compilation of the present article. RESULTS Approximately one quarter of patients with vitiligo have the onset before 10 years of age. Genetic, immunological, neurogenic and environmental factors may have a role to play in the pathogenesis. Vitiligo typically presents as acquired depigmented, well-demarcated macules/patches that appear milk- or chalk-white in color. Lesions tend to increase in number and enlarge centrifugally in size with time. Sites of predilection include the face, followed by the neck, lower limbs, trunk, and upper limbs. The clinical course is generally unpredictable. In children with fair skin, no active treatment is usually necessary other than the use of sunscreens and camouflage cosmetics. If treatment is preferred for cosmesis, topical corticosteroids, topical calcineurin inhibitors, and narrowband ultraviolet B phototherapy are the mainstays of treatment. CONCLUSION The therapeutic effect of all the treatment modalities varies considerably from individual to individual. As such, treatment must be individualized. In general, the best treatment response is seen in younger patients, recent disease onset, darker skin types, and head and neck lesions. Topical corticosteroids and calcineurin inhibitors are the treatment choice for those with localized disease. Topical calcineurin inhibitors are generally preferred for lesions on genitalia, intertriginous areas, face, and neck. Narrowband ultraviolet B phototherapy should be considered in patients who have widespread vitiligo or those with localized vitiligo associated with a significant impact on the quality of life who do not respond to treatment with topical corticosteroids and calcineurin inhibitors.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, The Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, The Hong Kong Children's Hospital, Hong Kong
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32
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Wu X, Yang Y, Xiang L, Zhang C. The fate of melanocyte: Mechanisms of cell death in vitiligo. Pigment Cell Melanoma Res 2020; 34:256-267. [PMID: 33346939 DOI: 10.1111/pcmr.12955] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/10/2020] [Indexed: 01/20/2023]
Abstract
Loss of melanocytes (MCs) is the most notable feature of vitiligo. Hence, it is critical to clarify the mechanisms of MC destruction in vitiligo. Apoptosis is most widely studied cell death pathways in vitiligo. In addition, the other two forms of cell death, conventional necrosis and autophagy seem to be involved in the death of vitiligo MCs under certain situations. Moreover, new types of regulated cell death including necroptosis, pyroptosis, and ferroptosis may also participate in the pathogenesis of vitiligo. Anoikis is likely to be connected with the death of detached MCs, which is provoked specifically by loss of anchorage. Primary phagocytosis, later called phagoptosis can execute death of viable cells, probably partly responsible for the loss of MCs in vitiligo. In this review, we aim to summarize the latest insights into various forms of MC death in vitiligo and discuss the corresponding mechanisms.
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Affiliation(s)
- Xiuyi Wu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yiwen Yang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Leihong Xiang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Chengfeng Zhang
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, PR China
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33
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Mukhatayev Z, Dellacecca ER, Cosgrove C, Shivde R, Jaishankar D, Pontarolo-Maag K, Eby JM, Henning SW, Ostapchuk YO, Cedercreutz K, Issanov A, Mehrotra S, Overbeck A, Junghans RP, Leventhal JR, Le Poole IC. Antigen Specificity Enhances Disease Control by Tregs in Vitiligo. Front Immunol 2020; 11:581433. [PMID: 33335528 PMCID: PMC7736409 DOI: 10.3389/fimmu.2020.581433] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Vitiligo is an autoimmune skin disease characterized by melanocyte destruction. Regulatory T cells (Tregs) are greatly reduced in vitiligo skin, and replenishing peripheral skin Tregs can provide protection against depigmentation. Ganglioside D3 (GD3) is overexpressed by perilesional epidermal cells, including melanocytes, which prompted us to generate GD3-reactive chimeric antigen receptor (CAR) Tregs to treat vitiligo. Mice received either untransduced Tregs or GD3-specific Tregs to test the hypothesis that antigen specificity contributes to reduced autoimmune reactivity in vitro and in vivo. CAR Tregs displayed increased IL-10 secretion in response to antigen, provided superior control of cytotoxicity towards melanocytes, and supported a significant delay in depigmentation compared to untransduced Tregs and vehicle control recipients in a TCR transgenic mouse model of spontaneous vitiligo. The latter findings were associated with a greater abundance of Tregs and melanocytes in treated mice versus both control groups. Our data support the concept that antigen-specific Tregs can be prepared, used, and stored for long-term control of progressive depigmentation.
