Beliefs and perceptions of Arab vitiligo patients regarding their condition

How Does Illness Perception Affect the Quality of Life and Sun Protection Behaviors of Rosacea Patients?

BACKGROUND

Previous studies have noted the link between rosacea severity and quality of life, but there is limited understanding of how disease perception impacts these aspects. Additionally, sun exposure is identified as a common trigger for rosacea flare-ups, emphasizing the importance of sun protection practices in managing the condition. This cross-sectional study aims to fill the gap in the literature by investigating the relationship between clinical severity, disease perception, quality of life, and sun protection behaviors in rosacea patients.

METHODS

Questionnaires assessing the quality of life, illness perception, sun protection behaviors, sun protection decisional balance, and its potential predictors were completed by 120 rosacea patients and 120 controls.

RESULTS

Patients exhibited a higher prevalence of sun protection behaviors than the control group (24.15 ± 5.76 vs. 17.63 ± 5.56, p < 0.001) and demonstrated greater determination in adhering to sun protection practices (13.43 ± 2.37 vs. 9.40 ± 3.09, p < 0.001). Hierarchical linear regression analyses showed that quality of life was related to clinical severity, illness perception (consequences, illness coherence, emotional representations), causal attribution (risk factors, immunity), and sun protection decisional balance variables (R2 = 0.45, F = 7.39, p < 0.001). Also, the perceived pros and cons of sun protection behaviors were predicted by illness perception (treatment control), causal attribution (risk factors, immunity, chance/accident), and quality of life variables (R2 = 0.24, F = 2.59, p = 0.004).

CONCLUSIONS

Providing more information to rosacea patients can improve their disease perception and quality of life, increasing adherence to sun protection behaviors.

Unveiling the Unseen Struggles: A Comprehensive Review of Vitiligo's Psychological, Social, and Quality of Life Impacts

This review explores the psychosocial impact of vitiligo on patients, its consequences for their quality of life, and the need for holistic support. Vitiligo's psychosocial burden, driven by the need to conceal lesions and societal beauty ideals, leads to stress, sadness, and low self-esteem. Social stigma affects self-esteem, especially in cultural contexts, exacerbating the need for culturally sensitive support. Anxiety and depression are common due to visible differences and societal pressures. Vitiligo significantly reduces the quality of life, especially in younger patients, impacting daily activities, careers, and relationships. Disease severity worsens these effects, particularly in visible areas and among individuals with darker skin tones. Long-term disease activity may improve acceptance and quality of life. Psychological support and counseling are crucial, as many patients don't seek medical help. Education plays a key role, improving understanding and reducing anxiety. Raising awareness about the impact of vitiligo can challenge perceptions and contribute to enhancing patients' well-being. In conclusion, this review highlights the interplay between psychosocial factors, quality of life, and the importance of addressing social stigma, providing psychological support, and advancing education and awareness for those with vitiligo.

The effect of patient characteristics on illness perception and sun protection behaviors in melasma

BACKGROUND/AIM

Melasma, a significant cosmetic problem, has been accepted by some authors as a photoaging illness in recent times. There is no published study evaluating the effects of the clinical and sociodemographic findings on illness perception and sun protection behaviors (SPBs) in patients with melasma.

PATIENTS/METHODS

Sociodemographic data, personal characteristics, and clinical features of 150 patients with melasma were recorded in this cross-sectional study. They were analyzed for their SPBs in three groups as "never," "rarely/sometimes," and "often/always." Patients completed the Melasma Quality of Life (QoL) Scale and Revised-Illness Perception Questionnaire.

RESULTS

Melasma patients with higher clinical severity and Qol scores, lower education level, concomitant chronic illness, and a history of previous melasma treatment thought more frequently that melasma had negative serious consequences. Majority of the patients blamed sun exposure as the cause of the melasma. However, SPBs were more frequent only in patients with higher socioeconomic and educational levels, a previous history of melasma treatment, and evaluating their disease as a chronic condition. Neither Qol nor clinical severity score had a significant effect on sun exposure causal attribution or SPBs. No significant effect of patients' perception of melasma was determined on the use of sunscreen or protective hat.

CONCLUSION

Being aware of the factors affecting the perception of melasma and QoL of patients might be helpful in making persistent individual recommendations for the regulation of SPBs.

