Quality of life and psychological morbidity in vitiligo patients: a study in a teaching hospital from north-East India

Estimating the burden of vitiligo: a systematic review and modelling study

BACKGROUND

Vitiligo is a chronic autoimmune disease characterised by depigmented skin patches, which can pose substantial psychosocial challenges particularly in individuals with dark skin tones. Despite its impact on quality of life, there is an absence of standardised global epidemiological data. We sought to address this gap with the present study.

METHODS

In this study we did a systematic review and modelling analysis to estimate the global, regional, and national prevalence and incidence of vitiligo. We did a comprehensive search of nine digital libraries (PubMed, Embase, Web of Science, Scientific Electronic Library Online, KCI Korean Journal Database, Russian Science Citation Index, Western Pacific Region Index Medicus, Informit, and Health Research and Development Information Network) from inception up to May 25, 2023. We included cross-sectional or cohort studies reporting the incidence rate or prevalence of vitiligo, or data from which incidence rate or prevalence could be calculated, in the general population of a country or area of a country. Summary estimate data were extracted. A main outcome was to estimate the worldwide, regional, and country-specific lifetime prevalence of vitiligo diagnosed by physicians or dermatologists among the general population and in adults and children (as per age groups defined in included studies). We used a Bayesian hierarchical linear mixed model to estimate prevalence, and calculated number of affected individuals using the UN population structure in 2022. In estimating lifetime prevalence, studies reporting point or period prevalence were excluded. Our other main outcome was to estimate incidence rates of vitiligo, but due to a small number of studies, the data on incidence were presented in a descriptive summary. This study was registered on PROSPERO, CRD42023390433.

FINDINGS

Our search identified 22 192 records, of which 90 studies met our inclusion criteria. Of these studies, six focused on the incidence of vitiligo, 79 reported on the prevalence of vitiligo, and five provided data on both incidence and prevalence. 71 studies reported on lifetime prevalence. In the most recent years studied, incidence rates in the general population ranged from 24·7 cases (95% CI 24·3-25·2) per 100 000 person-years in South Korea in 2019, to 61·0 cases (60·6-61·4) in the USA in 2017. In individual studies, incidence rates showed an increasing trend over the periods studied. The global lifetime prevalence of vitiligo diagnosed by a physician or dermatologist was estimated at 0·36% (95% credible interval [CrI] 0·24-0·54) in the general population (28·5 million people [95% CrI 18·9-42·6]), 0·67% (0·43-1·07) in the adult population (37·1 million adults [23·9-58·9]), and 0·24% (0·16-0·37) in the child population (5·8 million children [3·8-8·9]). Vitiligo prevalence was higher in adults than in children across all regions. Central Europe and south Asia reported the highest prevalence (0·52% [0·28-1·07] and 0·52% [0·33-0·82], respectively, in the general population).

INTERPRETATION

This study highlights the need for standardised epidemiological data collection globally to inform public health policies and improve vitiligo diagnosis and management. Emphasis on the impact on individuals with darker skin tones is crucial to reducing stigma and improving quality of life. Furthermore, our study highlights the need to conduct more research in regions and populations that have been historically under-represented, to effectively address the worldwide burden of vitiligo.

FUNDING

None.

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

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.

Gender differences in quality of life of vitiligo patients attending a tertiary care center

Background

Vitiligo is a common depigmenting dermatosis characterized by milky-white macules or patches. Any pathological discoloration of the skin has been linked to an impact on the body image of an individual, and vitiligo has been linked to decreased self-esteem and poor socialization of the affected people. In Indian society, vitiligo is labeled as Shweta-Kushta (i.e., white-colored leprosy) and is compared to leprosy-a more stigmatizing skin condition.

Aim

This study aims to study gender-related differences in the quality of life of Indian vitiligo patients.

Methodology

In this hospital-based cross-sectional study, a total of 55 vitiligo patients (females 25 and males 30) were enrolled using the purposive sampling technique. The sample was assessed on Dermatology Life Quality Index (DLQI) questionnaire, Rosenberg Self-Esteem Scale (RSS), and General Health Questionnaire-12 (GHQ-12) to assess their quality of life, self-esteem, and psychological well-being, respectively. The gender differences in sociodemographic and clinical details as well as their relationship with the quality of life of the patients were sought with the help of appropriate statistical measures.

Results

The patients of both genders were comparable in terms of all sociodemographic and clinical variables except the females being less educated and employed than the males. There was a statistically significant trend of higher mean DLQI total score in females than males (6.6 ± 3.55 vs 4.8 ± 2.71, Mann-Whitney U = 263.5, P =0.058). Significantly, the average DLQI score in female vitiligo patients was negatively related to family income (r s = -.659, P <.001) and it was significantly higher for the patients from a rural background than those from an urban background (8.55 ± 3.30 vs 5.07 ± 3.03, Mann-Whitney U = 33.5, P <.05). The average DLQI score was negatively correlated to RSS score but positively correlated to GHQ-12 score in patients of both genders.

Conclusion

The quality of life of female patients with vitiligo is poorer than the same in male patients. The poor financial condition of families and rural living are two factors related to the poorer quality of life of female patients. A poorer quality of life in vitiligo patients of both genders is linked with decreased self-esteem and decreased psychological well-being. Gender-related issues in the quality of life and the overall well-being of such patients are important in their management and policy-making.

Impact of Acne Vulgaris and Vitiligo on Quality of Life and Self-Esteem in the Patient Population of Madinah, Saudi Arabia

BACKGROUND

Acne vulgaris and vitiligo are skin disorders that can have a negative impact on a person's self-esteem and quality of life (QoL). The purpose of this study is to look into the impact of acne and vitiligo on the self-esteem and QoL of the patient population in Madinah, Saudi Arabia.