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Affiliation(s)
- Zhussipbek Mukhatayev
- Department of Dermatology, Northwestern University, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States.,Faculty of Biology and Biotechnology, Al-Farabi Kazakh National University, Almaty, Kazakhstan.,Laboratory of Molecular immunology and Immunobiotechnology, M.A. Aitkhozhin's Institute of Molecular Biology and Biochemistry, Almaty, Kazakhstan
| | - Emilia R Dellacecca
- Department of Dermatology, Northwestern University, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Cormac Cosgrove
- Department of Dermatology, Northwestern University, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Rohan Shivde
- Department of Dermatology, Northwestern University, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | - Dinesh Jaishankar
- Department of Dermatology, Northwestern University, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
| | | | - Jonathan M Eby
- Oncology Research Institute, Loyola University, Maywood, IL, United States
| | - Steven W Henning
- Oncology Research Institute, Loyola University, Maywood, IL, United States
| | - Yekaterina O Ostapchuk
- Laboratory of Molecular immunology and Immunobiotechnology, M.A. Aitkhozhin's Institute of Molecular Biology and Biochemistry, Almaty, Kazakhstan
| | - Kettil Cedercreutz
- Department of Dermatology, Northwestern University, Chicago, IL, United States
| | - Alpamys Issanov
- Department of Medicine, School of Medicine, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Shikhar Mehrotra
- Department of Surgery, Medical University of South Carolina, Charleston, SC, United States
| | - Andreas Overbeck
- Department for Surgery of Pigment Disorders, Lumiderm, Madrid, Spain
| | - Richard P Junghans
- Department of Hematology/Oncology, Boston University, Boston MA, United States
| | - Joseph R Leventhal
- Comprehensive Transplant Center, Northwestern Memorial Hospital, Chicago, IL, United States
| | - I Caroline Le Poole
- Department of Dermatology, Northwestern University, Chicago, IL, United States.,Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, United States
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Li M, Wang F, Ding X, Xu Q, Du J. Evaluation of the potential interference of camouflage on the treatment of vitiligo: An observer-blinded self-controlled study. Dermatol Ther 2020; 34:e14545. [PMID: 33190372 DOI: 10.1111/dth.14545] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/24/2020] [Accepted: 11/04/2020] [Indexed: 11/30/2022]
Abstract
Camouflage improves the quality of life in vitiligo patients. However, whether the use of camouflage interferes the efficacy of the treatment of vitiligo remains controversial. To evaluate the impact and safety of dihydroxyacetone (DHA)-containing camouflage on the treatment of vitiligo. Thirty patients were enrolled. Comparable vitiliginous patches in each patient were randomly divided into camouflage group or blank group. The therapeutic modalities including topical corticosteroids with or without NB-UVB phototherapy were applied to both groups of lesions. The outcomes were assessed at baseline and then every 4 weeks for up to 12 weeks, including types of repigmentation patterns, percentage of repigmentation, trans epidermal water loss (TEWL), and adverse events. Twenty-eight patients completed the study. There were no differences in repigmentation types and percentage of repigmentation at the endpoint of study between two groups. No difference in TEWL was found at the end of the study between the two groups. Temporary skin irritation (itching and tingling) occurred in one patient in camouflage group after phototherapy between 8 and 12 weeks' treatment. DHA-containing camouflage is a safe make-up for vitiligo. It has little impact on the efficacy of the treatment of vitiligo or on the function of skin barrier.