Vitiligo Prevalence and Quality of Life Among Adults in Europe, Japan, and the United States

Background

Vitiligo, an autoimmune disorder characterised by skin depigmentation, is associated with reduced quality of life (QoL). Vitiligo may be under‐reported, in part because of misconceptions that it is a cosmetic disease.

Objectives

This survey sought to characterise vitiligo prevalence and explore the relationship between sociodemographic and clinical characteristics with QoL in a population‐based, multinational study.

Methods

Participants aged ≥18 years were recruited via an online panel in Europe, Japan and the USA to answer questions regarding skin disorders they may have experienced. Those reporting vitiligo (diagnosed or undiagnosed) or vitiligo signs (experiencing loss of skin colour but unaware of vitiligo and not diagnosed) were included in the analyses of vitiligo prevalence. Participants who self‐reported physician‐diagnosed vitiligo were given a broader survey to characterise disease progression, management and QoL (as measured with the Vitiligo‐specific QoL [VitiQoL] instrument).

Results

The total estimated vitiligo prevalence among 35 694 survey participants (Europe, n = 18 785; USA, n = 8517; Japan, n = 8392) was 1.3% (diagnosed, 0.6%; undiagnosed, 0.4%; vitiligo signs, 0.3%). Among 219 patients formally diagnosed with vitiligo (Europe, n = 150; USA, n = 48; Japan, n = 21), total VitiQoL scores were associated with age (P = 0.00017), disease extent (P < 0.0001), disease progression (P < 0.0001), disease management (P < 0.0001) and time since diagnosis (P = 0.0015). Behaviour scores varied based on skin phototype (P = 0.024) and ethnicity (P = 0.048). Higher total VitiQoL scores were reported in patients with head lesions (P = 0.027) and those with head and hand and/or wrist lesions (P = 0.018). Substantial high concern (rated 8–10 on an 11‐point Likert scale) for lesions was found across all body areas and varied with geographical region.

Conclusions

The vitiligo prevalence rate may be higher than previously reported, with a substantial proportion attributed to people who have not received a formal diagnosis. Among formally diagnosed patients with vitiligo, QoL was most severely impacted by more progressive and higher extent of disease.

Variations in TAP1 and PSMB9 Genes Involved in Antigen Processing and Presentation Increase the Risk of Vitiligo in the Saudi Community

Background

The antigen processing 1 (TAP1) and proteasome 20S subunit beta 9 (PSMB9) genes are associated with strong susceptibility to many autoimmune diseases. Here, we explored whether TAP1/PSMB9 genetic variants, individually or combined, affected susceptibility to the complex, autoimmune-based skin disorder vitiligo.

Methods

Samples of genomic DNA from buccal cells of 172 patients with vitiligo and 129 healthy controls were analyzed using TaqMan™ genotyping assays for the TAP1 rs1135216 (A>G) and PSMB9 rs17587 (A>G) single nucleotide polymorphisms (SNPs). SNPStats software (https://www.snpstats.net) was utilized to choose the best interactive inheritance mode for selected SNPs.

Results

The genotype frequencies for the TAP1 rs1135216 and PSMB9 rs17587 SNPs were in Hardy-Weinberg equilibrium for cases (P= 0.11 and P= 0.10, respectively) but not for controls (P< 0.05). The TAP1 rs1135216 (D637G) and PSMB9 rs17587 (R60H) SNPs increased the risk of vitiligo four-fold and two-fold, respectively (odds ratio [OR]= 4.6; 95% confidence interval [CI], 3.2-6.5; P< 0.0001 and OR= 2.2; 95% CI, 1.5-3.1; P< 0.0001). The recessive model (G/G-D/G versus D/D) and the codominant model (R/R versus R/H) were the best models of inheritance for the rs113526 and rs17587 SNPs, respectively (OR= 16.4; 95% CI, 2.0-138; P= 0.0006 and OR= 1.7; 95% CI, 0.3-1.8; P= 0.013). Vulgaris, focal vulgaris, and acryl/acrofacial were the most common vitiligo subtypes in our sample (51%, 21%, and 19%, respectively). Heterozygous rs113526 (637D/G) and rs17587 (60R/H) were the most common genotypes in most vitiligo subtypes. The heterozygous 637D/G genotype and the 637G variant allele were significantly more common in patients with active disease than in patients with stable disease (P= 0.000052 and P= 0.0063, respectively).