METHODS

A cross-sectional survey of 171 Saudi adults (141 individuals with acne vulgaris (9.4%) and 30 with vitiligo (1.5%) between the ages of 16 and 35 was conducted in Madinah. A self-reported questionnaire with four domains was used: socio-demographic data, lifestyle and coexisting pathologic factors or diseases, Rosenberg's self-esteem scale, and the dermatology life quality index (DLQI).

RESULTS

Acne patients had a mean total score of 20.3 on the self-esteem scale, with 5% (n = 7) having low self-esteem, 48.2% (n = 68) having medium self-esteem, and 46.8% (n = 66) having high self-esteem. Females had higher self-esteem (75.29) than males (56.95). The mean DLQI score for acne patients was 5.4, with 30.5% (n = 47) unaffected, 29.1% (n = 45) mildly affected, 23.4% (n = 35) moderately affected, 5.6% (n = 10) severely affected, and 1.4% (n = 4) severely affected. Vitiligo patients had a mean self-esteem scale score of 13.7, with 63.3% (n = 19) having low self-esteem, 30% (n = 9) having medium self-esteem, and 6.7% (n = 2) having high self-esteem. The mean DLQI was 15.2, with 6.7% (n = 2) reporting that vitiligo had no effect on their lives, 10% (n = 3) reporting a moderate effect, 66.7% (n = 20) reporting a severe effect, and 16.7% (n = 5) reporting a very severe effect.

CONCLUSIONS

Our research confirms that acne vulgaris and vitiligo have a negative impact on self-esteem and quality of life. Along with medical treatment, effective treatment and psychological improvement of the patient should be prioritized.

Psychiatric morbidity among patients suffering from Vitiligo

Background

Vitiligo is a chronic acquired, stigmatizing disease characterized by discoloration of skin and mucous membranes. Patients suffering from this condition suffer from a lack of confidence and psychological stress.

Aim

To assess depression, anxiety, and social anxiety among patients suffering from vitiligo.

Material and Method

This hospital-based cross-sectional, observational, descriptive study was carried out in a tertiary care center on 100 patients suffering from vitiligo, who were consecutively enrolled after informed consent from the outpatient department (OPD) of the dermatology department. Permission was obtained from the institutional ethics committee Diagnosis of vitiligo was made by two consultants from the department of dermatology. Sociodemographic variables were recorded in the sociodemographic form. The General Health Questionnaire-12 (GHQ-12) was applied to all 100 patients. Patients who scored >3 on GHQ-12 were further subjected to the Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), and Social Interaction Anxiety Scale. Results were statistically analyzed on SPSS-22.0 (IBM, Armonk, USA).

Results

Of all the patients, 55% (n = 55) had a GHQ score >3 (i.e., Psychiatric morbidity was present in 55% of patients.). Out of 50 patients in the age group of 18-25 years, 41 patients in the age groups of 26-35 years, and 9 patients in the age groups of 36-45 years, 22 (44%), 17 (42.1%), and 6 patients had psychiatric morbidity, respectively. Of the total number of patients, 46% had depression according to the HAM-D scale. Of all the patients, 18% had mild, 22% had moderate, and 6% had severe depression. Age-wise analysis showed that out of 50 patients in the age group of 18-25 years, 41 patients in the age group of 26-35 years, and 9 patients in the age group of 36-45 years, 22 (44%), 20 (48.7%), and 4 patients had depression, respectively. Of the patients who had depression, 39% were male and 58% were female. On HAM-A, 47% of the patients had anxiety; 33% had mild, 12% had moderate, and 2% had severe anxiety. Age-wise analysis showed that out of 50 patients in the age group of 18-25, 41 patients in the age group of 26-35 years, and 9 patients in the age group of 36-45 years, 20 (40%), 23 (56.1%), and 3 patients had anxiety, respectively. On SIAS, 36% of the patients had social anxiety. Out of 50 patients in the age group of 18-25 years, 41 patients in the age group of 26-35 years, and 9 patients in the age group of 36-45 years, 23 (46%), 9 (7.8%) and 4 patients had social anxiety, respectively. According to gender-wise distribution, 17% of male and 63% of female patients had social anxiety.

Conclusion

A high prevalence of anxiety, depression, and social anxiety has been observed in this present study. Therefore, importance should be given to psychiatric evaluation of such patients and, if required, necessary interventions should be undertaken to improve their quality of life.

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

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.

Treating Vitiligo at the Angle of Lips: A Narrative Review

Vitiligo is a common autoimmune depigmentary disorder seen among Indian patients. It has a significant impact on the self-esteem of the patient. Specific sites including acral areas, joints, and lips are usually resistant to medical therapy and thus transfer of melanocytes is mandatory for the treatment. Vitiligo at the angle of lips is distinct from the vitiligo on other sites, with respect to response to therapy, lack of hair follicles, and high mobility of the area. Our aim was to review the various therapeutic modalities available for the treatment of vitiligo at this site. In our narrative review, we searched databases including PubMed, Google Scholar, and EBSCO with a full strategic search with keywords "Vitiligo," "leucoderma," "mucosal vitiligo," "lips," "labial," "angle of lips," "Minipunch grafting," "Suction Blister epidermal Grafting," "SBEG," "Micropigmentation," "tattooing," and "Excision" from 2005 to 2021. The relevant articles were extracted and included in the review. Various modalities including suction blister grafting, miniature punch grafting, split-thickness grafting, and micropigmentation have been reviewed with their advantages and disadvantages. Various potential modalities of therapy have also been proposed in the review.