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Affiliation(s)
- Man Li
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Fang Wang
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Xiaolan Ding
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Qianxi Xu
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
| | - Juan Du
- Department of dermatology, Peking University People's Hospital, Peking University, Beijing, China
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Kussainova A, Kassym L, Akhmetova A, Glushkova N, Sabirov U, Adilgozhina S, Tuleutayeva R, Semenova Y. Vitiligo and anxiety: A systematic review and meta-analysis. PLoS One 2020; 15:e0241445. [PMID: 33170870 PMCID: PMC7654800 DOI: 10.1371/journal.pone.0241445] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Vitiligo is an acquired depigmenting skin disease which is often accompanied by mental distress. There are numerous studies dedicated to local and global prevalence of depression in patients with vitiligo but anxiety has not been recognized as a major mental problem within named population. We aimed to evaluate the prevalence of anxiety among patients with vitiligo from different countries and to compare it with patients suffering from eczema, psoriasis, and acne. METHODS In November 2019, we conducted a systematic search for observational studies that examined the prevalence of anxiety in vitiligo patients. Fifteen studies comprising 1176 patients with vitiligo were included to our systematic review. RESULTS The general prevalence of anxiety among vitiligo patients was equal to 35.8%. Statistically significant difference in anxiety rates was found among female and male patients (47.32% vs 42.4%) (P = 0.03), but the clinical relevance of this issue remains arguable. In addition, the pooled odds ratio among vitiligo and non-vitiligo patients did not indicate a statistical significance among patients coming from different continents. CONCLUSIONS The pooled prevalence of anxiety among vitiligo patients worldwide was comparable to other severe skin disorders. This finding accentuates the necessity of anxiety awareness in management of patients with skin diseases.
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Affiliation(s)
- Assiya Kussainova
- Department of Dermatovenerology and Cosmetology, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Laura Kassym
- Nazarbayev University School of Medicine, Nur-Sultan, Republic of Kazakhstan
- * E-mail:
| | - Almira Akhmetova
- Department of Dermatovenerology and Cosmetology, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Natalya Glushkova
- Department of Epidemiology, Evidence-Based Medicine and Biostatistics, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Ulugbek Sabirov
- Republican Specialized Scientific and Practical Medical Center of Dermatovenerology and Cosmetology, Tashkent, Republic of Uzbekistan
| | - Saltanat Adilgozhina
- Department of Family Medicine, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Raikhan Tuleutayeva
- Department of Pharmacology Department, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Yuliya Semenova
- Department of Neurology, Ophthalmology, Otorhinolaryngology, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
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Savaş Erdoğan S, Falay Gür T, Doğan B. Anxiety and depression in pediatric patients with vitiligo and alopecia areata and their parents: A cross-sectional controlled study. J Cosmet Dermatol 2020; 20:2232-2239. [PMID: 33089618 DOI: 10.1111/jocd.13807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 09/27/2020] [Accepted: 10/12/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Alopecia areata (AA) and vitiligo are associated with various psychiatric comorbidities, and the care of a child with AA or vitiligo may be associated with higher anxiety and depression than healthy children. AIMS We aimed to identify psychiatric findings in children and adolescent groups with AA and vitiligo and to evaluate the levels of anxiety and depression in their parents. METHODS This study included 31 patients with AA and 29 patients with vitiligo, aged seven to 17 years, and their parents. Age- and gender-matched 30 controls and their parents were included. The patients and controls completed the Revised Child Anxiety and Depression Scales-Child version (RCADS-C), and their parents completed the parent version (RCADS-P). The parents also completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). In addition, the stressful event history of all cases was noted. RESULTS Stressful event history was higher in the vitiligo group compared to the AA group, and it was higher in the AA and vitiligo groups compared to the control group. Separation anxiety, generalized anxiety, social phobia, and major depressive disorder (MDD) scores were higher in the AA group than controls according to the RCADS-C. According to the RCADS-P, panic disorder (PD), MDD, and total anxiety scores were higher in the AA group. Only the PD and MDD scores were higher in the vitiligo group than those of the controls based on the RCADS-P. Lastly, no significant difference was observed between the three groups concerning the parents' BAI and BDI scores. CONCLUSIONS Stressful events were more common in pediatric patients with vitiligo than those with AA. Anxiety symptoms were more prevalent in patients with AA than those with vitiligo.
