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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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Bayraktar E, Çınar SL, Ozmen N. Do complaints related to vitiligo affect sexual quality of life and marital adjustment? Health Care Women Int 2024:1-15. [PMID: 38588606 DOI: 10.1080/07399332.2024.2335497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 03/23/2024] [Indexed: 04/10/2024]
Abstract
The authors aimed at evaluating the effect of vitiligo on female sexual function and Dyadic Adjustment in a hospital-based study as gender negatively affected the marital quality of vitiligo patients, more in women. A total of 153 patients who applied to the dermatology outpatient clinic of a tertiary university hospital were interviewed. However, 120 vitiligo patients who were married and had a sexually active partner and suitable the inclusion criteria were included in the study. It is seen that the mean score of the DAC is 43.13±5.11, and the mean score of the SQOL-F is 52.57±5.39. Vitiligo has a negative effect on a woman's sexual life and Dyadic Adjustment. Early identification of sexual problems in vitiligo patients and planning their future course of management can aid in improving the marital adjustment and quality of life.
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Affiliation(s)
- Evrim Bayraktar
- Department of Obstetrics and Gynecology Nursing, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Salih Levent Çınar
- Department of Dermatology Clinic, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Nurten Ozmen
- Department of Surgery Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
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Awal G, Kaur N, Singh G, Sharma N. Impact of Vitiligo on Quality of Life in Patients of Skin of Color and Its Correlation With Clinical Severity Assessment Scores Utilizing Disease Specific Scores: A Cross-Sectional Study. Dermatol Pract Concept 2024; 14:dpc.1402a75. [PMID: 38810078 PMCID: PMC11136000 DOI: 10.5826/dpc.1402a75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Assessment of disease severity of vitiligo is exigent as it is a psychosomatic ailment. VIDA (vitiligo disease activity score) and VASI (vitiligo area severity index) were previously used for this evaluation. Recently, the introduction of two vitiligo specific tools, vitiligo impact scale (VIS)-22 and Vitiligo Quality of Life Index (VitiQoL) has aided in assessing the quality of life (QOL) in a pertinent manner. OBJECTIVES To measure the QOL in vitiligo using disease specific indices (VitiQoL and VIS-22), to assess their relationship with disease severity (VASI and VIDA) and to determine the correlation between QOL scores (VIS-22 and VitiQoL). METHODS This observational cross-sectional study included 195 patients with vitiligo, and their disease severity was calculated using VASI and VIDA scoring. Patients were asked to fill questionnaires for assessing the QOL using validated tools i.e. VIS-22 and VitiQoL. RESULTS Significant correlation was demonstrated between both QOL scores and VASI score (P value 0.001) with slightly higher values for VitiQoL (r = 0.824) than with VIS 22 (r = 0.693). Both scores exhibited a significant association with VIDA score (P value < 0.001). Moreover, statistically significant correlation was found between VIS-22 and VitiQoL, thereby proving the concordance between these scores. CONCLUSIONS The study infers that QOL seemed to be remarkably dependent on the clinical severity scores and that higher disease activity corresponds to poorer QOL. It is imperative to precisely assess burden of vitiligo and the impairments caused by it in order to aid multi-modality management and allow more standardized research.
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Affiliation(s)
- Guneet Awal
- Department of Dermatology,Venereology and Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Navleen Kaur
- Department of Dermatology,Venereology and Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Guramrit Singh
- Department of Dermatology,Venereology and Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Nishant Sharma
- Department of Community Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
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Shiu J, Lentsch G, Polleys CM, Mobasher P, Ericson M, Georgakoudi I, Ganesan AK, Balu M. Non-invasive Imaging Techniques for Monitoring Cellular Response to Treatment in Stable Vitiligo. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.08.15.553419. [PMID: 37645823 PMCID: PMC10462045 DOI: 10.1101/2023.08.15.553419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Punch grafting procedures, where small pieces of normal skin are transplanted into stable vitiligo patches, results in repigmentation in only half of patients treated, yet the factors that determine whether a patient responds to treatment or not are still unknown. Reflectance confocal microscopy (RCM) is adept at visualizing melanocyte migration and epidermal changes over large areas while multiphoton microscopy (MPM) can capture metabolic changes in keratinocytes. With the overall goal of identifying optical biomarkers for early treatment response, we followed 12 vitiligo lesions undergoing punch grafting. Dendritic melanocytes adjacent to the graft site were observed before clinical evidence of repigmentation in treatment responsive patients but not in treatment non-responsive patients, suggesting that the early visualization of melanocytes is indicative of a therapeutic response. Keratinocyte metabolic changes in vitiligo skin adjacent to the graft site also correlated with treatment response, indicating that a keratinocyte microenvironment that more closely resembles normal skin is more hospitable for migrating melanocytes. Taken together, these studies suggest that successful melanocyte transplantation requires both the introduction of new melanocytes and modulation of the local tissue microenvironment.
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Affiliation(s)
- Jessica Shiu
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Griffin Lentsch
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA
| | | | - Pezhman Mobasher
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
| | - Marissa Ericson
- Biostatistics, Epidemiology and Research Design, University of California, Irvine, Irvine, CA, USA
| | - Irene Georgakoudi
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
| | - Anand K Ganesan
- Department of Dermatology, University of California, Irvine, Irvine, CA, USA
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
- Skin Biology Resource Center, University of California, Irvine, Irvine, CA, USA
| | - Mihaela Balu
- Beckman Laser Institute and Medical Clinic, University of California, Irvine, Irvine, CA, USA
- Skin Biology Resource Center, University of California, Irvine, Irvine, CA, USA
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Psychosocial implications of rare genetic skin diseases affecting appearance on daily life experiences, emotional state, self-perception and quality of life in adults: a systematic review. Orphanet J Rare Dis 2023; 18:39. [PMID: 36823650 PMCID: PMC9951542 DOI: 10.1186/s13023-023-02629-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Since the beginning of human genetic research, there are very few publications sharing insights of the negative impact of rare genetic skin diseases (RGSD) on patients' experiences. This systematic review assessed the psychosocial implications of these conditions in terms of daily life experiences, emotional state, self-perception, and Quality of Life (QoL). METHODOLOGY A systematic review was carried out on albinism, neurofibromatosis type 1 (NF1), birthmarks and inherited ichthyosis. The PubMed, Scopus, PsycArticle, PsychInfo, Psychology and Behavioral Sciences Collection, and SOCindex databases were queried. Inclusion criteria were adult patients with one of these RGSDs. Simple descriptive statistics and qualitative content analysis were conducted to summarize the main results reported by the authors. RESULTS Of the 9987 articles retrieved, 48 articles were included: albinism (16), NF1 (16), inherited ichthyosis (10), birthmarks (6). The majority of the studies on albinism were conducted in Africa. Twenty-seven studies quantitatively assessed diverse psychological parameters: 13 showed a significant impact of the disease on QoL, five on emotional state, two on self-representation and two others on psychiatric comorbidities. Disease severity and visibility were good predictors of QoL (except for albinism). Body image and appearance concerns were also associated with QoL and emotional state. The 19 qualitative studies highlighted recurring themes across each of these diseases: discrimination and stigma during childhood and adolescence, discomfort in social interactions, guilt of transmission, the importance of social support from family and friends, altered daily life functioning, altered romantic and sex life, limited academic and professional aspirations, lack of interest and support from the medical field, and the unpredictability of the evolution of the disease. The only two mixed-method studies in this review were unable to contribute to any inferential analyses but could corroborate some of the qualitative findings. CONCLUSION These results showed that RGSDs have a significant impact on different aspects of patients' lives. This review has demonstrated that there is a real need for support systems for patients with these diseases. Such systems should be developed to provide them with necessary information and to guide them through an appropriate care pathway.