Psychosocial Distress and Quality of Life Among Patients With a Chronic Skin Disorder at a Tertiary Care Hospital in Eastern India: A Hospital-Based Case-Control Study

Background Chronic skin disorder affects the physical and psychological well-being of patients. The impact of psychological burden ranges from low self-esteem and stress to anxiety and depression. Hence, this study was conducted to compare the psychological distress and quality of life (QoL) of patients with a comparative group without any apparent skin disorders. Methods This hospital-based case-control study was done on adult patients (≥18 years) suffering from any chronic skin disorder for three or more months and attending the dermatology out patient department (OPD) of a tertiary care institution of Eastern India. Data was collected from 101 patients and 101 controls (matched for age, gender, and place of residence) after obtaining written informed consent in May and June, 2017. Depression was assessed using the Patient Health Questionnaire-9, anxiety was assessed using the Generalised anxiety disorder-7 scale, and health-related quality of life (HRQoL) was assessed using the World Health Organization Quality-of-Life Scale (WHOQoL-BREF). Prevalence and mean scores were compared using Chi-square test and t-test. Results About half (49.5%) of the cases had clinically significant impairment of their dermatological quality of life. Clinically significant depression and anxiety was found in 45.54% and 41.58% patients respectively. Depression (OR=4.13, 95% CI 2.06-8.45) and anxiety (OR=4.42, CI=2.13-9.51) were significantly higher in cases as compared to the controls. No significant difference was seen in HRQoL scores. Conclusion Screening for anxiety, depression, and QoL should be done for patients of chronic skin disorders attending dermatology OPD so that appropriate psychiatric consultation can be offered to those in need.

The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes

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.

Combination of epidermal keratinocyte - melanocyte cells suspension and microneedling: Safe surgical approach in vitiligo

INTRODUCTION

Vitiligo is a skin disease that is associated with impaired skin immune systems and pigment degradation in skin melanocyte cells. Despite the significant impact of the disease on the quality of life of patients, treatment of the disease using effective method such as the transplantation of uncultivated melanocytes was considered by researchers around the world. The goal of this research was to use microneedling to transplant epidermal keratinocyte-melanocyte cells suspension for the treatment of vitiligo patients.

METHODS

In this study, 15 male and female vitiligo in face region patients aged 18 to 45 years were studied. In this study, melanocyte-keratinocyte cells suspension was sprayed. Patients underwent microneedling treatment after spraying the cells. Before and after transplantation, patients were biometrically examined, and the quantity of pigmentation and changes in the transplanted region were documented. Statistical software was used to examine the results.

RESULTS

The color difference between the lesion area and normal skin in one, two, and six months after treatment with cell suspension was significantly reduced compared to before treatment (by 48.95 %). Moreover, the amount of melanin was significantly increased 6 months after treatment compared to before treatment (129.8±4.16 vs. 195.2±3.54, P = 0.000). A significant decrease in skin brightness in the skin of the lesion area was observed compared to normal skin, 6 months after treatment compared to before treatment (43.7±1.44 vs. 27.9±1.24, P = 0.000).

CONCLUSION

Epidermal keratinocyte - melanocyte cells suspension in combination with microneedling could be considered as an effective treatment of vitiligo.

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.

Assessment of quality of life in vitiligo patients attending a tertiary care hospital - A cross sectional study

BACKGROUND

Vitiligo is a common form of localized depigmentation of skin which draws unusual attention to the patient especially when it is in visible areas of the body. The appearance of visible skin lesions and its chronic progression may cause a significant burden on patients' health-related quality of life and psychiatric morbidity may arise as a complication.

AIMS

An endeavor has been made to find out how the disease influences the quality of life of affected persons.

METHODOLOGY

This was a hospital based cross sectional study. Clinically diagnosed eighty vitiligo patients were selected from dermatology outpatient department with purposive sampling method and compared them with those of healthy control group. In selected cases Dermatology Life Quality Index (DLQI) questionnaire was used for the assessment of quality of life. Also International classification of mental and behavioral disorders research criteria along with 17-item Hamilton Rating scale of Depression were applied to diagnose the presence of depression. Data were collected and "Chi Square Test" or "Fisher Exact t Test" was used. All analysis were done using SPSS version 20.0.

RESULTS

In this study 92.5% of the patients had elevated DLQI scores. We found higher DLQI mean score in vitiligo patients ( 9.68+5.24) compared to (1.36+ 1.37) of control and depression was significantly associated with the impairment of quality of life.

CONCLUSION

Vitiligo patients have significant impairment in their quality of life and more in those who develops depression.

Análise da qualidade de vida de pacientes portadores de dermatoses benignas em um hospital de ensino de Minas Gerais

Objetivo: Analisar a qualidade de vida (QV) de pacientes portadores de dermatoses benignas em ambulatório de dermatologia de hospital de ensino do Sul de Minas Gerais. Métodos: Estudo quantitativo, transversal, do tipo pesquisa de campo e de perfil populacional e formas de promoção de saúde, no qual se fez a análise da QV de pacientes portadores de dermatoses benignas (psoríase, vitiligo, melasma, acne, dermatite e rosácea), de fevereiro a julho de 2017. Foram aplicados o Questionário Genérico de Qualidade de Vida - SF36 e o Dermatology Life Quality Index (DLQI-BRA), traduzidos e validados para a língua portuguesa. Resultados: Foram entrevistados 68 pacientes, dos quais 47 eram do sexo feminino (mín. 13; máx. 75 anos). No SF36, os domínios Limitação por Aspectos Emocionais (escore médio, EM, de 57,3) e Vitalidade (EM 58) foram os de pior resultado. No DLQI-BRA, o EM foi de 6,97, sendo Sintomas e Sentimentos (EM 2,69) e Atividades Diárias (EM 1,79) os de maior prejuízo para o doente. Não foram observadas correlações relevantes entre os diferentes domínios de cada questionário. Conclusão: Este estudo identificou piores escores nos Aspectos Emocionais e na Vitalidade do paciente no que diz respeito à QV de forma geral. Em relação à situação dermatológica foi pontuado escore geral de moderado efeito na QV dos pacientes. Os sintomas, sentimentos e as atividades diárias foram os fatores que causam maior prejuízo para o doente.