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Affiliation(s)
- Sevil Savaş Erdoğan
- Department of Dermatology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Tuğba Falay Gür
- Department of Dermatology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Bilal Doğan
- Department of Dermatology, University of Health Sciences, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey
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Alharbi MA. Identifying Patients at Higher Risk of Depression Among Patients with Vitiligo at Outpatient Setting. Mater Sociomed 2020; 32:108-111. [PMID: 32843857 PMCID: PMC7428888 DOI: 10.5455/msm.2020.32.108-111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Introduction: Chronic skin diseases including vitiligo could have profound psychological burden. The factors influencing the expression of depression in patients with vitiligo received little attention both nationally and internationally. Aim: The aim of the current study was to estimate the burden and severity of depression and to characterize their associated sociodemographic and clinical characteristics among patients with vitiligo. Methods: A cross-sectional survey study was conducted among patients with vitiligo of both genders attending dermatology outpatient clinics at a tertiary care hospital during 2019. Modified Beck Depression Inventory Scale was used for screening for depression. Results: A total 308 patients with vitiligo have been included in the current analysis. The average age was 27±14.5 years. Approximately 59.7% of the patients were males and the majority (63.6%) were single. A total 168 (54.5%) patients had some depressive symptoms. The majority of these patients had mild depression (52.4%), followed by moderate (33.3%) and severe (14.3%) depression. Moderate and/or severe depression were significantly higher among children and adolescents (p=0.036), single patients (p=0.006), those with lower than high school education (p<0.001), those with shorter duration of the disease (p<0.001), and those using phototherapy (p=0.003). Depression burden and severity were not significantly associated with gender and lesion distribution. Conclusion: Sociodemographic and clinical characteristics can easily characterize the risk of depression among patients with vitiligo. The current findings may help dermatologist to pick patients at higher risk of depression early after diagnosis of vitiligo. Dermatologists should have low threshold for referring such patients to psychiatry clinics.
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Affiliation(s)
- Mana Abdullah Alharbi
- Al Imam Mohammad Ibn Saud Islamic University, Department of Dermatology, Ryadh, Saudi Arabia
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Silpa-Archa N, Pruksaeakanan C, Angkoolpakdeekul N, Chaiyabutr C, Kulthanan K, Ratta-Apha W, Wongpraparut C. Relationship Between Depression and Quality of Life Among Vitiligo Patients: A Self-assessment Questionnaire-based Study. Clin Cosmet Investig Dermatol 2020; 13:511-520. [PMID: 32801827 PMCID: PMC7414931 DOI: 10.2147/ccid.s265349] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022]
Abstract
Background Vitiligo is a common chronic autoimmune disease that is characterized by progressive loss of skin color due to melanocyte destruction. In addition to the physical effects of vitiligo, this condition exerts adverse psychological effects and causes social stigmatization. Earlier studies reported that individuals with vitiligo suffer from poor quality of life (QoL), but data about the QoL of Thai vitiligo patients is scarce. Objective This study aimed to investigate the QoL and prevalence of depression in Thai vitiligo patients, association between QoL and depression, and factors associated with QoL and depression among Thai people with vitiligo. Methods This cross-sectional self-assessment questionnaire-based study was conducted at the phototherapy and vitiligo clinics of the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand). QoL was assessed using the Dermatology Life Quality Index (DLQI) questionnaire, and depression was evaluated via the Patient Health Questionnaire (PHQ-9). Results Among the 104 vitiligo patients that were recruited, the mean DLQI score was 7.46, and the prevalence of depression (PHQ-9 ≥9) was 13.5%. Factors significantly associated with a higher mean DLQI score were skin phototype IV compared to phototype III, active disease, new lesions within the last three months, lesions involving upper extremities, and PHQ-9 ≥9 (p<0.05). Moderate correlation was found between DLQI score and PHQ-9 score (Pearson’s correlation coefficient: 0.524, p<0.001). Factors significantly associated with depression were working status and developing new lesions within the last three months (p<0.05). Patients with new lesions were 4.12 times more likely to be depressed than those without new lesions (OR: 4.12, 95%CI: 1.20–14.16; p=0.025). Conclusion Developing new lesions, active disease, dark skin phototype (IV), and lesion on upper extremity had significant adverse effects on QoL. Vitiligo patients who were employed and who had new vitiligo lesions are significantly more likely to be depressed.