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Chernyshov PV, Tomas-Aragones L, Manolache L, Pustisek N, Salavastru CM, Marron SE, Bewley A, Svensson A, Poot F, Suru A, Salek SS, Augustin M, Szepietowski JС, Koumaki D, Katoulis AC, Sampogna F, Abeni D, Linder DM, Speeckaert R, van Geel N, Seneschal J, Ezzedine K, Finlay AY. Quality of life measurement in vitiligo. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes with external experts. J Eur Acad Dermatol Venereol 2023; 37:21-31. [PMID: 36259656 DOI: 10.1111/jdv.18593] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 09/13/2022] [Indexed: 12/31/2022]
Abstract
Members of the European Academy of Dermatology and Venereology (EADV) Task Force on Quality of Life (QoL) and Patient Oriented Outcomes reviewed the instruments available for health-related (HR) QoL assessment in vitiligo and together with external vitiligo experts (including representatives of the EADV Vitiligo Task Force) have made practical recommendations concerning the assessment of QoL in vitiligo patients. The Dermatology Life Quality Index (DLQI) was the most frequently used HRQoL instrument, making comparison of results between different countries possible. Several vitiligo-specific instruments were identified. The vitiligo Impact Scale (VIS) is an extensively validated vitiligo-specific HRQoL instrument with proposed minimal important change and clinical interpretation for VIS-22 scores. VIS-22 was developed for use in India, where there are some specific cultural beliefs concerning vitiligo. The EADV Task Force on QoL and Patient Oriented Outcomes recommends use of the DLQI and the Children's Dermatology Life Quality Index (CDLQI) as dermatology-specific instruments in vitiligo. There is a strong need for a valid (including cross-cultural validation) vitiligo-specific instrument that can be either a new instrument or the improvement of existing instruments. This validation must include the proof of responsiveness.
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Affiliation(s)
- Pavel V Chernyshov
- Department of Dermatology and Venereology, National Medical University, Kiev, Ukraine
| | | | | | - Nives Pustisek
- Children's Hospital Zagreb, Medical School, University of Zagreb, Zagreb, Croatia
| | - Carmen Maria Salavastru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Servando E Marron
- Department of Dermatology, University Hospital Miguel Servet, Aragon Psychodermatology Research Group (GAI+PD), Zaragoza, Spain
| | - Anthony Bewley
- Barts Health NHS Trust, London, UK.,Queen Mary University, London, UK
| | - Ake Svensson
- Department of Dermatology and Venereology, Skane University Hospital, Malmö, Sweden
| | - Françoise Poot
- Department of Dermatology, University Hospital Erasme, Brussels, Belgium
| | - Alina Suru
- Department of Paediatric Dermatology, Colentina Clinical Hospital, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - Sam S Salek
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jacek С Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Dimitra Koumaki
- Department of Dermatology and Venereology, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Alexander C Katoulis
- 2nd Department of Dermatology and Venereology, National and Kapodistrian University of Athens, Medical School, "Attikon" General University Hospital, Athens, Greece
| | | | | | - Dennis Michael Linder
- University Clinic for Medical Psychology and Psychotherapy, Medical University of Graz, Graz, Austria
| | | | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint-André, University of Bordeaux, Bordeaux, France
| | - Khaled Ezzedine
- Service de Dermatologie, AP-HP, Hôpital Henri-Mondor, Créteil, France.,EpiDermE - Epidemiology in Dermatology and Evaluation of Therapeutics, Université Paris-Est Créteil, Créteil, France
| | - Andrew Y Finlay
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
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Yang TT, Lee CH, Lan CCE. Impact of Vitiligo on Life Quality of Patients: Assessment of Currently Available Tools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14943. [PMID: 36429664 PMCID: PMC9690871 DOI: 10.3390/ijerph192214943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND How different tools for evaluating health-related quality of life (QoL) reflect the burden of vitiligo has rarely been compared. In this study, we aim to evaluate the impact of vitiligo on QoL using currently available tools. METHODS A single-center, cross-sectional study of vitiligo patients was performed. QoL was evaluated using the dermatology life quality index (DLQI), short form-36 (SF-36), and willingness to pay (WTP). As the original DLQI cutoff score (>10) indicating aginificantly impated QoL was found to underestimate QoL, receiver operating characteristic (ROC) curve was use to determine a new cutoff point discriminating vitiligo patients with positive mental stress (SF-36 mental health ≤ 52). RESULTS Of the 143 patients enrolled, 24.5% were identified having significant mental stress by SF-36 mental health domain score ≤ 52 while there were only 13.3% patients with significantly hampered QoL indicated by DLQI >10. Using ROC analysis, DLQI ≥ 7 was found to be a more appropriate DLQI cutoff value for identifying mental stress in vitiligo patients. Additionally, the median WTP for treating vitiligo was comparable to other inflammatory skin diseases. CONCLUSIONS There exist discrepancies in the outcomes identifying significant disease burden of vitiligo using DLQI and SF-36, making the current DLQI cutoff score (>10) for identifying significantly affected QoL inappropriate for these patients.
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Affiliation(s)
- Ting-Ting Yang
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Dermatology, Pingtung Hospital, Ministry of Health and Welfare, Pingtung 900, Taiwan
| | - Chien-Hung Lee
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Cheng-Che E. Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
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Juntongjin P, Abouelsaad S, Sugkraroek S, Taechakraichana N, Lungchukiet P, Nuallaong W. Awareness of vitiligo among multi-ethnic populations. J Cosmet Dermatol 2022; 21:5922-5930. [PMID: 35785468 DOI: 10.1111/jocd.15211] [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: 04/08/2022] [Revised: 06/16/2022] [Accepted: 06/30/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Vitiligo is a common acquired pigmentary disorder reported worldwide. Although asymptomatic, vitiligo negatively affects the patients' quality of life because it provokes psychological stigmatization and social discrimination. There are several misconceptions regarding vitiligo. OBJECTIVE This study aimed to evaluate the knowledge of and attitudes toward vitiligo in the general population and in different ethnic groups. METHODS A cross-sectional survey was conducted during which the participants were required to watch a brief video portraying a waitress affected by vitiligo and to fill a questionnaire related to the video content. Participants were recruited from among people who visited a private international hospital in Bangkok, Thailand, and who freely accepted to participate in the study. RESULTS Out of 405 participants who voluntarily participated in the study, approximately 30% were able to identify the condition as vitiligo. Approximately 66% and 88% of the participants had sufficient knowledge about and positive attitudes toward vitiligo, respectively. Those with sufficient knowledge scores significantly had more positive attitudes (p = 0.001). However, there were some differences among ethnic groups (p < 0.0001). Arabians had the highest knowledge and attitude scores. Regarding close-relationship attitudes, Asians tended to have perceptions that were different from that of others. CONCLUSION Knowledge of and attitudes toward vitiligo varied among ethnicities. Only 30% of the study population could identify this condition. Arabians had the highest knowledge score, whereas Caucasians had the highest prevalence of positive attitudes. Therefore, global awareness of vitiligo should be emphasized.
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Affiliation(s)
- Premjit Juntongjin
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Sara Abouelsaad
- Division of Dermatology, Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand
| | | | - Nimit Taechakraichana
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Palita Lungchukiet
- Department of Medical Education and Clinical Research Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Winitra Nuallaong
- Department of Psychiatry, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
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Chaudhary A, Patel M, Singh S. Current Debates on Etiopathogenesis and Treatment Strategies for Vitiligo. Curr Drug Targets 2022; 23:1219-1238. [PMID: 35388753 DOI: 10.2174/1389450123666220406125645] [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: 07/07/2021] [Revised: 12/12/2021] [Accepted: 12/31/2021] [Indexed: 01/25/2023]
Abstract
Vitiligo is an acquired, chronic, and progressive depigmentation or hypopigmentation characterized by the destruction of melanocytes and the occurrence of white patches or macules in the skin, mucosal surface of eyes, and ears. Melanocytes are the melanin pigment-producing cells of the skin which are destroyed in pathological conditions called vitiligo. Approximately 0.5 - 2.0% of the population is suffering from vitiligo, and a higher prevalence rate of up to 8.8% has been reported in India. It is caused by various pathogenic factors like genetic predisposition, hyperimmune activation, increased oxidative stress, and alteration in neuropeptides level. Genetic research has revealed a multi- genetic inheritance that exhibits an overlap with other autoimmune disorders. However, melanocytes specific genes are also affected (such as DDR1, XBP1, NLRP1, PTPN22, COMT, FOXP3, ACE, APE, GSTP1, TLR, SOD, and CTLA-4). A number of therapeutic options are employed for the treatment of vitiligo. The topical corticosteroids and immunomodulators are currently in practice for the management of vitiligo. Phototherapies alone and in combinations with other approaches are used in those patients who do not respond to the topical treatment. The main focus of this review is on the etiopathological factors, pharmacological management (phototherapy, topical, systemic, and surgical therapy), and herbal drugs used to treat vitiligo.