Conclusion

Our findings suggest a crucial role for TAP1 rs1135216 and PSMB9 rs17587 in the risk and progression of vitiligo in the Saudi community. Genomic analyses are needed to identify more candidate genes and more genetic variants associated with vitiligo.

Illness perception in patients with Alopecia areata under topical immunotherapy

Alopecia areata (AA) is a chronic autoimmune-mediated disorder. There is little research on how AA patients conceptualize their disease. The purpose of this study was to investigate the perception and attitude of patients with AA about their illness. The cross-sectional study was performed on 102 patients with AA referred to our alopecia clinic. Patients between 16 and 60 years were enrolled in the study. A questionnaire including demographic and clinical characteristics and Illness Perception Questionnaire-Revised (IPQ-R) was administered to each patient. More than half of patients (55%) experienced their illness as a long-lasting (17.3 ± 5.5, median reference score = 18), and timely variable (13.4 ± 2.8, median reference score = 12) disorder. Patients perceived that their illness negatively affects their lives (18.9 ± 4.8, median reference score = 18) and are considered an effective role for themselves in controlling disease (20.3 ± 4.9, median reference score = 18). Moreover, patients had a fairly good accepting of their illness (13.4 ± 2.8, median reference score = 15). We observed significant negative effects of illness on the patient's emotions (21.5 ± 5.5, median reference score = 18). We also found that men had a stronger belief in personal control compared with women (21.5 ± 4.8 vs 19.5 ± 4.8; P = .03). A positive correlation was observed between educational status and illness coherence (r = .21; P = .03). Most patients with AA considered undesirable consequences of their illness. High scores of negative affective symptoms indicate the harmful effects of this disease on patients' lives leading to problems of mental health.

Psychosocial Effects of Vitiligo: A Systematic Literature Review

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.

Meta-Analytic Review of High Anxiety Comorbidity among Patients with Vitiligo

Background

Vitiligo is a disfiguring skin disease with profound psychosocial impacts, such as anxiety, but the reported effect sizes of associations vary. We aimed to conduct a meta-analysis to quantify the strength of association between anxiety and vitiligo and to estimate the prevalence of anxiety among individuals with vitiligo.

Methods

A systematic literature search was performed in five online databases (MEDLINE, Embase, Web of Science, Cochrane Library, and PsycINFO) from inception until March 20, 2020. All of the eligible studies were comprehensively reviewed, and all of the available data were analyzed according to our predefined criteria.

Results

Twenty-one studies involving 3259 patients in 11 countries were included in this meta-analysis. Compared with the healthy control group, patients with vitiligo often had concomitant anxiety (OR = 6.14 [95% CI: 3.35–11.24], I² = 30.1%). The pooled prevalence of anxiety in female patients was significantly higher than that in males (OR = 2.24 [95% CI: 1.31–3.84], I² = 0.0%). Subgroup analysis showed that the pooled prevalence of clinical anxiety disorder and anxiety symptoms was 12% (95% CI: 7%–16%, I² = 76.3%) and 34% (95% CI: 21%–46%, I² = 94.7%), respectively. No publication bias has been detected by Begg's funnel plot and Egger's test.

Conclusion

Patients with vitiligo have high anxiety comorbidity, with female predominance. Dermatologists and psychiatrists should be vigilant to the presence of anxiety, apply appropriate interventions to reduce the psychological impacts in a timely manner, and thus promote recovery in vitiligo patients. However, due to some objective limitations (poor information about the OR and diversity in assessment tools among included studies), findings should be interpreted with caution.

Variations in TAP1 and PSMB9 Genes Involved in Antigen Processing and Presentation Increase the Risk of Vitiligo in the Saudi Community

BACKGROUND

The antigen processing 1 (TAP1) and proteasome 20S subunit beta 9 (PSMB9) genes are associated with strong susceptibility to many autoimmune diseases. Here, we explored whether TAP1/PSMB9 genetic variants, individually or combined, affected susceptibility to the complex, autoimmune-based skin disorder vitiligo.

METHODS

Samples of genomic DNA from buccal cells of 172 patients with vitiligo and 129 healthy controls were analyzed using TaqMan™ genotyping assays for the TAP1 rs1135216 (A>G) and PSMB9 rs17587 (A>G) single nucleotide polymorphisms (SNPs). SNPStats software (https://www.snpstats.net) was utilized to choose the best interactive inheritance mode for selected SNPs.