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Affiliation(s)
- Narumol Silpa-Archa
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chutipon Pruksaeakanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Chayada Chaiyabutr
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Woraphat Ratta-Apha
- Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chanisada Wongpraparut
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Deng Y, Li J, Yang G. 308-nm Excimer Laser Plus Platelet-Rich Plasma for Treatment of Stable Vitiligo: A Prospective, Randomized Case-Control Study. Clin Cosmet Investig Dermatol 2020; 13:461-467. [PMID: 32801821 PMCID: PMC7398870 DOI: 10.2147/ccid.s260434] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/23/2020] [Indexed: 12/15/2022]
Abstract
Purpose 308-nm excimer laser has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. The effect of 308-nm excimer laser combined with PRP on vitiligo has been rarely reported. This study investigated the effect of PRP combined with 308-nm excimer laser on stable vitiligo. Patients and Methods A total of 60 patients with localized stable vitiligo who received treatment at Beijing Friendship Hospital and Xi’an Vitiligo Specialist Hospital between May 2019 and January 2020 were consecutively enrolled. They were equally randomized into three groups according to different treatment methods: intradermal PRP injection (group I), 308-nm excimer laser alone (group II), and 308-nm excimer laser plus PRP injection (group III). All treatments lasted for 3 months. At 3 months after treatment, clinical assessments were performed in terms of the visual analogue scale (VAS) score, repigmentation response and side effects. Results The VAS scores showed significant differences among the three groups (P<0.001), with the highest score in group III, followed by group II and then group I. Repigmentation responses also showed significant differences among the groups (P<0.001), and the best effect was observed in group III. No side effects were reported in any of the groups. Conclusion The effect of PRP combined with 308-nm excimer laser on stable vitiligo is significantly better than that of PRP and 308-nm excimer laser alone. It is safe and satisfactorily tolerant.
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Affiliation(s)
- Yanyan Deng
- Department of Dermatology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, People's Republic of China.,Department of Dermatology, The Second People's Hospital of Changzhi, Changzhi 046000, People's Republic of China
| | - Jia Li
- Department of Dermatology, Taiyuan Central Hospital of Shanxi Medical University, Taiyuan 030009, People's Republic of China
| | - Gaoyun Yang
- Department of Dermatology, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, People's Republic of China
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40
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Ucuz I, Altunisik N, Sener S, Turkmen D, Kavuran NA, Marsak M, Colak C. Quality of life, emotion dysregulation, attention deficit and psychiatric comorbidity in children and adolescents with vitiligo. Clin Exp Dermatol 2020; 46:510-515. [PMID: 32064670 DOI: 10.1111/ced.14196] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Vitiligo is an acquired pigmentation disorder, which can have a negative effect on patient quality of life (QoL). AIM To evaluate QoL and psychiatric comorbidity in paediatric patients with vitiligo. METHODS In total, 30 patients aged 8-18 years who were diagnosed with vitiligo and 30 age- and sex-matched healthy controls (HCs) were included in the study. The Children's Depression Inventory, Screen for Child Anxiety Related Disorders, State-Trait Anxiety Inventory for Children and Child Somatization Inventory were completed for both patients and controls. The Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version (K-SADS-PL) was administered to all patients by a child psychiatrist. Families were also asked to complete the Pediatric Quality of Life Inventory and Emotion Regulation Checklist for children. RESULTS The K-SADS-PL evaluation showed that 90% of the patients in the vitiligo group had at least one psychiatric diagnosis, whereas this rate was 20% in the HCs (P < 0.001). There were statistically significant differences between vitiligo and HCs in terms of anxiety, state and trait anxiety scores (P < 0.05). Attention deficit and hyperactivity disorder (ADHD) was detected in 36.6% of the patients. CONCLUSION The most important finding of this study is that anxiety disorders are more prominent than depression in childhood vitiligo. Another important finding of this study is that the prevalence of ADHD is significantly higher than the normal population.
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Affiliation(s)
- I Ucuz
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - N Altunisik
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - S Sener
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - D Turkmen
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - N A Kavuran
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - M Marsak
- Department of Dermatology, Faculty of Medicine, Inonu University, Malatya, Turkey
| | - C Colak
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Inonu University, Malatya, Turkey
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41
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Simons RE, Zevy DL, Jafferany M. Psychodermatology of vitiligo: Psychological impact and consequences. Dermatol Ther 2020; 33:e13418. [PMID: 32297399 DOI: 10.1111/dth.13418] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 04/13/2020] [Indexed: 12/20/2022]
Abstract
Vitiligo is an autoimmune dermatologic disorder that causes chronic skin depigmentation, which affects an estimated 1% of the world's population. This disfiguring condition can have devastating psychological consequences on its sufferers. The field of psychodermatology examines psychiatric manifestations of dermatologic conditions. Although previous research in this area has been done on other skin disorders, no large-scale review exists on the dermatologic-psychiatric connection in vitiligo specifically. The current article will discuss the psychodermatology of vitiligo with an emphasis on depression, stress, and low self-esteem. The social and cultural considerations will also be explored. Finally, the implications of these psychiatric manifestations on treatment will be discussed, with the goal of implementing early psychiatric intervention for those with vitiligo.