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Affiliation(s)
- Ankit Chaudhary
- Department of Pharmacology, Neuropharmacology Division, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Mayank Patel
- Department of Pharmacology, Neuropharmacology Division, ISF College of Pharmacy, Moga, Punjab 142001, India
| | - Shamsher Singh
- Department of Pharmacology, Neuropharmacology Division, ISF College of Pharmacy, Moga, Punjab 142001, India
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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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Liu X, Yao Z, Wang Y, Chai L, Zhou X. Vitamin D analogs combined with different types of phototherapy in the treatment of vitiligo: A systematic review of randomized trials and within-patient studies. Int Immunopharmacol 2022; 109:108789. [DOI: 10.1016/j.intimp.2022.108789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/29/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
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12
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Liu C, Wahefu A, Lu X, Abdulla R, Dou J, Zhao H, Aisa HA, Xin X, Liu Y. Chemical Profiling of Kaliziri Injection and Quantification of Six Caffeoyl Quinic Acids in Beagle Plasma by LC-MS/MS. Pharmaceuticals (Basel) 2022; 15:ph15060663. [PMID: 35745582 PMCID: PMC9230828 DOI: 10.3390/ph15060663] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 02/01/2023] Open
Abstract
Vitiligo is a stubborn multifactorial skin disease with a prevalence of approximately 1% in the global population. Kaliziri, the seeds of Vernonia anthelmintica (L.) Willd., is a well-known traditional Uyghur medicine for the treatment of vitiligo. Kaliziri injections is a Chinese-marketed treatment approved by the China Food and Drug Administration for the treatment of vitiligo. The significant effects of Kaliziri injection have been thoroughly studied. However, chemical components studies and plasma quantification studies are lacking for Kaliziri injection. Ultra-high-performance liquid chromatography coupled with hybrid quadrupole orbitrap mass spectrometry was employed to comprehensively characterize the caffeoyl quinic acid derivatives present in Kaliziri injection. Based on accurate mass measurements, key fragmental ions and comparisons with reference standards, 60 caffeoyl quinic acid derivatives were identified in Kaliziri injections, including caffeoyl quinic acids, coumaroyl caffeoyl quinic acids, dicaffeoyl quinic acids, feruloyl caffeoyl quinic acids, and dicaffeoyl quinic acid hexosides. Moreover, an HPLC-MS/MS method was developed and validated for the quantitative analysis of 5-caffeoyl quinic acid, 4-caffeoyl quinic acid, 1,3-dicaffeoyl quinic acid, 3,4-dicaffeoyl quinic acid, 3,5-dicaffeoyl quinic acid and 4,5-dicaffeoyl quinic acid in beagle plasma. The quantitative HPLC-MS/MS method was applied to quantify these six major caffeoyl quinic acids in beagle plasma after the subcutaneous administration of Kaliziri injection. All of the six analytes reached their peak plasma of concentrations within 30 min.
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Affiliation(s)
- Changhua Liu
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Atikanmu Wahefu
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xueying Lu
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
| | - Rahima Abdulla
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
| | - Jun Dou
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
| | - Haiqing Zhao
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
| | - Haji Akber Aisa
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
| | - Xuelei Xin
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
- Correspondence: (X.X.); (Y.L.)
| | - Yongqiang Liu
- State Key Laboratory Basis of Xinjiang Indigenous Medicinal Plants Resource Utilization, Key Laboratory of Plant Resources and Chemistry of Arid Zone, Xinjiang Technical Institute of Physics and Chemistry, Chinese Academy of Sciences, Urumqi 830011, China; (C.L.); (A.W.); (X.L.); (R.A.); (J.D.); (H.Z.); (H.A.A.)
- Correspondence: (X.X.); (Y.L.)
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13
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Faraj S, Kemp EH, Gawkrodger DJ. Patho-immunological mechanisms of vitiligo: the role of the innate and adaptive immunities and environmental stress factors. Clin Exp Immunol 2022; 207:27-43. [PMID: 35020865 PMCID: PMC8802175 DOI: 10.1093/cei/uxab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 10/04/2021] [Accepted: 10/15/2021] [Indexed: 12/17/2022] Open
Abstract
Epidermal melanocyte loss in vitiligo, triggered by stresses ranging from trauma to emotional stress, chemical exposure or metabolite imbalance, to the unknown, can stimulate oxidative stress in pigment cells, which secrete damage-associated molecular patterns that then initiate innate immune responses. Antigen presentation to melanocytes leads to stimulation of autoreactive T-cell responses, with further targeting of pigment cells. Studies show a pathogenic basis for cellular stress, innate immune responses and adaptive immunity in vitiligo. Improved understanding of the aetiological mechanisms in vitiligo has already resulted in successful use of the Jak inhibitors in vitiligo. In this review, we outline the current understanding of the pathological mechanisms in vitiligo and locate loci to which therapeutic attack might be directed.
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Affiliation(s)
- Safa Faraj
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - David John Gawkrodger
- Department of Infection, Immunology and Cardiovascular Disease, University of Sheffield, Sheffield, UK
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14
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Song J, Liu K, Chen W, Liu B, Yang H, Lv L, Sun X, Mao Y, Ye D. Circulating Vitamin D Levels and Risk of Vitiligo: Evidence From Meta-Analysis and Two-Sample Mendelian Randomization. Front Nutr 2022; 8:782270. [PMID: 35004812 PMCID: PMC8727691 DOI: 10.3389/fnut.2021.782270] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The association between circulating vitamin D levels and risk of vitiligo was inconsistent among observational studies, and whether these observed associations were causal remained unclear. Therefore, we aimed to evaluate the effect of vitamin D on the risk of vitiigo using meta-analysis and Mendelian randomization (MR). Methods: At the meta-analysis stage, literature search was performed in PubMed and Web of Science to identify eligible observational studies examining the association of circulating 25-hydroxyvitamin D [25(OH)D] or 25-hydroxyvitamin D3 [25(OH)D3] levels with risk of vitiligo up to April 30, 2021. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) of 25(OH)D and 25(OH)D3 in patients with vitiligo relative to controls were pooled. Then at the MR stage, genetic instruments for circulating 25(OH)D (N = 120,618) and 25(OH)D3 (N = 40,562) levels were selected from a meta-analysis of genome-wide association studies (GWAS) of European descent, and summary statistics of vitiligo were obtained from a meta-analysis of three GWASs including 4,680 cases and 39,586 controls. We used inverse-variance weighted (IVW) as main method, followed by weighted-median and likelihood-based methods. Pleiotropic and outlier variants were assessed by MR-Egger regression and MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) test. Results: In the meta-analysis, patients with vitiligo had a lower level of circulating 25(OH)D compared with controls [SMD = −1.40; 95% confidence interval (CI): −1.91, −0.89; P < 0.001], while no statistically significant difference of 25(OH)D3 between vitiligo cases and controls was found (SMD = −0.63; 95% CI: −1.29, 0.04; P = 0.064). However, in the MR analyses, genetically predicted 25(OH)D [odds ratio (OR) = 0.93, 95% CI = 0.66–1.31, P = 0.66] and 25(OH)D3 levels (OR = 0.95, 95% CI = 0.80–1.14, P = 0.60) had null associations with risk of vitiligo using the IVW method. Sensitivity analyses using alternative MR methods and instrumental variables (IV) sets obtained consistent results, and no evidence of pleiotropy or outliers was observed. Conclusion: Our study provided no convincing evidence for a causal effect of 25(OH)D or 25(OH)D3 levels on the risk of vitiligo. Further longitudinal and experimental studies, as well as functional studies are warranted to elucidate the role of vitamin D in the development of vitiligo.