Relationship Between Depression and Quality of Life Among Vitiligo Patients: A Self-assessment Questionnaire-based Study

Background

Vitiligo is a common chronic autoimmune disease that is characterized by progressive loss of skin color due to melanocyte destruction. In addition to the physical effects of vitiligo, this condition exerts adverse psychological effects and causes social stigmatization. Earlier studies reported that individuals with vitiligo suffer from poor quality of life (QoL), but data about the QoL of Thai vitiligo patients is scarce.

Objective

This study aimed to investigate the QoL and prevalence of depression in Thai vitiligo patients, association between QoL and depression, and factors associated with QoL and depression among Thai people with vitiligo.

Methods

This cross-sectional self-assessment questionnaire-based study was conducted at the phototherapy and vitiligo clinics of the Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University (Bangkok, Thailand). QoL was assessed using the Dermatology Life Quality Index (DLQI) questionnaire, and depression was evaluated via the Patient Health Questionnaire (PHQ-9).

Results

Among the 104 vitiligo patients that were recruited, the mean DLQI score was 7.46, and the prevalence of depression (PHQ-9 ≥9) was 13.5%. Factors significantly associated with a higher mean DLQI score were skin phototype IV compared to phototype III, active disease, new lesions within the last three months, lesions involving upper extremities, and PHQ-9 ≥9 (p<0.05). Moderate correlation was found between DLQI score and PHQ-9 score (Pearson’s correlation coefficient: 0.524, p<0.001). Factors significantly associated with depression were working status and developing new lesions within the last three months (p<0.05). Patients with new lesions were 4.12 times more likely to be depressed than those without new lesions (OR: 4.12, 95%CI: 1.20–14.16; p=0.025).

Conclusion

Developing new lesions, active disease, dark skin phototype (IV), and lesion on upper extremity had significant adverse effects on QoL. Vitiligo patients who were employed and who had new vitiligo lesions are significantly more likely to be depressed.

Cosmetic camouflage as an adjuvant to vitiligo therapies: Effect on quality of life

BACKGROUND

Vitiligo is a pigmentary disorder associated with considerable psychological imbalance. Partial response to therapy and long duration for repigmentation are common. Meanwhile, camouflage may help through concealing vitiligo lesions and improving patient confidence and self-esteem.

AIM

To assess the Dermatology Life Quality Index (DLQI) in vitiligo patients, and to determine the patients' acceptance and willingness to utilize camouflage regularly and the impact of using camouflage as an adjuvant modality.

PATIENTS/METHODS

The study was carried out on 100 vitiligo patients who underwent thorough history taking, clinical examination, and DLQI assessment. Forty patients were randomly chosen, taught how to apply camouflage, and followed up over 1 month of regular application.

RESULTS

Dermatology Life Quality Index in the 100 vitiligo patients was found to be 12.2 ± 3.9, denoting the very large effect on quality of life vitiligo has. It was significantly worse in female patients, adolescents, students, and high-socioeconomic level patients, in visible sites and genitalia, and in unstable cases. There was a significant positive correlation between the DLQI and disease duration (r = 0.75, P < .001) and VES (r = 0.79, P < .001). The 40 cases on camouflage showed a significant percent reduction in their DLQI when compared to noncamouflage users (P: .00).

CONCLUSIONS

Dermatology Life Quality Index is significantly affected by vitiligo. Camouflaging is a technique that needs to be taught to the patient to overcome the anticipated problems that drive them away from using it; especially, it significantly improves their DLQI in their devastating disease.

Psychodermatology of vitiligo: Psychological impact and consequences

Vitiligo is an autoimmune dermatologic disorder that causes chronic skin depigmentation, which affects an estimated 1% of the world's population. This disfiguring condition can have devastating psychological consequences on its sufferers. The field of psychodermatology examines psychiatric manifestations of dermatologic conditions. Although previous research in this area has been done on other skin disorders, no large-scale review exists on the dermatologic-psychiatric connection in vitiligo specifically. The current article will discuss the psychodermatology of vitiligo with an emphasis on depression, stress, and low self-esteem. The social and cultural considerations will also be explored. Finally, the implications of these psychiatric manifestations on treatment will be discussed, with the goal of implementing early psychiatric intervention for those with vitiligo.