RESULTS

The genotype frequencies for the TAP1 rs1135216 and PSMB9 rs17587 SNPs were in Hardy-Weinberg equilibrium for cases (P= 0.11 and P= 0.10, respectively) but not for controls (P< 0.05). The TAP1 rs1135216 (D637G) and PSMB9 rs17587 (R60H) SNPs increased the risk of vitiligo four-fold and two-fold, respectively (odds ratio [OR]= 4.6; 95% confidence interval [CI], 3.2-6.5; P< 0.0001 and OR= 2.2; 95% CI, 1.5-3.1; P< 0.0001). The recessive model (G/G-D/G versus D/D) and the codominant model (R/R versus R/H) were the best models of inheritance for the rs113526 and rs17587 SNPs, respectively (OR= 16.4; 95% CI, 2.0-138; P= 0.0006 and OR= 1.7; 95% CI, 0.3-1.8; P= 0.013). Vulgaris, focal vulgaris, and acryl/acrofacial were the most common vitiligo subtypes in our sample (51%, 21%, and 19%, respectively). Heterozygous rs113526 (637D/G) and rs17587 (60R/H) were the most common genotypes in most vitiligo subtypes. The heterozygous 637D/G genotype and the 637G variant allele were significantly more common in patients with active disease than in patients with stable disease (P= 0.000052 and P= 0.0063, respectively).

CONCLUSION

Our findings suggest a crucial role for TAP1 rs1135216 and PSMB9 rs17587 in the risk and progression of vitiligo in the Saudi community. Genomic analyses are needed to identify more candidate genes and more genetic variants associated with vitiligo.

Vitiligo and anxiety: A systematic review and meta-analysis

BACKGROUND

Vitiligo is an acquired depigmenting skin disease which is often accompanied by mental distress. There are numerous studies dedicated to local and global prevalence of depression in patients with vitiligo but anxiety has not been recognized as a major mental problem within named population. We aimed to evaluate the prevalence of anxiety among patients with vitiligo from different countries and to compare it with patients suffering from eczema, psoriasis, and acne.

METHODS

In November 2019, we conducted a systematic search for observational studies that examined the prevalence of anxiety in vitiligo patients. Fifteen studies comprising 1176 patients with vitiligo were included to our systematic review.

RESULTS

The general prevalence of anxiety among vitiligo patients was equal to 35.8%. Statistically significant difference in anxiety rates was found among female and male patients (47.32% vs 42.4%) (P = 0.03), but the clinical relevance of this issue remains arguable. In addition, the pooled odds ratio among vitiligo and non-vitiligo patients did not indicate a statistical significance among patients coming from different continents.

CONCLUSIONS

The pooled prevalence of anxiety among vitiligo patients worldwide was comparable to other severe skin disorders. This finding accentuates the necessity of anxiety awareness in management of patients with skin diseases.

Identifying Patients at Higher Risk of Depression Among Patients with Vitiligo at Outpatient Setting

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.

Clinico-Epidemiological Profile and Treatment Pattern of Vitiligo in Selected Dermatological Clinics of Mekelle City, Northern Ethiopia

Background

Vitiligo is not a well-studied disease in Ethiopia. Therefore, this study assessed its clinico-epidemiological profile and treatment patterns.

Methods

An institutional-based cross-sectional study was conducted in conveniently selected dermatologic clinics of Mekelle city, Ethiopia. A two-phased study was conducted, in which the first was to determine prevalence of vitiligo while the second phase was to describe the clinico-epidemiological profile and treatment pattern of vitiligo. Four-hundred three randomly selected dermatological patients were included in the first phase study. The second phase study included vitiligo cases from the first phase study and additional vitiligo cases found in a two months period prospective study.

Results

Of the 403 randomly selected dermatological patients who presented in the year 2017 to 2019, the prevalence of vitiligo was 13.15%. Of the 79 cases with vitiligo, nearly two-thirds (50, 63.3%) were males with five years as the median age at onset of the disease. Positive family history of vitiligo was recorded in about one-third (25, 31.6%) of the cases. Limbs (48, 44.5%) followed by the head and neck (26, 24%) were the most commonly affected parts of the body at the onset of the disease. The most prevalent clinical form of vitiligo was vulgaris (39.2%) followed by the focal type (26.6%). Emotional upset (24, 33.8%) and physical traumas (23, 32.4%) were the frequently reported triggering factors of vitiligo. Three-fourths (75.5%) of the cases had prescriptions of topical corticosteroids, and 24.5% of them had prescriptions of sun screen lotion.