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Affiliation(s)
- Robert E Simons
- Central Michigan University College of Medicine, Department of Psychiatry, Saginaw, Michigan, USA
| | - Danna L Zevy
- Central Michigan University College of Medicine, Department of Psychiatry, Saginaw, Michigan, USA
| | - Mohammad Jafferany
- Central Michigan University College of Medicine, Department of Psychiatry, Saginaw, Michigan, USA
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Öztekin A, Öztekin C. Sleep Quality and Depression in Vitiligo Patients. EURASIAN JOURNAL OF FAMILY MEDICINE 2020. [DOI: 10.33880/ejfm.2020090105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aim: Vitiligo is a common disorder that has not only dermatological but also psychological consequences. The aim of this study was to compare depression and sleep quality of vitiligo patients with healthy control group.
Methods: In this cross-sectional case-control study, patients admitted to the Dermatology Clinic of Skin and Venereal Diseases Department of Hitit University Erol Olçok Education and Research Hospital between August 2018 and August 2019 were compared with healthy control group. The study included 67 patients and 69 control group participants who were matched for age, sex, marriage status, and education level. The subjects were asked to complete a sociodemographic data form, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index.
Results: The median total Pittsburgh Sleep Quality Index score was higher in the patient group compared with the control group. The median scores for subjective sleep quality, sleep latency, and sleep disturbance were also higher in the patient group compared with the control group. A family history of vitiligo was present in 18 (26.9%) patients. The most common type was acrofacial vitiligo, which was present in 29 (43.3%) patients.
Conclusions: Increased probability levels of depression and impaired sleep quality in vitiligo patients suggest that psychiatric evaluation and treatment should be provided for vitiligo patients as a part of a multidisciplinary approach in order to increase the success of the treatment.
Keywords: Vitiligo, depression, sleep quality
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Affiliation(s)
- Aynure Öztekin
- Department of Dermatology, Faculty of Medicine, Hitit University
| | - Coşkun Öztekin
- Department of Family Medicine, Faculty of Medicine, Hitit University
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Bergqvist C, Ezzedine K. Vitiligo: A Review. Dermatology 2020; 236:571-592. [DOI: 10.1159/000506103] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 01/23/2020] [Indexed: 11/19/2022] Open
Abstract
Vitiligo, a common depigmenting skin disorder, has an estimated prevalence of 0.5–2% of the population worldwide. The disease is characterized by the selective loss of melanocytes which results in typical nonscaly, chalky-white macules. In recent years, considerable progress has been made in our understanding of the pathogenesis of vitiligo which is now clearly classified as an autoimmune disease. Vitiligo is often dismissed as a cosmetic problem, although its effects can be psychologically devastating, often with a considerable burden on daily life. In 2011, an international consensus classified segmental vitiligo separately from all other forms of vitiligo, and the term vitiligo was defined to designate all forms of nonsegmental vitiligo. This review summarizes the current knowledge on vitiligo and attempts to give an overview of the future in vitiligo treatment.
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Chen CY, Wang WM, Chung CH, Tsao CH, Chien WC, Hung CT. Increased risk of psychiatric disorders in adult patients with vitiligo: A nationwide, population-based cohort study in Taiwan. J Dermatol 2020; 47:470-475. [PMID: 32124495 DOI: 10.1111/1346-8138.15290] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/05/2020] [Indexed: 01/26/2023]
Abstract
Vitiligo is an autoimmune skin disease that has a major impact on the quality of life of patients. However, a nationwide study of the association between vitiligo and the incidence of inclusive psychiatric diseases has not been conducted in the Asian population. Therefore, this study aimed to analyze the association between vitiligo and the risk of psychiatric disorders using a nationwide database in Taiwan. Data were collected from the National Health Insurance Research Database of Taiwan from 2000 to 2013. In total, 1432 subjects with vitiligo and 5728 age-, sex- and index year-matched controls were enrolled in this study. Patients with vitiligo tend to have more coexisting psychiatric disorders than healthy individuals, regardless of their sex, age group and facility level of care. After adjusting for sex, age, comorbidity, urbanization and facility level of care, the adjusted hazard ratio of overall psychiatric disorders for patients with vitiligo was 2.926 (95% confidence interval [CI], 2.646-3.236; P < 0.001). Among them, the highest adjusted hazard ratios were found for obsessive-compulsive disorder, at 10.790 (95% CI, 9.756-11.932; P < 0.001). Vitiligo is associated with an increased risk of various psychiatric disorders. By providing a better understanding of the psychosocial burden associated with vitiligo, these results emphasize the need to evaluate the mental health of patients with vitiligo by treating physicians.
