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Zhang X, Naz AF, Jiang L, Fu C, Huang J, Liang Y, Zhu L, Zhang F, Chen J, Lei L, Zeng Q. Disease Awareness and Treatment Preferences in Vitiligo: A Cross-sectional Study in China. Acta Derm Venereol 2023; 103:adv11643. [PMID: 37787420 PMCID: PMC10561102 DOI: 10.2340/actadv.v103.11643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 08/15/2023] [Indexed: 10/04/2023] Open
Abstract
In China, there is a lack of data regarding the awareness and treatment preferences among patients with vitiligo and their families. To address this gap, a cross-sectional questionnaire-based study was conducted to investigate disease awareness and treatment preferences in Chinese patients with vitiligo. The study also evaluated willingness to pay, using 2 standardized items, and assessed quality of life, using the Dermatology Life Quality Index (DLQI) score. Data from 307 patients with vitiligo (59.3% women, mean age 28.98 years, range 2-73 years) were analysed. Of these patients, 44.7% had insufficient knowledge of vitiligo, particularly those from rural areas or with low levels of education. Mean DLQI total score was 4.86 (5.24 for women and 4.30 for men). Among the most accepted treatments were topical drugs, phototherapy, and systemic therapy. Patients were relatively conservative about the duration and cost of treatment, with only 27.7% willing to pay more than 10,000 Chinese yuan renminbi (CNY) for complete disease remission. High level of education, high income, skin lesions in specific areas, and skin transplantation therapy predicted higher willingness to pay. Insufficient knowledge was associated with a higher burden of disease. In order to reduce the disease burden and improve treatment adherence it is crucial to enhance disease awareness and take into account patient preferences.
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Affiliation(s)
- Xiaolin Zhang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Adnan Falak Naz
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Ling Jiang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Chuhan Fu
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Jinhua Huang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Yixuan Liang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Lu Zhu
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Fan Zhang
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Jing Chen
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China
| | - Li Lei
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China.
| | - Qinghai Zeng
- Department of Dermatology, Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Changsha, Hunan, 410013, P.R. China.
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Murshidi R, Shewaikani N, Al Refaei A, Alfreijat B, Al-Sabri B, Abdallat M, Murshidi M, Khamis T, Al-Dawoud Y, Alattar Z. Public Knowledge and Attitude towards Vitiligo: A Cross-Sectional Survey in Jordan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6183. [PMID: 37372769 DOI: 10.3390/ijerph20126183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 06/15/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Vitiligo is an autoimmune disease affecting approximately 2% of the world's population. Besides vitiligo cosmetic issues, patients suffer from psychological comorbidities. This results from the stigmatization they encounter from surrounding individuals. Accordingly, the current study was the first to assess Jordanians' knowledge and attitude toward vitiligo. METHODS Data collection was completed by an online questionnaire consisting of four sections to capture participants' sociodemographic characteristics, previous exposure, and knowledge and attitude toward vitiligo. The analysis took place through R and RStudio. RESULTS Of our 994 surveyed participants, only 8.45% and 12.47% had a low level of vitiligo knowledge and negative total attitude score, respectively. Moreover, independent predictors of positive attitudes included younger age (18-30), high school education or lower, hearing about or living with a vitiligo patient, and higher knowledge scores. The highest prevalence of positive attitudes was observed when physicians were the source of knowledge. CONCLUSION Some critical misconceptions were identified despite the Jordanian public having sufficient overall knowledge. Furthermore, higher knowledge reflected a higher prevalence of positive attitudes toward the patients. We recommend that future efforts target the public understanding of the nature of the disease and its being non-communicable. Moreover, we emphasize that medical knowledge should be communicated through qualified healthcare providers.