Conclusion

The prevalence of vitiligo was found to be high. The clinico-epidemiological profile of vitiligo in Ethiopia was similar with that found globally. However, treatment options of vitiligo were very limited in Ethiopia.

Assessment of Anxiety, Depression, Stress, and Associated Psychological Morbidities among Patients Receiving Ayurvedic Treatment for Different Health Issues: First Study from Sri Lanka

Background

Good mental condition is a vital part of health. Physical impairments would potentially have psychiatric manifestations during the course of a disease that could cause patients to experience a wide range of psychological conditions. This study was conducted to determine prevalence of anxiety, depression, stress, and psychological morbidities among the patients who received warded treatments at Gampaha Wickramarachchi Ayurveda Teaching Hospital, Sri Lanka.

Methods

A total of 148 patients admitted to the hospital were selected for the study on a random systematic basis under four systemic groups (gastrointestinal, integumentary, musculoskeletal, and nervous system) depending on the chief complaint. The presence of depressive, anxiety, and stress symptoms was assessed by the Depression Anxiety Stress Scale 21 item version (DASS 21). The General Linear Model (GLM) was used for statistical analysis.

Results

Over 50% of the participants in all four patient groups belonged to age group of 35 to 65 years, encompassing the fraction of population that actively contribute to the workforce in the society. Stress, anxiety, and depression values of patients belonging to different complications varied significantly, as indicated by GLM (p < 0.05). Patients diagnosed with integumentary system-related issues denoted the highest stress levels (27.7 ± 2.54), while the mean stress values among the other systemic groups were not significantly different among each other. The highest anxiety levels were indicated by patients with nervous system-related issues (18.6 ± 1.51), while the lowest anxiety levels were indicated by patients with integumentary disorders (6.0 ± 2.73). The highest depression level was identified from patients suffering from integumentary system-related disorders (31.7 ± 3.42), followed by nervous system (23.2 ± 1.78), gastrointestinal (19.5 ± 3.77), and musculoskeletal (16.8 ± 1.57) disorders.

Conclusion

Overall, high distress levels were observed among the majority of the patients. Furthermore, integumentary issues may lead to significant psychological impacts. As most of the patients seek for Ayurveda treatments when their diseased condition becomes chronic, it is vital to focus on a biopsychosocial approach to patient assessment and patient care, in actual practice.

Replenishing Regulatory T Cells to Halt Depigmentation in Vitiligo

Vitiligo is a cutaneous autoimmune disease, especially devastating to patients with darker skin tones because of the contrast between unaffected and lesional skin. We studied immune cells infiltrating vitiligo skin and found very few regulatory T cells (Tregs). Vitiligo was not associated with a reduced frequency or function of circulating Tregs. To manipulate Treg function, we used mouse models expressing melanocyte-reactive TCRs, following changes in pelage color. We also isolated splenocytes to measure Treg function and evaluated cutaneous Treg abundance. Even small numbers of Tregs transferred into depigmenting mice could effectively interfere with depigmentation. The same holds true for treatment with rapamycin, readily translatable for use in human patients; such treatment may be well tolerated. Because vitiligo skin is relatively devoid of cells that produce the chemokine CCL22, whereas circulating Tregs express normal levels of its receptor CCR4, we overexpressed Ccl22 in the skin of vitiligo-prone mice to assess the resulting levels of depigmentation. Markedly reduced depigmentation was accompanied by Treg infiltration to the skin. With several options available to support a healthy balance between Tregs and effector T cells, the next challenge will be to render such treatment antigen specific and avoid general immunosuppression.

The prevalence of psychological comorbidity in people with vitiligo: a systematic review and meta-analysis

BACKGROUND

Vitiligo is a chronic disorder causing skin depigmentation with global prevalence varying from 0·2% to 1·8%. U.K. guidelines recommend assessment of psychological state during clinical evaluation of vitiligo. However, the prevalence of psychological comorbidity in people with vitiligo has not been described.

OBJECTIVES

To establish the prevalence of psychological symptoms or disorders in people with vitiligo and describe the outcome measures used.