Sleep Quality and Depression in Vitiligo Patients

Aim: Vitiligo is a common disorder that has not only dermatological but also psychological consequences. The aim of this study was to compare depression and sleep quality of vitiligo patients with healthy control group. Methods: In this cross-sectional case-control study, patients admitted to the Dermatology Clinic of Skin and Venereal Diseases Department of Hitit University Erol Olçok Education and Research Hospital between August 2018 and August 2019 were compared with healthy control group. The study included 67 patients and 69 control group participants who were matched for age, sex, marriage status, and education level. The subjects were asked to complete a sociodemographic data form, the Beck Depression Inventory, and the Pittsburgh Sleep Quality Index. Results: The median total Pittsburgh Sleep Quality Index score was higher in the patient group compared with the control group. The median scores for subjective sleep quality, sleep latency, and sleep disturbance were also higher in the patient group compared with the control group. A family history of vitiligo was present in 18 (26.9%) patients. The most common type was acrofacial vitiligo, which was present in 29 (43.3%) patients. Conclusions: Increased probability levels of depression and impaired sleep quality in vitiligo patients suggest that psychiatric evaluation and treatment should be provided for vitiligo patients as a part of a multidisciplinary approach in order to increase the success of the treatment. Keywords: Vitiligo, depression, sleep quality

The relationship between stress and vitiligo: Evaluating perceived stress and electronic medical record data

Vitiligo is a T-cell mediated skin disorder characterized by progressive loss of skin color. In individuals genetically predisposed to the disease, various triggers contribute to the initiation of vitiligo. Precipitating factors can stress the skin, leading to T-cell activation and recruitment. Though hereditary factors are implicated in the pathogenesis of vitiligo, it is unknown whether precipitating, stressful events play a role in vitiligo. To understand this, we utilized a validated perceived stress scale (PSS) to measure this parameter in vitiligo patients compared to persons without vitiligo. Additionally, we probed a clinical database, using a knowledge linking software called ROCKET, to gauge stress-related conditions in the vitiligo patient population. From a pool of patients in an existing database, a hundred individuals with vitiligo and twenty-five age- and sex-matched comparison group of individuals without vitiligo completed an online survey to quantify their levels of perceived stress. In parallel, patients described specifics of their disease condition, including the affected body sites, the extent, duration and activity of their vitiligo. Perceived stress was significantly higher among vitiligo individuals compared to those without vitiligo. ROCKET analyses suggested signs of metabolic-related disease (i.e., ‘stress’) preceding vitiligo development. No correlation was found between perceived stress and the stage or the extent of disease, suggesting that elevated stress may not be a consequence of pigment loss alone. The data provide further support for stress as a precipitating factor in vitiligo development.

The color of skin: psychiatric ramifications

Skin color is one of the major attributes that defines both individual distinctiveness and differences between groups. There is a preference for lighter skin world-wide, among both light- and dark-skinned individuals, further leading to skin-color bias based upon skin-color hierarchy within certain ethnoracial groups. The psychiatric and psychosocial ramifications of skin color are important in several situations, including (1) disorders of skin discoloration (eg, vitiligo), which can significantly affect the psychosocial development of the patient especially when it has its first onset during adolescence; (2) widespread use of skin-lightening products, which are used despite knowledge about serious toxicity from inorganic mercury and potent corticosteroids that are some of their main constituents; (3) indoor tanning, which is a recognized carcinogen and practiced by over 50% of university-age adults and 20% of adolescents. Educating about photocarcinogenicity does not change tanning behaviors, which is strongly driven by peer pressure; and (4) when a psychiatric disorder, such as body dysmorphic disorder or major depressive disorder, is the primary basis for skin color dissatisfaction. Despite the role of complex sociocultural and psychiatric factors in clinical manifestations involving skin color, a supportive relation with the dermatologist can significantly aid the patient in managing their disease burden.

Pruritus in Autoimmune and Inflammatory Dermatoses

Pruritus in autoimmune and inflammatory dermatoses is a common symptom that can be severe and affect the quality of life of patients. In some diseases, pruritus is related to disorders activity and severity or may occur independent of the disease. Despite the high prevalence, the symptom is still underrated and there are only a few trials investigating the efficacy of drugs for disease-specific pruritus. In this review, the characteristics and possible pathomechanisms of pruritus in various dermatoses like autoimmune bullous diseases, connective tissue diseases as well as autoimmune-associated dermatoses (atopic dermatitis, psoriasis vulgaris) is illustrated. Additionally, studies analyzing the antipruritic treatment are discussed. Summarizing, the prevalence of pruritus in these diseases demonstrates the importance for symptom recognition and the need for an efficient antipruritic therapy.

Gender Differences in Depression, Coping, Stigma, and Quality of Life in Patients of Vitiligo

Though vitiligo is one of the psychodermatological disorders which do not cause direct physical impairment, it is cosmetically disfiguring leading to serious psychological problems in daily life. We undertook this research to study patients of vitiligo the prevalence of depression, coping, stigma, and quality of life and comparison of the same in both genders. Patients diagnosed clinically as having vitiligo by consultant dermatologist were enrolled after informed consent and ethics approval. 156 patients were screened, of which 100 satisfying criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of Beck's depression inventory, participation scale, dermatology life quality index, and adjustment to chronic skin diseases questionnaire. Depression prevalence was 63.64% in females and 42.86% in males (p<0.0457); the total mean BDI scores were significant with females having higher scores than males (p<0.0083). No significant differences were seen on participation scale though 52% females felt stigmatized as compared to 45% males (p <0.5779). While almost 97% of our patients had impaired quality of life there was no significant difference in both genders on the total score (p<0.3547). Females had significantly higher faulty coping style than males with significant differences on all domains and total scores (p< 0.0094). There was a strong association of depression with faulty coping and stigma (p< 0.0001) in both genders. Also association of stigma with quality of life showed highly significant findings in both genders (p< 0.0001) on all the domains of DLQI. This study helps in early identification of psychological problems in vitiligo patients and planning their future course of management, hence improving the prognosis and quality of life.