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Affiliation(s)
- Chih-Yu Chen
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Chang-Huei Tsao
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Tsung Hung
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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Abstract
Skin color is one of the major attributes that defines both individual distinctiveness and differences between groups. There is a preference for lighter skin world-wide, among both light- and dark-skinned individuals, further leading to skin-color bias based upon skin-color hierarchy within certain ethnoracial groups. The psychiatric and psychosocial ramifications of skin color are important in several situations, including (1) disorders of skin discoloration (eg, vitiligo), which can significantly affect the psychosocial development of the patient especially when it has its first onset during adolescence; (2) widespread use of skin-lightening products, which are used despite knowledge about serious toxicity from inorganic mercury and potent corticosteroids that are some of their main constituents; (3) indoor tanning, which is a recognized carcinogen and practiced by over 50% of university-age adults and 20% of adolescents. Educating about photocarcinogenicity does not change tanning behaviors, which is strongly driven by peer pressure; and (4) when a psychiatric disorder, such as body dysmorphic disorder or major depressive disorder, is the primary basis for skin color dissatisfaction. Despite the role of complex sociocultural and psychiatric factors in clinical manifestations involving skin color, a supportive relation with the dermatologist can significantly aid the patient in managing their disease burden.
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Affiliation(s)
- Madhulika A Gupta
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Psychmed Research, London, Ontario, Canada.
| | - Aditya K Gupta
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Mediprobe Research, London, Ontario, Canada
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46
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Khattab FM, Abdelbary E, Fawzi M. Evaluation of combined excimer laser and platelet‐rich plasma for the treatment of nonsegmental vitiligo: A prospective comparative study. J Cosmet Dermatol 2019; 19:869-877. [DOI: 10.1111/jocd.13103] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/23/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Fathia M. Khattab
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine Zagazig University Zagazig Egypt
| | - Eman Abdelbary
- Pathology Department, Faculty of Medicine Zagazig University Zagazig Egypt
| | - Maggie Fawzi
- Clinical Pathology Department, Faculty of Medicine Zagazig University Zagazig Egypt
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47
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Gender Differences in Depression, Coping, Stigma, and Quality of Life in Patients of Vitiligo. Dermatol Res Pract 2019; 2019:6879412. [PMID: 31065260 PMCID: PMC6466925 DOI: 10.1155/2019/6879412] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/10/2019] [Accepted: 02/24/2019] [Indexed: 12/19/2022] Open
Abstract
Though vitiligo is one of the psychodermatological disorders which do not cause direct physical impairment, it is cosmetically disfiguring leading to serious psychological problems in daily life. We undertook this research to study patients of vitiligo the prevalence of depression, coping, stigma, and quality of life and comparison of the same in both genders. Patients diagnosed clinically as having vitiligo by consultant dermatologist were enrolled after informed consent and ethics approval. 156 patients were screened, of which 100 satisfying criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of Beck's depression inventory, participation scale, dermatology life quality index, and adjustment to chronic skin diseases questionnaire. Depression prevalence was 63.64% in females and 42.86% in males (p<0.0457); the total mean BDI scores were significant with females having higher scores than males (p<0.0083). No significant differences were seen on participation scale though 52% females felt stigmatized as compared to 45% males (p <0.5779). While almost 97% of our patients had impaired quality of life there was no significant difference in both genders on the total score (p<0.3547). Females had significantly higher faulty coping style than males with significant differences on all domains and total scores (p< 0.0094). There was a strong association of depression with faulty coping and stigma (p< 0.0001) in both genders. Also association of stigma with quality of life showed highly significant findings in both genders (p< 0.0001) on all the domains of DLQI. This study helps in early identification of psychological problems in vitiligo patients and planning their future course of management, hence improving the prognosis and quality of life.