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Affiliation(s)
- Rand Murshidi
- Department of Dermatology, School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Nour Shewaikani
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Assem Al Refaei
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Balqis Alfreijat
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | | | - Mahmoud Abdallat
- Department of Neurosurgery, Jordan University Hospital, Amman 11942, Jordan
| | - Muayyad Murshidi
- Department of Dermatology, The Jordanian Royal Medical Services, Amman 11942, Jordan
| | - Tala Khamis
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Yasmin Al-Dawoud
- School of Medicine, The University of Jordan, Amman 11942, Jordan
| | - Zahraa Alattar
- School of Medicine, The University of Jordan, Amman 11942, Jordan
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Hwang JR, Driscoll MS. Review of Ruxolitinib for Treatment of Non-Segmental Vitiligo. Ann Pharmacother 2022:10600280221143748. [PMID: 36564903 DOI: 10.1177/10600280221143748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To review the pharmacokinetics, efficacy, and safety of topical ruxolitinib for treatment of nonsegmental vitiligo. DATA SOURCES Literature published between January 1983 and October 2022 was reviewed from MEDLINE and ClinicalTrials.gov. STUDY SELECTION AND DATA EXTRACTION Relevant articles in English and data from clinical trials were included. DATA SYNTHESIS In 2 phase II trials, treatment with ruxolitinib cream showed significant improvements in Vitiligo Area Scoring Index (VASI) scores compared with controls. The 1.5% concentration applied twice daily showed the best results after 52 weeks, with 50% VASI improvement in 58% of patients, 75% VASI improvement in 52% of patients, and 90% VASI improvement in 33% of patients. In 2 phase III trials, more patients achieved at least 75% improvement in facial VASI at 24 weeks (primary endpoint; trial 1: 29.9%, trial 2: 29.9%) than controls (trial 1: 7.5% [P < 0.0001], trial 2: 12.9% [P < 0.01]). Common adverse effects were erythema, pruritus, and acne; all events were mild. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON TO EXISTING DRUGS This review summarizes the pharmacokinetics, efficacy, and safety data regarding topical ruxolitinib for vitiligo. Ruxolitinib is associated with significant clinical improvements with low bioavailability and minimal adverse effects compared with conventional topical steroids, calcineurin inhibitors, phototherapy, and depigmentation agents. CONCLUSIONS Ruxolitinib cream is the first therapy approved by the Food and Drug Administration for repigmentation of nonsegmental vitiligo. Clinicians should consider these benefits when recommending treatment as conventional therapies may be time-intensive and carry greater risks of adverse effects.
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Affiliation(s)
- Jacqueline R Hwang
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcia S Driscoll
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, MD, USA
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Keraryi FA, Hakami AAH, Hakami NAH, Mahfouz MS, Hakami HAH. Does the Saudi Population Have Sufficient Awareness of Vitiligo in Southwest Saudi Arabia? A Cross-Sectional Survey, 2022. Clin Pract 2022; 12:876-884. [PMID: 36412671 PMCID: PMC9680397 DOI: 10.3390/clinpract12060092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/27/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Vitiligo is a common acquired hypopigmentation skin condition defined by an idiopathic, gradual, and restricted loss of melanin pigment from otherwise healthy-looking skin. The present study aims to evaluate the knowledge and perceptions of and attitudes toward vitiligo among the general population of Jazan Province, Saudi Arabia. Methods: An observational cross-sectional survey targeting adults of the Jazan region was conducted in 2022. The data were collected using an electronic questionnaire distributed through social media in the region. Statistical analysis was performed using the SPSS computer program. Knowledge and attitude scores were computed. Results: Most of the respondents (83.7%) had an adequate knowledge level of vitiligo, and almost half of the respondents (46.8%) had a positive attitude toward the disease. The majority of the respondents (84.5%) knew that vitiligo is not contagious. However, the majority of the participants (78.6%) did not know that vitiligo is an autoimmune disease. Most of the respondents (93.1%) do not avoid shaking hands with a vitiligo patient to prevent infection, accept food prepared by a vitiligo patient (69.4%), accept sharing a plate with a vitiligo patient (73.6%), and accept to be helped by a vitiligo patient (86.7%). However, about half of the participants (50.4%) refused to marry a person diagnosed with vitiligo. The knowledge of vitiligo in the study population was not correlated with any of the demographic characters, such as age, gender, education, or occupation (p > 0.05). The most important factors associated with good attitudes were male gender (COR = 1.92; 95% CI: 1.92−2.84; p = 0.001) and being aged over 50 years (COR = 3.06; 95% CI: 1.53−6.13; p = 0.002). Conclusions: The population in Jazan had a good level of knowledge of vitiligo and a positive attitude toward patients with vitiligo. Social media is the source of information for vitiligo for the majority of the study population. The good attitude toward patients with vitiligo was more prevalent in males and older people. More efforts are needed to improve the knowledge of and attitudes toward vitiligo.