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Affiliation(s)
- Jie Song
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke Liu
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Weiwei Chen
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Bin Liu
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Hong Yang
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Linshuoshuo Lv
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Xiaohui Sun
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Yingying Mao
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ding Ye
- Department of Epidemiology, School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
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15
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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: 63] [Impact Index Per Article: 21.0] [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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16
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Jaladat AM, Amiri-Ardekani E, Ramezani PS, Boroughani M, Emami Alorizi M, Parvizi MM. Correlation between gastrointestinal symptoms and adherence to traditional Persian medicine dietary recommendations in patients with vitiligo; a cross-sectional study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 18:813-820. [PMID: 33818030 DOI: 10.1515/jcim-2020-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Vitiligo is a chronic disease associated with the depigmentation of regions of the skin secondary to structural or functional damage to melanocytes. This damage results from interactions between the immune system and oxidative stress. In traditional Persian medicine (TPM), the concept of 'Barass' or 'Pissi' encompasses a group of skin diseases including vitiligo, for which there has been an emphasis on the preventive and therapeutic role of dietary modifications. METHODS In this cross-sectional study, 200 vitiligo patients and 200 controls were enrolled with a random sampling method. The participants included patients with vitiligo referred to the Dermatology Clinic of Shahid Faghihi Hospital (Shiraz, Iran), with the control group being comprised individuals who referred to this clinic for cosmetic purposes. Questionnaires comparing the severity of gastrointestinal symptoms and the rate of adherence to TPM dietary recommendations were filled by all participants. Data were analyzed using SPSS version 24.0. RESULTS The case group was significantly less adherent to TPM recommendations than the control group (8.25 ± 27.16 vs. 31.8 ± 10.47; p<0.001). However, there was no significant difference between both groups in the Gastrointestinal Symptom Rating Scale (GSRS) scores (14.09 ± 14.84 vs. 12.62 ± 11.71; p = 0.105). In the case group, the level of adherence to the recommendations of TPM was significantly lower among patients with lower education levels (R=-0.194; p=0.017). Furthermore, there was a significant negative relationship between the length of the disease and adherence to TPM dietary recommendations (R=-0.247; p=0.002). CONCLUSIONS In this study, the level of adherence to TPM recommendations was significantly lower among patients with vitiligo than the control group. Hence, further studies are suggested to identify the probable role of dietary habits in the pathogenesis of vitiligo.
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Affiliation(s)
- Amir Mohammad Jaladat
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Amiri-Ardekani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Phytopharmaceuticals (Traditional Pharmacy), Shiraz University of Medical Sciences, Shiraz, Iran.,Student Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohadese Boroughani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Phytopharmaceuticals (Traditional Pharmacy), Shiraz University of Medical Sciences, Shiraz, Iran.,Student Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Emami Alorizi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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17
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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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18
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Yang B, Zhao H, Zhao N, Zhou B, Chen G, Wang Y, Zhang H, Lin Y, Liu H, Kundu R. Reliability and validity of the Chinese version of the vitiligo specific quality of life instrument (VitiQoL). DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_48_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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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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20
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Taïeb A, Meurant JM. Should we prioritize psychological interventions in the management of vitiligo? J Eur Acad Dermatol Venereol 2020; 32:2053-2054. [PMID: 30488996 DOI: 10.1111/jdv.15297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A Taïeb
- Department of Dermatology and Pediatric Dermatology, CHU de Bordeaux, Bordeaux, France
| | - J-M Meurant
- Association Française du Vitiligo (AFV) and Vitiligo International Patient Organizations Committee (VIPOC), Paris, France
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21
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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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22
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Relke N, Gooderham M. The Use of Janus Kinase Inhibitors in Vitiligo: A Review of the Literature. J Cutan Med Surg 2019; 23:298-306. [PMID: 30902022 DOI: 10.1177/1203475419833609] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Vitiligo is a common acquired depigmenting disorder characterized by the development of white macules and patches due to the loss of melanocytes. Patients with vitiligo can be stigmatized by society, making the disease a source of psychological stress that can considerably affect quality of life. The goal of vitiligo treatment is to obtain skin repigmentation in the majority of cases, and less commonly to depigment the remaining normal skin. There is no consistent, long-term, durable therapy for vitiligo for all patients, highlighting the unmet need for new safe and effective therapies to control this disease. Recently, JAK inhibitors have been explored as a promising novel treatment option in vitiligo. The JAK and signal transducers and activators of transcription (STAT) pathway is an attractive therapeutic target because IFN-γ-dependent cytokines produced through this pathway have been implicated in the pathogenesis of disease. This literature review describes vitiligo pathophysiology, explains the usefulness of the JAK inhibitors for treatment, and summarizes published case reports, case series, and open-label studies. Research outlined here shows JAK inhibitors in patients with vitiligo have a favorable safety profile and effectively produce repigmentation of lesions, especially with concomitant ultraviolet exposure. Additional studies are required to confirm efficacy, establish safety, and investigate durability of repigmentation.
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Affiliation(s)
| | - Melinda Gooderham
- 1 Queen's University, Kingston, ON, Canada.,2 SKiN Centre for Dermatology, Peterborough, ON, Canada.,3 Probity Medical Research, Waterloo, ON, Canada
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23
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Boniface K, Seneschal J, Picardo M, Taïeb A. Vitiligo: Focus on Clinical Aspects, Immunopathogenesis, and Therapy. Clin Rev Allergy Immunol 2018; 54:52-67. [PMID: 28685247 DOI: 10.1007/s12016-017-8622-7] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Vitiligo is an acquired chronic depigmenting disorder of the skin, with an estimated prevalence of 0.5% of the general population, characterized by the development of white macules resulting from a loss of epidermal melanocytes. The nomenclature has been revised after an extensive international work within the vitiligo global issues consensus conference, and vitiligo (formerly non-segmental vitiligo) is now a consensus umbrella term for all forms of generalized vitiligo. Two other subsets of vitiligo are segmental vitiligo and unclassified/undetermined vitiligo, which corresponds to focal disease and rare variants. A series of hypopigmented disorders may masquerade as vitiligo, and some of them need to be ruled out by specific procedures including a skin biopsy. Multiple mechanisms are involved in melanocyte disappearance, namely genetic predisposition, environmental triggers, metabolic abnormalities, impaired renewal, and altered inflammatory and immune responses. The auto-immune/inflammatory theory is the leading hypothesis because (1) vitiligo is often associated with autoimmune diseases; (2) most vitiligo susceptibility loci identified through genome-wide association studies encode immunomodulatory proteins; and (3) prominent immune cell infiltrates are found in the perilesional margin of actively depigmenting skin. However, other studies support melanocyte intrinsic abnormalities with poor adaptation of melanocytes to stressors leading to melanocyte instability in the basal layer, and release of danger signals important for the activation of the immune system. Recent progress in the understanding of immune pathomechanisms opens interesting perspectives for innovative treatment strategies. The proof of concept in humans of targeting of the IFNγ /Th1 pathway is much awaited. The interplay between oxidative stress and altered immune responses suggests that additional strategies aiming at limiting type I interferon activation pathway as background stabilizing therapies could be an interesting approach in vitiligo. This review covers classification and clinical aspects, pathophysiology with emphasis on immunopathogenesis, and promising therapeutic approaches.