METHODS

We performed a comprehensive search of MEDLINE, Embase, CINAHL and PsycINFO to identify observational studies assessing the prevalence of psychological symptoms or disorders (December 2016). DerSimonian and Lard random-effects models were used to estimate the overall pooled prevalence.

RESULTS

We identified 29 studies with 2530 people with vitiligo. Most studies included a measure of either depression (n = 25) or anxiety (n = 13). The commonest tools were the Hospital Anxiety and Depression Scale and the Centre for Epidemiology Studies Depression Scale. Ten studies provided information on 13 other psychological outcomes. Pooled prevalence using depression-specific and anxiety-specific questionnaires was 0·29 [95% confidence interval (CI) 0·21-0·38] and 0·33 (95% CI 0·18-0·49), respectively. Prevalence was lower for clinically diagnosed depression (0·21, 95% CI 0·15-0·28) and anxiety (0·15, 95% CI 0·06-0·24). When nonspecific tools were used the prevalence remained similar for depression (0·27, 95% CI 0·08-0·46) but increased for anxiety (0·46, 95% CI 0·39-0·52). High heterogeneity was observed.

CONCLUSIONS

A range of psychological outcomes are common in people with vitiligo. The prevalence of anxiety was influenced by type of screening tool, suggesting the need for validation of psychological outcome screening tools in the field of dermatology.

Prevalence and predictors of depressive symptoms among attendees of a tertiary care dermatology clinic in Muscat, Oman

BACKGROUND

Various studies have suggested that depression is more prevalent among patients with skin disorders than in the general population. Most of the studies addressing this subject involve Euro-American populations.

OBJECTIVES

The present study aimed to estimate the prevalence of depressive symptoms among patients with dermatological disorders and, then, to decipher the clinical-demographic factors associated with depressive symptoms.

METHODS

A cross-sectional analytical study was conducted among a random sample of patients attending a dermatology clinic in Muscat. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depressive symptoms. A logistic regression model was used to find the adjusted and unadjusted odds ratios (ORs).

RESULTS

A total of 260 patients participated in this study, with a response rate of 81%. The prevalence of depression symptoms was 24%. According to regression analysis, family history of depression, comorbid medical disorders, and treatment with topicals or isotretinoin were significant predictors of depression (OR = 9.41, 95% confidence interval [CI]: 2.27-39.05, P = 0.002; OR = 2.0, 95% CI: 1.2-3.21, P = 0.05; OR = 2.28, 95% CI: 1.09-4.76, P = 0.028; and OR = 2.78; 95% CI: 1.08-7.19, P = 0.035, respectively).

CONCLUSION

This study indicates that depressive symptoms are common among patients with dermatological disorders in Oman, particularly in those with a family history of depression and medical comorbidities, and those who use a specific dermatological medication. Screening for depression in patients attending dermatology clinics is essential in order to detect and promptly treat patients suffering from depression.

The prevalence and odds of depression in patients with vitiligo: a meta-analysis

OBJECTIVE

The objective of this study was to provide a pooled estimate of the prevalence and odds of depression in patients with vitiligo.

METHODS

A systematic literature search of Medline, Embase and Cochrane library databases was conducted. The proportions and mean questionnaire values for depression were pooled according to different evaluation methods. In controlled studies, odds ratio and standardized mean differences compared depression in vitiligo patients with healthy controls.

RESULTS

One thousand nine hundred and sixty-five patients were identified from 20 eligible cohorts to be included in the present meta-analysis review. Sample sizes ranged from 30 to 308 for each analysis. The pooled prevalence of depression across 17 unique populations (n = 1711) was 29% (95% CI 20-39). The prevalence of clinical depression was 8% (95% CI 2%-14%) using Diagnostic and Statistical Manual of Mental Disorders IV or International Classification of Diseases codes-10, and the prevalence of depressive symptoms was 33% (95% CI 23%-44%) using validated screening inventory and rating scales. Patient with vitiligo was 4.96 times more likely to display depression compared with controls. Subgroup analysis showed that the prevalence of depression in Asian and female patients with vitiligo was significantly higher than that in Caucasian and male ones. The pooled prevalence of depressive symptoms was higher (56%, 95% CI 0.5-0.62), and the heterogeneity was lowering cases with Hamilton Depression Rating Scale (HDRS) questionnaire when compared with other questionnaires.