A comparative study between suction blistering graft, mini punch graft, and hair follicle transplant in treatment of patients with stable vitiligo

Background: Vitiligo is an acquired disfiguring common depigmented skin disease. Objectives: This study aimed to compare the clinical efficacy and safety of suction blistering graft, mini punch and hair follicle techniques in treatment of patients with stable vitiligo. Methods: Thirty patients with stable vitiligo were included. Patients were divided into 3 groups, in group (A) 10 patient underwent suction blistering technique, in group (B) 10 patients underwent mini punch technique and in group (C) 10 patients underwent hair follicle technique. Then all patients in the three techniques were subjected to narrow-band ultraviolet B (NB-UVB) phototherapy for 3 months. All patients were assessed by determining the percentage of repigmentation and Dermatology Life Quality Index (DLQI) before and 3 months after the operation. Results: The percentage of repigmentation of vitiligo in suction blister technique was significantly higher than both mini punch and hair follicle techniques (p value .001 and .0001 respectively). There was a statistically significant difference between the three techniques regarding DLQI score after operation (p value = .0001). Conclusion: This study concluded that suction blistering technique is more effective and safe than mini punch technique and hair follicle technique in treatment of stable vitiligo.

International Initiative for Outcomes (INFO) for vitiligo: workshops with patients with vitiligo on repigmentation

BACKGROUND

There is no cure or firm clinical recommendations for the treatment of vitiligo. One of the main issues is the heterogeneity of outcome measures used in randomized controlled trials for vitiligo.

OBJECTIVES

To define successful repigmentation from the patients' point of view and to propose how and when repigmentation should be evaluated in clinical trials in vitiligo.

METHODS

We conducted three workshops with patients with vitiligo and their parents or caregivers. Workshop 1 was held at World Vitiligo Day (Detroit, MI), workshop 2 at the University of Texas Southwestern Medical Center and workshop 3 at the Vitiligo and Pigmentation Institute of Southern California, University of California.

RESULTS

Seventy-three participants were recruited. Consensus on the following questions was achieved unanimously: (i) the definition of 'successful repigmentation' was 80-100% of repigmentation of a target lesion and (ii) both an objective and a subjective scale to measure repigmentation should be used.

CONCLUSIONS

This was the largest patients' outcomes workshop. We followed the guidance from the CSG-COUSIN and the Vitiligo Global Issues Consensus Group. Our recommendations to use percentage of repigmentation quartiles (0-25%, 26-50%, 51-79%, 80-100%) and the Vitiligo Noticeability Scale are based on the best available current evidence. A limitation of the research is that the workshops were conducted only in the U.S.A., due to pre-existing organisational support and the availability of funding.

Pregnancy outcomes in patients with vitiligo: A nationwide population-based cohort study from Korea

BACKGROUND

Vitiligo is a chronic autoimmune skin disorder affecting 1% of populations worldwide. Few large-scale studies have explored adverse pregnancy outcomes in patients with vitiligo.

OBJECTIVE

To investigate adverse pregnancy outcomes in patients with vitiligo.

METHODS

We performed a retrospective cohort study on 4738 pregnancies of women with vitiligo and 47,380 pregnancies of age-matched controls without vitiligo using the Korean National Health Insurance Claims database from 2007 to 2016. Multivariate logistic regression models were used to evaluate the associations between vitiligo and pregnancy outcomes, including live births, spontaneous abortion, cesarean delivery, preterm delivery, gestational diabetes mellitus, stillbirth, pre-eclampsia/eclampsia, and intrauterine growth retardation.

RESULTS

Patients with vitiligo exhibited a significantly lower live birth rate (odds ratio, 0.870; 95% confidence interval, 0.816-0.927) and a higher incidence of spontaneous abortion (odds ratio, 1.250; 95% confidence interval, 1.148-1.362) than the control group.

LIMITATION

The Korean National Health Insurance Claims database lacks detailed clinical information on individual patients.

CONCLUSION

Vitiligo was significantly associated with an increased risk of spontaneous abortion. Further studies are needed to determine whether systemic autoimmunity explains our finding.

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.

Suction Blister Epidermal Grafting for Vitiligo Involving Angles of Lip: Experience of 112 Patients

Background:

Lip vitiligo is usually resistant to medical modalities of treatment, and in all these cases, surgery offers a hope. Suction blister grafting (SBG) has been tried since long for lip vitiligo with high rate of success. There have been no long-term follow-up studies of patients with SBG at a difficult-to-treat site like angles of lip, which prompted us to conduct this study.

Aims and Objectives:

To assess the pigmentation rate and patient satisfaction of SBG on vitiligo involving angles of lip.

Materials and Methods:

This is a prospective study conducted on 112 patients with stable vitiligo involving angles of lip. SBG was carried out in all the patients using the standard procedure. Patients were advised to apply topical psoralen followed by sun exposure (PUVASOL) for 8–12 weeks after operation. The patients were followed up at 3, 6, 12, 18, and 24 months for assessment of pigmentation and overall satisfaction.

Results:

We found a pigmentation success rate of 83.7%, 84.9%, 85.7%, 78.3%, and 77.8% in the patients who were followed up at 3, 6, 12, 18, and 24 months, respectively. A total of 77.8% of patients who came for follow-up at the end of 24 months were very happy with the treatment.

Discussion:

Our data show clearance of vitiligo and persistence of pigmentation gained through SBG in 77.8% of cases at the end of 2 years as well as excellent patient satisfaction in the cohort of patients who followed up with us.

Conclusion:

SBG is an easy and cost-effective way of repigmentation of vitiligo involving angles of lip.

Impact on Quality of Life in Vitiligo Patients Treated with Narrowband Ultraviolet B Phototherapy

Context:

Vitiligo is a psychosocial problem which significantly affects quality of life in Indian scenario.

Aims:

The purpose of this study was to compare the changes in quality of life in patients of vitiligo before and after treatment with narrowband ultraviolet B (NBUVB) phototherapy.