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Affiliation(s)
- Katia Boniface
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France
| | - Julien Seneschal
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France.,Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Saint-André and Pellegrin Hospital, Bordeaux, France
| | | | - Alain Taïeb
- INSERM U1035, ATIP-AVENIR, Université de Bordeaux, Bordeaux, France. .,Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Saint-André and Pellegrin Hospital, Bordeaux, France. .,Department of Dermatology and Pediatric Dermatology, St André Hospital, Bordeaux University Hospitals, 1 Rue Jean Burguet, 33075, Bordeaux, France.
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24
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Holahan HM, Farah RS, Fitz S, Mott SL, Ferguson NN, McKillip J, Link B, Liu V. Health-related quality of life in patients with cutaneous T-cell lymphoma? Int J Dermatol 2018; 57:1314-1319. [DOI: 10.1111/ijd.14132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 05/31/2018] [Accepted: 06/13/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Heather M. Holahan
- Rutgers-New Jersey Medical School; Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Ronda S. Farah
- Department of Dermatology; University of Minnesota; Minneapolis MN USA
| | - Sara Fitz
- Medical Associates Clinic & Health Plans; Dubuque IA USA
| | - Sarah L. Mott
- University of Iowa Hospitals and Clinics; Holden Comprehensive Cancer Center; Iowa City IA USA
| | - Nkanyezi N. Ferguson
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Julie McKillip
- Department of Dermatology; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Brian Link
- Department of Internal Medicine-Hematology, Oncology, and Blood and Marrow Transplantation; University of Iowa Hospitals and Clinics; Iowa City IA USA
| | - Vincent Liu
- Departments of Dermatology and Pathology; University of Iowa Hospitals and Clinics; Iowa City IA USA
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25
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Modified Technique of Cultured Epithelial Cells Transplantation on Facial Segmental Vitiligo. J Craniofac Surg 2017; 28:1462-1467. [DOI: 10.1097/scs.0000000000003834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Social Anxiety and Quality of Life in Vitiligo and Acne Patients with Facial Involvement: A Cross-Sectional Controlled Study. Am J Clin Dermatol 2016; 17:305-11. [PMID: 26818062 DOI: 10.1007/s40257-016-0172-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vitiligo and acne vulgaris, commonly affecting the face, have significant psychological effects and impair the quality of life of the affected individuals. Because of their negative effect on physical appearance, these conditions may act as a potential barrier to social relationships and cause social anxiety. OBJECTIVE The objective of the study was to investigate the social anxiety, quality of life, anxiety, and depression levels of acne and vitiligo patients with facial involvement and compare these levels with healthy controls. METHODS Thirty-seven vitiligo and 37 acne patients, aged older than 18 years, with facial involvement and 74 age- and sex-matched healthy control subjects were included in the study. The patients and healthy controls were asked to complete the Liebowitz Social Anxiety Scale, the Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. Disease severity was evaluated both objectively by the physician and subjectively by the patients using a visual analog scale. RESULTS Social anxiety, depression, and anxiety levels of vitiligo and acne patients were significantly higher than healthy controls (p < 0.05). Quality of life was impaired in both patient groups (Dermatology Life Quality Index scores for vitiligo: 5.6 ± 5.1; acne: 6.4 ± 6.2). There was no correlation between psychiatric scale scores and disease severity. Quality of life was negatively correlated with social anxiety and depression levels in both patient groups in our study. CONCLUSION Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.
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27
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The Vitiligo Impact Patient Scale (VIPs): Development and Validation of a Vitiligo Burden Assessment Tool. J Invest Dermatol 2016; 136:52-8. [PMID: 26763423 DOI: 10.1038/jid.2015.398] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 07/14/2015] [Accepted: 07/29/2015] [Indexed: 12/24/2022]
Abstract
Vitiligo has a major impact on health-related quality of life. Although a few vitiligo-specific quality of life instruments exist, there is no specific vitiligo burden tool. We developed and validated a specific vitiligo burden tool according to skin phototype. In total, 301 patients completed 35 items of the Vitiligo Impact Patient scale, of whom 235 were of skin phototype I to III and 66 of phototype IV to VI. The dimensionality of the items was evaluated using factor analyses, with results suggesting three factors in fair- and dark-skinned patients ("Psychological effects on daily life," "Relationships and Sexuality," and "Economic Constraints, Care & Management of Disease"). Unidimensionality was confirmed by higher order factor analysis. Cronbach's α were high-and intradimensional coherences all demonstrated good reliability (α > 0.8). The final instrument consists of 29 items (19 items common to all patients, 3 specific to fair skin, and 7 to dark skin). The test-retest reliability demonstrated very good reproducibility. The intraclass correlation of each dimension was greater than 0.90 for each population. External validity was confirmed by the correlation coefficients and Bland and Altman plots of the Vitiligo Impact Patient scale-Fair Skin and Vitiligo Impact Patient scale-Dark Skin versus the Short-Form-12, PVC Metra, Body Image States Scale, and Daily Life Quality Index assessment tools.
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Whitton M, Pinart M, Batchelor JM, Leonardi-Bee J, Gonzalez U, Jiyad Z, Eleftheriadou V, Ezzedine K. Evidence-based management of vitiligo: summary of a Cochrane systematic review. Br J Dermatol 2016; 174:962-9. [PMID: 26686510 DOI: 10.1111/bjd.14356] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 01/18/2023]
Abstract
Vitiligo affects around 1% of the world's population. Despite it being relatively common, there is still no effective treatment. The objective of this study was to update the Cochrane systematic review of randomized clinical trials (RCTs) to evaluate the efficacy of treatments for vitiligo. We carried out searches of a range of databases to October 2013 for RCTs of interventions for vitiligo regardless of language or publication status. At least two reviewers independently assessed study eligibility and methodological quality and extracted data using data extraction forms approved by the Cochrane Skin Group. Our primary outcomes of interest were quality of life, > 75% repigmentation and adverse effects. We retrieved 96 studies, of which 39 were new studies, with an overall total of 4512 participants. Repigmentation was assessed in all studies, although only five reported on all three of our primary outcomes. Regarding our two secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation at 2 years' follow-up. Most of the studies evaluated combination treatments, which generally showed better repigmentation than monotherapies. Of the new studies, seven were surgical interventions. The majority of the studies had fewer than 50 participants. The quality of the studies was poor to moderate at best. Very few studies specifically included children or participants with segmental vitiligo. Five years after the last update of this review, there are still important variations in study design and outcome measures in clinical trials for vitiligo, limiting the evidence for the efficacy of different therapeutic options. The best evidence from individual trials showed short-term benefit from topical corticosteroids and various forms of ultraviolet radiation combined with topical preparations. Long-term follow-up and patient-rated outcomes should be incorporated into study design, and more studies should assess psychological interventions.