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Affiliation(s)
- Fatmah Ahmed Keraryi
- Department of Dermatology, Sabya General Hospital, Ministry of Health, Jazan 45142, Saudi Arabia
| | | | - Nouf Adel Hadi Hakami
- King Fahd Central Hospital, Ministry of Health, Jazan 45142, Saudi Arabia
- Correspondence:
| | - Mohamed Salih Mahfouz
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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Ning X, Zhang Y, Wang W, Yan H, Xia Y. Evaluation of the Behavioral and Psychological Symptoms in Patients with Vitiligo in China. Psychol Res Behav Manag 2022; 15:2107-2116. [PMID: 35979226 PMCID: PMC9377344 DOI: 10.2147/prbm.s370445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Vitiligo is a common, acquired depigmenting disorder. The pathogenesis is not clear, neuropsychological factors may be involved. Vitiligo will affect the individual’s physical and psychological health, leading to different levels of psychological behavior problems. However, there are few research on psychological symptoms in patients with vitiligo in China. Methods Adult patients with vitiligo were selected in convenient sampling method from March 2019 to November 2019 from the dermatology clinic. They were evaluated by the DLQI (Dermatology Life Quality Index), SCL-90 (Symptom Checklist-90), SADS (Social Avoidance and Distress Scale) and MCMQ (Medical Coping Modes Questionnaire). Results The DLQI score was 7.56 ± 6.11, which was in the third level. The SCL-90 score of patients with vitiligo was 136.44 ± 39.19, significantly higher than the Chinese norms (P < 0.05), and it mainly manifested as interpersonal sensitivity, depression, anxiety and phobia, which may be affected by the patient’s gender, marital status, severity of disease, stage and location of skin lesions. The total score of SADS in patients was 10.30 ± 6.38. The total score and scores in all dimensions of SADS were significantly higher than the Chinese norms (all P < 0.05), which were related with the patient’s gender, educational attainment, severity, type and stage of skin lesions. For MCMQ, the facing score was significantly lower than the Chinese norms (P < 0.05), and the avoiding and yielding scores were significantly higher than the Chinese norms (all P < 0.05). Conclusion In China, vitiligo affects the patient’s quality of life to varying degrees, resulting in a series of psychological and behavioral problems. We should actively concern and improve the psychological health status and behavior of patients, and multidisciplinary treatment strategies and education about vitiligo should be given to the patients.
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Affiliation(s)
- Xiaoying Ning
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yanfei Zhang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Wei Wang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Huling Yan
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yumin Xia
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, Pandya AG. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol 2021; 22:757-774. [PMID: 34554406 PMCID: PMC8566637 DOI: 10.1007/s40257-021-00631-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration PROSPERO (CRD42020162223). Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00631-6.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, Paris, France.
| | | | | | | | | | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Mountain View, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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Clinical Features, Immunopathogenesis, and Therapeutic Strategies in Vitiligo. Clin Rev Allergy Immunol 2021; 61:299-323. [PMID: 34283349 DOI: 10.1007/s12016-021-08868-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
Vitiligo is an autoimmune disease of the skin characterized by epidermal melanocyte loss resulting in white patches, with an approximate prevalence of 0.5-2% worldwide. Several precipitating factors by chemical exposure and skin injury present commonly in patients with vitiligo. Although the diagnosis appears to be straightforward for the distinct clinical phenotype and specific histological features, vitiligo provides many challenges including chronicity, treatment resistance, frequent relapse, associated profound psychosocial effect, and negative impact on quality of life. Multiple mechanisms are involved in melanocyte disappearance, including genetics, environmental factors, and immune-mediated inflammation. Compelling evidence supports the melanocyte intrinsic abnormalities with poor adaptation to stressors leading to instability and release of danger signals, which will activate dendritic cells, natural killer cells, and innate lymphoid cells to initiate innate immunity, ultimately resulting in T-cell mediated adaptive immune response and melanocyte destruction. Importantly, the cross- talk between keratinocytes, melanocytes, and immune cells, such as interferon (IFN)-γ signaling pathway, builds inflammatory loops that give rise to the disease deterioration. Improved understanding of the immune pathogenesis of vitiligo has led to the development of new therapeutic options including Janus kinase (JAK) inhibitors targeting IFN-γ signaling pathways, which can effectively reverse depigmentation. Furthermore, definition of treatment goals and integration of comorbid diseases into vitiligo management have revolutionized the way vitiligo is treated. In this review, we highlight recent developments in vitiligo clinical aspects and immune pathogenesis. Our key objective is to raise awareness of the complexity of this disease, the potential of prospective therapy strategies, and the need for early and comprehensive management.
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