Subjects and Methods:

A total of 54 patients had completed the study. The age ranged between 16 and 70 years with a mean age of 26.77±14.2 years. The initial dose of NBUVB was 300 mJ/cm² in adults and 150 mJ/cm² in children twice weekly with 20% dose increment on subsequent visits. It was given for a maximum period of 6 months and was followed up for another 6 months to determine stability of repigmentation.

Results:

The average number of exposure given to the patients was 45.63±12.74 while the mean irradiation cumulative dose was 39.8 J/cm². Mean Dermatology Life Quality Index (DLQI) of the vitiligo patients was 8.64±4.32 while those patients with acrofacial vitiligo had a mean DLQI of 11.78±5.61. After treatment with NBUVB, mean DLQI of all vitiligo patients was significantly reduced to 5.86±2.15 (P<0.01).

Conclusions:

This study showed that phototherapy had a positive therapeutic outcome in vitiligo, especially in younger patients. Even a small, depigmented lesion in a child could be psychosocially devastating.

Vitiligo and Psychiatric Morbidity: A Profile from a Vitiligo Clinic of a Rural-based Tertiary Care Center of Eastern India

Background

Vitiligo is an idiopathic acquired progressive de/hypopigmentary disorder of skin and mucosae. In Indian skin depigmentaion is very much obvious and can cause psychological distress, low self esteem and social stigmatization.

Aims

The primary objective of this study was to evaluate the psychiatric morbidity in vitiligo patients and secondary objective was to assess the morbidity in all eight dimensions of psychosocial and physical aspects, i.e. cognitive, social, discomfort, limitations, depression, fear, embarrassment and anger.

Materials and Methods

An institution based case-control study with sixty-one patients of vitiligo and equal number of healthy age and sex matched controls was undertaken. The self-reporting questionnaire-24 (SRQ-24) and skindex (A 61-item survey questionnaire) were used to assess the psychiatric morbidity in both the groups.

Results

The SRQ-assessed psychiatric morbidity in the study group was 63.93%, compared with 24.59% in the control group (P<0.0001). Acral vitiligo had maximum association with psychiatric morbidity (86.67%) followed by vitiligo vulgaris (68%), mucosal vitiligo (62.5%) and others. According to the skindex, the most common psychiatric morbidity in vitiligo patients was depression (62.29%) followed by embarrassment (55.73%), social problem (54.09%), cognitive impairment (50.81%), physical limitation (47.54%), discomfort (40.98%), anger (36.06%) and fear (24.59%). The difference in Skindex scoring that marked the psychiatric morbidity among the case and control groups was statistically significant for depression, discomfort, social problem, cognitive impairment, embarrassment (P<0.0001) and physical limitation (P=0.0044).

Conclusion

Vitiligo has a high degree of psychiatric morbidity.

Analysis of quality of life and influencing factors in 197 Chinese patients with port-wine stains

Port-wine stains (PWS) are congenital capillary malformations, usually occurring on the face, neck, and other exposed parts of the skin, that have serious psychological and social impact on the patient. Most researchers focus on the treatment of PWS, but the quality of life (QoL) of PWS patients is seldom researched. The objective of this study is to evaluate the QoL of patients with PWS on exposed parts and explore the factors influencing the QoL of PWS patients. The QoL of 197 cases with PWS on exposed parts were prospectively studied using the Dermatology Life Quality Index questionnaire (DLQI), and the factors influencing the patients' QoL were analyzed by single-factor analysis and multiple-factor logistic regression analysis. The reliability and validity of the QoL of PWS patients were then assessed by DLQI. A total of 197 valid questionnaires were collected. The DLQI scores in PWS cases ranged from 2 to 16, with 2 to 5 in 52.29% (103/197), 6 to 10 in 42.13% (83/197), and 11 to 20 in 5.58% (11/197). The main score elements of the DLQI focused on symptoms and feelings, daily activities, and social entertainment. Single-factor analysis and multiple-factor logistic regression analysis showed that the main influencing factors were female sex, skin hypertrophy, and lesion area >30 cm. The inter-item correlation averaged 47.46% and the Cronbach α was 0.740, indicating high internal consistency. Correlation of the 6 dimensions of the DLQI questionnaires with the total scores showed that the Spearman correlation coefficient r ranged from 0.550 to 0.782 (P < .001), with symptoms and feelings having a correlation coefficient of 0.782 and a high correlation with total scores. This study shows that PWS has mild to moderate influence on the QoL of most patients, mainly on daily activities, social entertainment, and feelings.

[Systemic treatment of vitiligo : Balance and current developments]

Systemic drug treatment of vitiligo is currently limited to predominantly adjuvant measures for increasing the effectiveness of UV light therapy. We here present new approaches for the systemic treatment of vitiligo currently under clinical investigation. These include the α‑MSH-analogue afamelatonide and oral immunosuppressants such as the Janus kinase (JAK) inhibitors which target interferon-α-dependent autotoxic inflammatory reactions. In 2015 the first publications on the successful systemic use of Janus kinase (JAK) inhibitors in vitiligo appeared. The effectiveness was experimentally supported by animal models of vitiligo and by the characterization of new biomarkers in the serum of vitiligo patients. This may significantly expand the range of treatment options for vitiligo. Topical antiinflammatory and UV therapies are still the main components of vitiligo treatment, often in combination. The main outcome parameters include the extent and duration of repigmentation, cessation of spreading, avoidance of side effects and improvement in the quality of life of patients.