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Affiliation(s)
- M Whitton
- Cochrane Skin Group, University of Nottingham, Nottingham, U.K
| | - M Pinart
- Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,Hospital del Mar Research Institute (IMIM), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Department of Experimental and Health Sciences, University of Pompeu Fabra (UPF), Barcelona, Spain
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - J Leonardi-Bee
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, U.K
| | - U Gonzalez
- Unit of Dermatology, CLÍNICA GO&FER, Barcelona, Spain
| | - Z Jiyad
- Department of Dermatology, St George's Hospital, London, U.K
| | - V Eleftheriadou
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, U.K
| | - K Ezzedine
- Department of Dermatology, AP-HP, Hôpital Henri Mondor, Créteil, France.,EA EpiDermE (Epidémiologie en Dermatologie et Evaluation des Thérapeutiques), UPEC, Créteil, France.,Université Paris-Est Créteil, Créteil, France
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29
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Amer AAA, Gao XH. Quality of life in patients with vitiligo: an analysis of the dermatology life quality index outcome over the past two decades. Int J Dermatol 2016; 55:608-14. [PMID: 26749040 DOI: 10.1111/ijd.13198] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/27/2015] [Accepted: 08/24/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Xing-Hua Gao
- Department of Dermatology; No. 1 Hospital of China Medical University; Shenyang China
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30
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Bonotis K, Pantelis K, Karaoulanis S, Katsimaglis C, Papaliaga M, Zafiriou E, Tsogas P. Eine Untersuchung von Faktoren, die mit der gesundheitsbezogenen Lebensqualität und der psychologischen Belastung bei Vitiligo verbunden sind. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.80_12729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Konstantinos Bonotis
- Department of Psychiatry; Faculty of Medicine; University of Thessaly; Larisa Griechenland
| | - Konstantinos Pantelis
- Department of Psychiatry; Faculty of Medicine; University of Thessaly; Larisa Griechenland
| | - Sokratis Karaoulanis
- Department of Psychiatry; Faculty of Medicine; University of Thessaly; Larisa Griechenland
| | | | - Maria Papaliaga
- Department of Psychiatry; Faculty of Medicine; University of Thessaly; Larisa Griechenland
| | - Efterpi Zafiriou
- Department of Dermatology; Faculty of Medicine; University of Thessaly; Larisa Griechenland
| | - Panagiotis Tsogas
- Department of Psychiatry; Faculty of Medicine; University of Thessaly; Larisa Griechenland
- Vitiligo Center Clinics; Athen Griechenland
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31
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Bonotis K, Pantelis K, Karaoulanis S, Katsimaglis C, Papaliaga M, Zafiriou E, Tsogas P. Investigation of factors associated with health-related quality of life and psychological distress in vitiligo. J Dtsch Dermatol Ges 2015; 14:45-9. [DOI: 10.1111/ddg.12729] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Konstantinos Bonotis
- Department of Psychiatry, Faculty of Medicine, University of Thessaly; Larisa Greece
| | - Konstantinos Pantelis
- Department of Psychiatry, Faculty of Medicine, University of Thessaly; Larisa Greece
| | - Sokratis Karaoulanis
- Department of Psychiatry, Faculty of Medicine, University of Thessaly; Larisa Greece
| | | | - Maria Papaliaga
- Department of Psychiatry, Faculty of Medicine, University of Thessaly; Larisa Greece
| | - Efterpi Zafiriou
- Department of Dermatology, Faculty of Medicine, University of Thessaly; Larisa Greece
| | - Panagiotis Tsogas
- Department of Psychiatry, Faculty of Medicine, University of Thessaly; Larisa Greece
- Vitiligo Center Clinics; Athens Greece
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Cohen BE, Elbuluk N, Mu EW, Orlow SJ. Alternative Systemic Treatments for Vitiligo: A Review. Am J Clin Dermatol 2015; 16:463-74. [PMID: 26329814 DOI: 10.1007/s40257-015-0153-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Vitiligo is a common, acquired disorder of skin pigmentation that can significantly impact quality of life. It often represents a therapeutic challenge, which has resulted in interest in alternative treatments such as herbal and vitamin supplements. In this review, we provide an overview of the most commonly studied complementary agents, describe proposed mechanisms of action, identify potential adverse effects, and discuss the primary evidence supporting their use. Our discussion focuses on L-phenylalanine, Polypodium leucotomos, khellin, Ginkgo biloba, and vitamins and minerals, including vitamins B12, C, and E, folic acid, and zinc used as monotherapy or in combination with other treatments for the management of vitiligo.
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Affiliation(s)
- Brandon E Cohen
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Nada Elbuluk
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Euphemia W Mu
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA
| | - Seth J Orlow
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, 240 East 38th Street, New York, NY, 10016, USA.
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33
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Ezzedine K, Grimes PE, Meurant JM, Seneschal J, Léauté-Labrèze C, Ballanger F, Jouary T, Taïeb C, Taïeb A. Living with vitiligo: results from a national survey indicate differences between skin phototypes. Br J Dermatol 2015; 173:607-9. [PMID: 25892476 DOI: 10.1111/bjd.13839] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- K Ezzedine
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Pellegrin Children's Hospital, 33075, Bordeaux, France.,INSERM U1035, Bordeaux Segalen University, Bordeaux, France
| | - P E Grimes
- The Vitiligo and Pigmentation Institute of Southern California, Los Angeles, CA, U.S.A
| | - J-M Meurant
- Association Française du Vitiligo, Paris, France
| | - J Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Pellegrin Children's Hospital, 33075, Bordeaux, France.,INSERM U1035, Bordeaux Segalen University, Bordeaux, France
| | - C Léauté-Labrèze
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Pellegrin Children's Hospital, 33075, Bordeaux, France
| | - F Ballanger
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Pellegrin Children's Hospital, 33075, Bordeaux, France
| | - T Jouary
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Pellegrin Children's Hospital, 33075, Bordeaux, France.,Department of Dermatology, Centre Hospitalier De Pau, Pau, France
| | - C Taïeb
- Public Health, Pierre Fabre SA, Paris, France
| | - A Taïeb
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Pellegrin Children's Hospital, 33075, Bordeaux, France.,INSERM U1035, Bordeaux Segalen University, Bordeaux, France
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Abstract
Vitiligo, an acquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide, with an estimated prevalence of 1%. The disorder can be psychologically devastating and stigmatising, especially in dark skinned individuals. Vitiligo is clinically characterised by the development of white macules due to the loss of functioning melanocytes in the skin or hair, or both. Two forms of the disease are well recognised: segmental and non-segmental vitiligo (the commonest form). To distinguish between these two forms is of prime importance because therapeutic options and prognosis are quite different. The importance of early treatment and understanding of the profound psychosocial effect of vitiligo will be emphasised throughout this Seminar.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Hôpital Pellegrin, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale. U1035, University of Bordeaux, Bordeaux, France.
| | | | - Maxine Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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35
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Daniel BS, Wittal R. Vitiligo treatment update. Australas J Dermatol 2014; 56:85-92. [DOI: 10.1111/ajd.12256] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 08/16/2014] [Indexed: 11/30/2022]
Affiliation(s)
| | - Richard Wittal
- University of New South Wales; Sydney New South Wales Australia
- Skin and Cancer Foundation; Sydney New South Wales Australia
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36
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Ingordo V, Cazzaniga S, Medri M, Raone B, Digiuseppe MD, Musumeci ML, Romano I, Fai D, Pellegrino M, Pezzarossa E, Di Lernia V, Peccerillo F, Battarra VC, Sirna R, Patrizi A, Naldi L. To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index. Dermatology 2014; 229:240-7. [PMID: 25358871 DOI: 10.1159/000363407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is believed that vitiligo has an impact on the overall patient quality of life (QoL). OBJECTIVE To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire. METHODS One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire. RESULTS The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset. CONCLUSIONS The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.
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Affiliation(s)
- Vito Ingordo
- Outpatient Department of Dermatology, District No. 6, Health Local Unit, Taranto, Italy
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37
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Chan MF, Thng TGS, Aw CWD, Goh BK, Lee SM, Chua TL. Investigating factors associated with quality of life of vitiligo patients in Singapore. Int J Nurs Pract 2014; 19 Suppl 3:3-10. [PMID: 24090292 DOI: 10.1111/ijn.12179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Skin disease is often visible to others. People who have dermatological condition may also suffer from its psychological consequences. The purpose of this study is to explore the quality of life of patients with vitiligo and to identify factors associated with their quality of life. A descriptive correlational study was conducted with 222 patients with vitiligo recruited from two skin centres in Singapore from 2009 to 2011. Data were collected by a structured questionnaire. Three outcome variables were measured in the study: predisposal, clinical and psychological outcomes. Results showed that almost two-thirds of the participants reported vitiligo had moderate to extreme impact on their quality of life. Multiple regression analyses showed that patients who were depressed, had thyroid disease and had not used multiclear treatment were more likely to report poor quality of life. It is recommended that providing health care consultation for patients with vitiligo may help reduce depressive symptoms and maintain their psychological health, thus enhance their quality of life.