CONCLUSIONS

This meta-analysis review indicates that the prevalence of depression is high in patients with vitiligo. The HDRS questionnaire may be the most sensitive tool for testing the depressive symptoms among patients with vitiligo.

Knowledge, beliefs, and perceptions of Turkish vitiligo patients regarding their condition

BACKGROUND:

Vitiligo is an acquired pigmentary skin disorder that affects 0.5% to 2.0% of the population.

OBJECTIVE:

Patients' knowledge, opinions, and attitudes about vitiligo were evaluated.

METHODS:

The team conducted a cross-sectional, descriptive, prospective study between June 2014 and May 2015. The study included 100 patients aged over 12 years who were diagnosed with vitiligo. A questionnaire including items on knowledge, opinions, and beliefs about vitiligo and the Illness Perception Questionnaire (IPQ) were filled out by the patients, and the results were analyzed.

RESULTS:

In total, 100 (58 female, 42 male) patients were included in the study. Of them, 74% knew the name of their disease, 90% thought that vitiligo was not contagious, 48% reported that they obtained information on the disease from a doctor, and 69% believed they had adequate information on vitiligo. Eighty percent reported no negative effects from vitiligo on relationships with friends or family. It was believed that stress, excessive sun exposure, and heredity were causes of vitiligo, according to 84%, 37%, and 22% of the patients, respectively. Thirty-six patients (36%) believed that their illness was a serious disease and 35% deemed that it did not have a major impact on their lives.

CONCLUSIONS:

Our results show that vitiligo patients were generally highly aware of their condition. The disease did not negatively affect patient opinions or attitudes about vitiligo. The authors believe that improving patient-physician communication will impact positively on the course of the disease.

The psychosocial impact of acne, vitiligo, and psoriasis: a review

Introduction

Chronic skin conditions have been well reported to affect a patient’s quality of life on multiple dimensions, including the psychosocial domain. Psychosocial is defined as the interrelation of social factors with an individual’s thoughts and behavior. The assessment of the psychosocial impact of skin disease on a patient can help direct the dermatologists’ treatment goals. To evaluate the psychosocial impact of skin disease, we conducted a review of the literature on three skin conditions with onsets at various stages of life: acne, vitiligo, and psoriasis.

Methods

A PubMed search was conducted in March 2015 using the terms “psychosocial” AND “acne”, “psychosocial” AND “vitiligo”, and “psychosocial” AND “psoriasis”. The results were limited to articles published in English in the past 5 years studying patients of all ages. Results and their references were evaluated for relevance according to their discussion of psychosocial qualities in their patients and the validity of psychosocial assessments. The search for acne yielded 51 results, and eleven were found to be relevant; vitiligo yielded 30 results with ten found to be relevant; and psoriasis yielded 70 results with seven found to be relevant.

Results

According to the articles evaluated, 19.2% of adolescent patients with acne were affected in their personal and social lives. Social phobia was present in 45% of patients with acne compared to 18% of control subjects. Race and sex played a role in self-consciousness and social perceptions of the disease. Vitiligo negatively affected marriage potential and caused relationship problems in >50% of patients. Psoriasis negatively affected multiple domains of life, including work, relationships, and social activities. Anxiety and depression affected not only psoriasis patients but also their cohabitants; up to 88% of cohabitants had an impaired quality of life.

Conclusion

Though all three skin conditions resulted in an increase in anxiety and depression among their patient populations, the psychosocial focus varied slightly for each disease. Overall, acne, vitiligo, and psoriasis can have negative psychosocial impact in different stages of life development.

Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients: Cross-sectional study

OBJECTIVES

This study aimed to determine the prevalence of depression, anxiety and stress among Saudi Arabian dermatology patients and to assess associations with sociodemographic and clinical characteristics.

METHODS

This cross-sectional study was conducted among 300 consecutive dermatology patients visiting King Abdulaziz Medical City in Riyadh, Saudi Arabia, in August 2015. The Arabic version of the Depression, Anxiety and Stress Scale was used to screen for symptoms of depression, anxiety and stress. Quality of life (QOL) was assessed using the Dermatology Life Quality Index.