Vitiligo and depression: a systematic review and meta-analysis of observational studies

Vitiligo is a common depigmenting disorder with profound psychosocial impacts. Previous observational studies have suggested a link between vitiligo and psychiatric morbidity, such as depression. However, variability in study design makes it difficult to quantify accurately the relationship between vitiligo and depression. We aimed to investigate the underlying prevalence and risk of depression among patients with vitiligo. A comprehensive search of MEDLINE, Embase and the Cochrane Library was conducted. Cross-sectional, case-control or cohort studies that assessed the prevalence of depression among patients with vitiligo or the relationship between vitiligo and depression were included. DerSimonian and Laird random-effects models were utilized to calculate the pooled prevalence and relative risks. Publication bias was evaluated by funnel plots and Egger's tests. Twenty-five studies with 2708 cases of vitiligo were included. Based on diagnostic codes, the pooled prevalence of depression among patients with vitiligo was 0·253 [95% confidence interval (CI) 0·16-0·34; P < 0·001)]. Using self-reported questionnaires, the pooled prevalence of depressive symptoms was 0·336 (95% CI 0·25-0·42; P < 0·001). The pooled odds ratio of depression among patients with vitiligo was 5·05 vs. controls (95% CI 2·21-11·51; P < 0·001). Moderate-to-high heterogeneity was observed between the studies. Patients with vitiligo were significantly more likely to suffer from depression. Clinical depression or depressive symptoms can be prevalent, with the actual prevalence differing depending on screening instruments or, possibly, geographical regions. Clinicians should actively evaluate patients with vitiligo for signs/symptoms of depression and provide appropriate referrals to manage their psychiatric symptoms accordingly.

Impact of Vitiligo on Quality of Life

INTRODUCTION AND OBJECTIVE

Vitiligo is a chronic autoimmune skin disease caused by the destruction of melanocytes. Although quality of life (QOL) in vitiligo has been studied in different countries, it has not yet been investigated in Mexico. The aim of this study was to assess the QOL of Mexican patients with vitiligo.

MATERIAL AND METHOD

We conducted a cross-sectional study at the research unit of Centro Dermatológico Dr. Ladislao de la Pascua in Mexico City. We included adults with vitiligo and excluded those with other pigmentation disorders or a neurological or psychiatric disorder. Patients on psychoactive medications were also excluded. All the patients were administered the Dermatology Life Quality Index (DLQI), a vitiligo-specific quality of life instrument (the VitiQoL), and the Beck Depression and Anxiety Inventories.

RESULTS

We studied 150 patients with vitiligo (103 women [68.7%] and 47 men [31.3%]). The median (interquartile range) age was 38 (20) years. The mean (SD) scores on the DLQI and VitiQoL were 5.2 (5.4) and 32.1 (22.7) out of total possible scores of 30 and 90, respectively. The correlation between questionnaire scores was 0.675 (P<.001). Patients with genital involvement scored significantly worse on the VitiQoL than those without lesions in this area (43.95 [28.4]) vs. 28.98 [20.08], P<.001). The prevalence of depression and anxiety was 34% and 60%, respectively.

CONCLUSION

Vitiligo has a minimal impact on the QOL of our patients. QOL was worse in patients with genital lesions.

Effectiveness and safety of topical tacrolimus in treatment of vitiligo

Vitiligo is one of the most primitive well-known dermatoid disorders with different suggested therapies. Therefore, this study investigated the efficiency and safety of topical tacrolimus in treatment of patients with vitiligo. This study was a clinical randomized designed study pre- post-test method, has been conducted on thirty cases with vitiligo who have referred to polyclinic and dermatology clinic. Participant's evaluated and demographic information recorded in designed checklist. In the next stage, the disease activity scored by vitiligo index disease activity system. Photography and depigmentation percent has recorded before treatment and further in 4^th, 8^th, 12^th, 16^th, 20^th, and 24^th weeks. Finally, gathered data compared through SPSS-20 software. The final sample comprised 30 persons including: 12 men (40%) and 18 women (60%). The average of patient's age in this study was 26/13 ± 18/20 (2-76-year-old). Eleven persons was ≤15 years old and rest was older than 15. Sixty-six lesions have funded in patients that maximum has accrued on face and neck (37/87%) and trunk (21/21%). In addition, minimum of lesions is related to genitalia (9/09%). In the in 4^th, 8^th, 12^th, 16^th weeks, improvement in face and neck had increased significantly, into the past weeks. In the 20^th and 24^th weeks, the improvement has increased although it was not significant enhancement. Also about trunk, in the 4^th week the improvement does not have significant increasing in compare to the past week. In the eighth, 12^th, 16^th, 20^th, and 24^th weeks the improvement has been increased significantly in compare to the past weeks. Although in the case of limbs and genitalia, the improvement was lower. There was no significant difference between male and females and age. Although the improvement was, slow in older persons. Study results, has presented applying topical tacrolimus in vitiligo, particularly in face and neck, could be effective and does not seen any specified adverse effects during consumption of tacrolimus, it could be effective in decreasing effects in use of corticosteroid.

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.

[Treatment of vitiligo]

The range of treatment options for vitiligo has significantly expanded in the last 10 years and we can offer our patients more effective treatment strategies supported by European guidelines and consensus findings. Topical and UV therapy are-often in combination-the main components of vitiligo treatment. The main outcome parameters include extent and maintenance of gained repigmentation, cessation of spreading, avoidance of side effects and the influence of the treatment on the quality of life. The efficacy of the currently available treatments is often limited. New options include antioxidative or melanocyte-stimulating adjuvant therapies in combination with UV or laser light as well as a topical maintenance treatment to reduce the risk of recurrences. In many cases, psychological support is indicated.