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Affiliation(s)
- Moon Fai Chan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
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38
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Reimann E, Kingo K, Karelson M, Reemann P, Vasar E, Silm H, Kõks S. Whole Transcriptome Analysis (RNA Sequencing) of Peripheral Blood Mononuclear Cells of Vitiligo Patients. Dermatopathology (Basel) 2014; 1:11-23. [PMID: 27047918 PMCID: PMC4772995 DOI: 10.1159/000357402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Vitiligo is an idiopathic disorder characterized by depigmented patches on the skin due to a loss of melanocytes. The cause of melanocyte destruction is not fully understood. The aim of this study was to detect the potential pathways involved in the vitiligo pathogenesis to further understand the causes and entity of vitiligo. For that the transcriptome of peripheral blood mononuclear cells of 4 vitiligo patients and 4 control subjects was analyzed using the SOLiD System platform and whole transcriptome RNA sequencing application. Altogether 2,470 genes were expressed differently and GRID2IP showed the highest deviation in patients compared to controls. Using functional analysis, altogether 993 associations between the gene groups and diseases were found. The analysis revealed associations between vitiligo and diseases such as lichen planus, limb-girdle muscular dystrophy type 2B, and facioscapulohumeral muscular dystrophy. Additionally, the gene groups with an altered expression pattern are participating in processes such as cell death, survival and signaling, inflammation, and oxidative stress. In conclusion, vitiligo is rather a systemic than a local skin disease; the findings from an enormous amount of RNA sequencing data support the previous findings about vitiligo and should be further analyzed.
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Affiliation(s)
- E Reimann
- Department of Physiology, Tartu, Estonia; Department of Dermatology and Venereology, Tartu, Estonia; Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - K Kingo
- Department of Dermatology and Venereology, Tartu, Estonia; Department of Dermatology Clinic of Tartu University Hospital, Tartu, Estonia
| | - M Karelson
- Department of Dermatology and Venereology, Tartu, Estonia
| | - P Reemann
- Department of Physiology, Tartu, Estonia; Department of Dermatology and Venereology, Tartu, Estonia
| | - E Vasar
- Department of Physiology, Tartu, Estonia; Department of Centre of Translational Medicine, University of Tartu, Tartu, Estonia
| | - H Silm
- Department of Dermatology and Venereology, Tartu, Estonia
| | - S Kõks
- Department of Pathological Physiology, Tartu, Estonia; Department of Centre of Translational Medicine, University of Tartu, Tartu, Estonia; Institute of Veterinary Medicine and Animal Sciences, Estonian University of Life Sciences, Tartu, Estonia
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Allam M, Riad H. Concise review of recent studies in vitiligo. Qatar Med J 2013; 2013:1-19. [PMID: 25003059 PMCID: PMC4080492 DOI: 10.5339/qmj.2013.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 10/20/2013] [Indexed: 12/12/2022] Open
Abstract
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's lamp; also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment modalities.
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Affiliation(s)
- Mohamed Allam
- Dermatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Riad
- Dermatology Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
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40
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Noh S, Kim M, Park CO, Hann SK, Oh SH. Comparison of the psychological impacts of asymptomatic and symptomatic cutaneous diseases: vitiligo and atopic dermatitis. Ann Dermatol 2013; 25:454-61. [PMID: 24371393 PMCID: PMC3870214 DOI: 10.5021/ad.2013.25.4.454] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 11/08/2022] Open
Abstract
Background Vitiligo and atopic dermatitis (AD) are common dermatological disorders which may cause significant psychological and social distress leading to impaired quality of life (QoL) in patients. Objective We evaluated the degree of psychological stress and impairment of QoL in vitiligo patients as compared with AD patients and normal controls (NCs). Methods A total of 60 patients from each group and 60 NCs were enrolled. Five questionnaires on depression (Beck depression inventory, BDI), state anxiety (SA) and trait anxiety (TA), interaction anxiousness (IAS), private body consciousness (PBC) and dermatologic QoL were used. Results The vitiligo patients had a significantly higher level of TA (p<0.01), PBC (p<0.001) and impaired QoL (p<0.001) than NCs, but not BDI, SA and IAS. The AD patients had significantly higher scores for all five questionnaire items compared with NCs. In the comparison between the AD and vitiligo groups, all of the indexes except body consciousness were higher in AD patients than in vitiligo patients: BDI (p<0.01), SA (p<0.05), TA (p<0.001), IAS (p<0.01) and impaired QoL (p<0.001). Exposure of vitiligo lesions was not a significant variable in the analysis of the contribution of clinical variables of vitiligo on psychological stress and QoL. Conclusion Vitiligo, which is not accompanied by any symptoms, involves less psychological impact than AD, which is accompanied by itching. Compared to NCs, however, the elevated general anxiety and body consciousness in patients with vitiligo suggests that they may be more concerned with the aggravation of hypopigmented patches than difficulties in social interactions.
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Affiliation(s)
- Seongmin Noh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Miri Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ook Park
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Kyung Hann
- Korea Institute of Vitiligo Research and Drs. Woo and Hann's Skin Center, Seoul, Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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41
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Bilgiç Ö, Bilgiç A, Bahalı K, Bahali AG, Gürkan A, Yılmaz S. Psychiatric symptomatology and health-related quality of life in children and adolescents with alopecia areata. J Eur Acad Dermatol Venereol 2013; 28:1463-8. [PMID: 24237476 DOI: 10.1111/jdv.12315] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 10/11/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a very limited amount of data available regarding the relationship between alopecia areata (AA) and psychiatric morbidity and quality of life (QoL) in children and adolescents. OBJECTIVES The aim of this study was to determine the psychiatric state and health-related quality of life (HRQL) of children and adolescents with AA, as well as their relationships with clinical parameters. METHODS The sample consisted of 74 children with AA aged 8-18 years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients. The study and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological condition. RESULTS In the child group, patients had higher state anxiety and trait anxiety scores; they also had lower parent-rated psychosocial and total area HRQL scores than the controls did. In addition, the depression score was prone to show a positive relationship with having AA in the children. In the adolescent group, however, only the state anxiety score had a significant association with AA. All of the parent-rated HRQL scores were also prone to being lower compared with controls in this age group. Regarding determinants of HRQL, prolonged disease duration and later disease onset had positive effects, whereas severity of scalp involvement, trait anxiety and depression had negative effects, for the sample as a whole. CONCLUSIONS Alopecia areata is associated with poor psychiatric status and QoL, especially in childhood. The impact of the disease on QoL occurs through both clinical and psychiatric parameters.
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Affiliation(s)
- Ö Bilgiç
- Department of Dermatology, Selcuk University Faculty of Medicine, Konya, Turkey
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Ajose FOA, Parker RA, Merrall ELC, Adewuya AO, Zachariah MP. Quantification and comparison of psychiatric distress in African patients with albinism and vitiligo: a 5-year prospective study. J Eur Acad Dermatol Venereol 2013; 28:925-32. [PMID: 23875952 DOI: 10.1111/jdv.12216] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 05/05/2013] [Accepted: 06/21/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Vitiligo and albinism are two disorders of pigmentation that make the affected African highly visible and strikingly different from their peers. Both pose considerable management challenges, attract significant stigma and profound impairment of quality of life. OBJECTIVE AND METHODS To determine and compare psychiatric distress in vitiligo and albinism using the Hospital Anxiety and Depression Scale (HADS). Participants were 87 albinos and 102 vitiligo adult patients seen at an urban tertiary hospital in Nigeria between 2004 and 2009. RESULTS Prevalence of psycho morbidity was 59% (60/102) in vitiligo compared with 26% (23/87) in the albinos. The mean anxiety score was estimated to be 2.55 points lower for albino patients (95% CI: 1.47 to 3.64), and the mean depression score 2.76 points lower (95% CI: 1.84 to 3.68), after adjustment for age, sex and marital status. However, significant differences were not observed when comparing the vitiligo patients with the subset of albino patients with skin cancer. Older patients had significantly higher anxiety and depression scores. Females had significantly higher anxiety scores (but not depression scores) compared to males. Genital involvement in vitiligo was significantly associated with anxiety but not depression. CONCLUSIONS We found that the African with vitiligo suffers significantly higher psychiatric distress than the African albino on average. Clinical evaluation of these patients would be incomplete without assessment of their psycho morbidity. There is need for increased focus on cancer prevention strategies in the African albino.