RESULTS

A total of 254 dermatology patients participated in the study (response rate: 84.7%). The prevalence of depression, anxiety and stress was 12.6%, 22.1% and 7.5%, respectively. The presence of at least one of these negative emotional states was noted among 24.4% of the cohort (95% confidence interval: 19.3-30.2%). Depression was significantly higher among subjects who lacked family support (26.5% versus 10.7%; P = 0.006) while anxiety was less common among patients who engaged in physical exercise (14.5% versus 29.4%; P = 0.005). According to the multivariate logistic regression analysis, poor QOL and a lack of family support were significant predictors of a negative emotional state.

CONCLUSION

Almost a quarter of the studied Saudi Arabian dermatology patients were found to suffer from at least one negative emotional state. A lack of family support and poor QOL were the primary factors associated with a negative emotional state. Interventional studies are needed to examine the effects of social and family support on psychological conditions among Saudi Arabian dermatology patients.

The Prevalence of Anxiety and Depression in Arab Dermatology Patients

BACKGROUND

Psychiatric disorders are common among patients with physical illnesses.

OBJECTIVES

To estimate the prevalence of anxiety and depression in Arab dermatology patients and to study its association with the patients' characteristics.

MATERIALS AND METHODS

A cross-sectional study was carried out on 875 patients attending the Dermatology Clinic at King Khalid University Hospital in Riyadh, Saudi Arabia. Each patient was asked to complete the Hospital Anxiety and Depression Scale and the demographic-clinical questionnaire.

RESULTS

The frequency of anxiety and depression in Arab dermatology patients was 29% for anxiety and 14% for depression. These frequencies were not related to sociodemographic and clinical variables (p>.05), except skin disease type (p<.05). Patients suffering from hair loss had the highest anxiety and depression scores (OR 1.725 [95% CI 1.247-2.386] and OR 1.686 [95% CI 1.101-2.581], respectively). On the other hand, patients suffering from psoriasis had the highest depression scores (OR 2.909 [95% CI 1.611-5.254]).

CONCLUSION

Anxiety and depression are frequent among Arab dermatology patients.

Stress involvement as trigger factor in different skin conditions

Dermatological conditions are intimately related to stress. There was a great interest in this field in the last years. Stress could be involved as a trigger factor for a lot of cutaneous diseases: alopecia areata, psoriasis, vitiligo, lichen planus, acne, atopic dermatitis, urticaria. For other conditions: seborrheic dermatitis, hyperhydrosis, herpes, pemphigus, a.s.o, there are anecdotal notices. On the other hand, the skin disease itself could induce a secondary stress for the patient, influencing his quality of life. The stress per se is less important than the “perceived stress”, the patient’s perception of the stressful situation. This perception could be influenced by the psychological state of the patient. Anxiety, depression could change the perception of the event. It is important to take care of these aspects during the consultation. A good cooperation with psychiatrist or/and psychologist could improve the results, besides the specific therapy.

Public perceptions and attitudes toward vitiligo

BACKGROUND

Previous studies have discussed attitudes of vitiligo patients toward their disease. However, no studies have addressed this issue from the public's point of view.

OBJECTIVE

To explore the perceptions, attitudes, and misconceptions of the public toward vitiligo.

METHODS

A self-administered questionnaire was distributed to attendees of primary health care centers in Riyadh, Saudi Arabia, between January and August 2010.

RESULTS

Overall, 924 of the 1,000 distributed questionnaires were returned, and 429 were males (46.8%). Moreover, 33.1% (303 of 916) believed that vitiligo is contagious or did not know that it is not. The cause of vitiligo was thought to be infectious by 20.4% of respondents (182 of 894), inherited by 40.5% (365 of 902), autoimmune by 41.2% (370 of 899), and due to a lack of hygiene by 22.5% (199 of 883). Unmarried individuals and those with less education were more likely to state that vitiligo is caused by an infection (.  =  .02, .  =  .03, respectively). Younger individuals and those with less education were more likely to think that vitiligo is caused by a lack of hygiene (.  =  .01, .  =  .001, respectively). More than half of the participants (56.1%, 504 of 898) would be unwilling to marry a vitiligo patient. Younger individuals and males were less likely to marry a vitiligo patient (.  =  .01, .  =  .05, respectively), whereas those of lower income were more likely to accept it (.  =  .002).

CONCLUSIONS

Various misconceptions and negative attitudes about vitiligo among the public are prevalent. Educating the public about vitiligo could ultimately lead to better psychosocial well-being of vitiligo patients.