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Mir-Palomo S, Nácher A, Ofelia Vila Busó MA, Caddeo C, Manca ML, Manconi M, Díez-Sales O. Baicalin and berberine ultradeformable vesicles as potential adjuvant in vitiligo therapy. Colloids Surf B Biointerfaces 2018; 175:654-662. [PMID: 30590326 DOI: 10.1016/j.colsurfb.2018.12.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/29/2018] [Accepted: 12/19/2018] [Indexed: 12/27/2022]
Abstract
0.5-1% of the world's population is affected by vitiligo, a disease characterized by a gradual depigmentation of the skin. Baicalin and berberine are natural compounds with beneficial activities, such as antioxidant, anti-inflammatory and proliferative effects. These polyphenols could be useful for the treatment of vitiligo symptoms, and their efficacy can be improved by loading in suitable carriers. The aim of this work was to formulate and characterize baicalin or berberine loaded ultradeformable vesicles, and demonstrate their potential as adjuvants in the treatment of vitiligo. The vesicles were produced using a previously reported simple, scalable method. Their morphology, size distribution, surface charge and entrapment efficiency were assessed. The ability of the vesicles to promote the permeation of the polyphenols was evaluated. The antioxidant and photoprotective effects were investigated in vitro using keratinocytes and fibroblasts. Further, the stimulation of melanin production and tyrosinase activity in melanocytes after treatment with the vesicles were assessed. Ultradeformable vesicles were small in size, homogeneously dispersed, and negatively charged. They were able to incorporate high amounts of baicalin and berberine, and promote their skin permeation. In fact, the polyphenols concentration in the epidermis was higher than 10%, which could be indicative of the formation of a depot in the epidermis. The vesicles showed remarkable antioxidant and photoprotective capabilities, presumably correlated with the stimulation of melanin production and tyrosinase activity. In conclusion, baicalin or berberine ultradeformable vesicles, and particularly their combination, may represent promising nanosystem-based adjuvants for the treatment of vitiligo symptoms.
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Affiliation(s)
- Silvia Mir-Palomo
- Dept. Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Spain
| | - Amparo Nácher
- Dept. Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Spain; Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain.
| | | | - Carla Caddeo
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, via Ospedale 72, 09124, Cagliari, Italy
| | - Maria Letizia Manca
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, via Ospedale 72, 09124, Cagliari, Italy
| | - Maria Manconi
- Dept. of Scienze della Vita e dell'Ambiente, University of Cagliari, via Ospedale 72, 09124, Cagliari, Italy
| | - Octavio Díez-Sales
- Dept. Pharmacy, Pharmaceutical Technology and Parasitology, Faculty of Pharmacy, University of Valencia, Spain; Instituto Interuniversitario de Investigación de Reconocimiento Molecular y Desarrollo Tecnológico (IDM), Universitat Politècnica de València, Universitat de València, Av. Vicent Andrés Estellés s/n, 46100, Burjassot, Valencia, Spain
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Patel K, Singam V, Rastogi S, Lee H, Silverberg N, Silverberg J. Association of vitiligo with hospitalization for mental health disorders in
US
adults. J Eur Acad Dermatol Venereol 2018; 33:191-197. [DOI: 10.1111/jdv.15255] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 09/05/2018] [Indexed: 12/20/2022]
Affiliation(s)
- K.R. Patel
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - V. Singam
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - S. Rastogi
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - H.H. Lee
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
| | - N.B. Silverberg
- Department of Dermatology Mount Sinai Icahn School of Medicine New York NY USA
| | - J.I. Silverberg
- Department of Dermatology Northwestern University Feinberg School of Medicine Chicago IL USA
- Departments of Dermatology, Preventive Medicine and Medical Social Sciences Northwestern University Feinberg School of Medicine Chicago IL USA
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50
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Dixon LJ, Witcraft SM, Perry MM. How Does Anxiety Affect Adults with Skin Disease? Examining the Indirect Effect of Anxiety Symptoms on Impairment Through Anxiety Sensitivity. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9942-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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