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Affiliation(s)
- F O A Ajose
- Consultant Physician Dermatologist, Department of Medicine, Lagos State University College of Medicine, Ikeja LAGOS Nigeria, Lagos, Nigeria
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Kiprono S, Chaula B, Makwaya C, Naafs B, Masenga J. Quality of life of patients with vitiligo attending the Regional Dermatology Training Center in Northern Tanzania. Int J Dermatol 2013; 52:191-4. [PMID: 23347306 DOI: 10.1111/j.1365-4632.2012.05600.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vitiligo is an acquired, predominantly asymptomatic, depigmenting disorder with profound psychological effects. METHODS This was a cross-sectional study conducted at the Regional Dermatology Training Center in Moshi, Tanzania. All 88 patients with vitiligo older than 15 years of age who attended the skin clinic from October 2009 to April 2010 were recruited. Data were collected using a structured questionnaire, Dermatology Life Quality Index questionnaire (DLQI), and Vitiligo European Task Force form. RESULTS Vitiligo moderately affects patient's quality of life, as indicated by a DLQI mean score of 7.2 ± 4.8. The mean age was 41 years with a male/female ratio of 1:1.7. The mean age of disease onset was 33.5 years (range 16-83 years); vitiligo vulgaris was the most common disease form seen (n = 49). None of the factors considered were found to be significantly associated with impaired quality of life on multivariate analysis. The majority of patients (73.8%) perceived that their disease was moderate to severe in contrast to the clinical grading in which only 49.2% patients were classified as having mild disease. This difference in classification of disease severity was statistically significant (Fishers exact test = 0.001). CONCLUSION Patients with vitiligo of African descent have a moderate impairment of quality of life.
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Lilly E, Lu PD, Borovicka JH, Victorson D, Kwasny MJ, West DP, Kundu RV. Development and validation of a vitiligo-specific quality-of-life instrument (VitiQoL). J Am Acad Dermatol 2013; 69:e11-8. [DOI: 10.1016/j.jaad.2012.01.038] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 11/22/2011] [Accepted: 01/29/2012] [Indexed: 11/30/2022]
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Senol A, Yücelten AD, Ay P. Development of a Quality of Life Scale for Vitiligo. Dermatology 2013; 226:185-90. [DOI: 10.1159/000348466] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 01/23/2013] [Indexed: 11/19/2022] Open
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Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V, Ezzedine K, Gauthier Y, Gawkrodger DJ, Jouary T, Leone G, Moretti S, Nieuweboer-Krobotova L, Olsson MJ, Parsad D, Passeron T, Tanew A, van der Veen W, van Geel N, Whitton M, Wolkerstorfer A, Picardo M. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2012; 168:5-19. [PMID: 22860621 DOI: 10.1111/j.1365-2133.2012.11197.x] [Citation(s) in RCA: 236] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence-based and expert-based recommendations (S1 level).
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Affiliation(s)
- A Taieb
- Service de Dermatologie, CHU de Bordeaux, Bordeaux Cedex, France
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Chan MF, Chua TL. The effectiveness of therapeutic interventions on quality of life for vitiligo patients: A systematic review. Int J Nurs Pract 2012; 18:396-405. [DOI: 10.1111/j.1440-172x.2012.02047.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Moon Fai Chan
- Alice Lee Centre for Nursing Studies; Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Tse Lert Chua
- Respiratory & Critical Care Medicine; Singapore General Hospital; Singapore
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Abolfotouh MA, Al-Khowailed MS, Suliman WE, Al-Turaif DA, Al-Bluwi E, Al-Kahtani HS. Quality of life in patients with skin diseases in central Saudi Arabia. Int J Gen Med 2012; 5:633-42. [PMID: 22866015 PMCID: PMC3410718 DOI: 10.2147/ijgm.s33276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Previous national and international studies of quality of life (QoL) in patients with skin diseases have revealed different levels of QoL impairment. The aims of this study were to assess QoL in patients with skin diseases in central Saudi Arabia using the newly validated Skindex-16 instrument and to determine the association between QoL in patients with skin disease, sociodemographic data, and disease characteristics. Methods A cross-sectional study was conducted in 283 adult patients who visited the outpatient dermatology clinics of King Abdulaziz Medical City, Riyadh, Saudi Arabia, over 3 months. The patients were interviewed using a pretested Arabic version of the Skindex-16 to measure the effect of skin disorders on their QoL during the previous 7 days. Patient characteristics, medical history, and clinical findings were collected. Multiple linear regression analyses were used to relate the demographic and clinical characteristics to the percentage mean QoL score, and P ≤ 0.05 was considered to be statistically significant. Results QoL was good in 69% of the respondents, with a total percent mean score of 31.80 ± 20.16. The emotional domain was the most affected (mean percentage score 44.27 ± 27.06), followed by symptoms (31.45 ± 28.40) and functioning (14.61 ± 22.75). After adjustment for potential confounders, poorer QoL was significantly associated with female gender (P = 0.03), older age (P = 0.003), rural origin (P = 0.03), positive family history of the same lesion(s) (P = 0.01), shorter duration of ≤6 months (P = 0.02), generalized spread (P ≤ 0.02), and lack of isotretinoin treatment (P = 0.02). Conclusion . The QoL results in this study were generally more optimistic than those of many previous studies. This discrepancy may be due to biases in questionnaire responses or to cultural differences in experience of skin disease and perception of disability. Significant predictors of QoL were not the same for the three domains of the Skindex scale. Further studies of specific diseases and educational programs targeting patients at higher risk for QoL impairments are recommended.
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Affiliation(s)
- Mostafa A Abolfotouh
- King Abdullah International Medical Research Center, King Saud Bin- Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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Ezzedine K, Lim HW, Suzuki T, Katayama I, Hamzavi I, Lan CCE, Goh BK, Anbar T, Silva de Castro C, Lee AY, Parsad D, van Geel N, Le Poole IC, Oiso N, Benzekri L, Spritz R, Gauthier Y, Hann SK, Picardo M, Taieb A. Revised classification/nomenclature of vitiligo and related issues: the Vitiligo Global Issues Consensus Conference. Pigment Cell Melanoma Res 2012; 25:E1-13. [PMID: 22417114 PMCID: PMC3511780 DOI: 10.1111/j.1755-148x.2012.00997.x] [Citation(s) in RCA: 372] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
During the 2011 International Pigment Cell Conference (IPCC), the Vitiligo European Taskforce (VETF) convened a consensus conference on issues of global importance for vitiligo clinical research. As suggested by an international panel of experts, the conference focused on four topics: classification and nomenclature; definition of stable disease; definition of Koebner's phenomenon (KP); and 'autoimmune vitiligo'. These topics were discussed in seven working groups representing different geographical regions. A consensus emerged that segmental vitiligo be classified separately from all other forms of vitiligo and that the term 'vitiligo' be used as an umbrella term for all non-segmental forms of vitiligo, including 'mixed vitiligo' in which segmental and non-segmental vitiligo are combined and which is considered a subgroup of vitiligo. Further, the conference recommends that disease stability be best assessed based on the stability of individual lesions rather than the overall stability of the disease as the latter is difficult to define precisely and reliably. The conference also endorsed the classification of KP for vitiligo as proposed by the VETF (history based, clinical observation based, or experimentally induced). Lastly, the conference agreed that 'autoimmune vitiligo' should not be used as a separate classification as published evidence indicates that the pathophysiology of all forms of vitiligo likely involves autoimmune or inflammatory mechanisms.
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Affiliation(s)
- K Ezzedine
- Department of Dermatology and Pediatric Dermatology; National Centre for Rare Skin Disorders, Hôpital Pellegrin, Bordeaux, France.
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