Psychiatric morbidity and quality of life in vitiligo patients

EGR1 Mediated Reduction of Fibroblast Secreted-TGF-β1 Exacerbated CD8+ T Cell Inflammation and Migration in Vitiligo

Vitiligo is a T cell-mediated depigment skin disease caused by the complex interplay between melanocyte dysfunction, environmental stimulation, and dysregulated immune signals. Transforming growth factor-β1 (TGF-β1), which typically derives from regulatory T cells, has long been identified at low levels in the peripheral system of vitiligo patients. Here, through RNA-sequencing and transcription factor enrichment, we revealed that in response to CD8+ T cell-secreted interferon-gamma (IFN-γ), stromal fibroblast downregulates early growth response 1 (EGR1) activity, leading to TGF-β1 deficiency. The defective immune regulation loop further exacerbated local CD8+ T cell inflammation and promoted inflammatory cell migration in vitiligo. Thus, fibroblast-derived TGF-β1 plays an important stromal signal in vitiligo pathogenesis.

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.

Photoprotection for people with skin of colour: needs and strategies

Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoageing changes such as uneven skin tone, and are predisposed to pigmentary disorders. In fact, one of the most common conditions leading to dermatology consultations by patients with skin of colour is photoexacerbated pigmentary disorders. Unfortunately, individuals with skin of colour may be less prone to engage in photoprotective measures, including the use of sunscreens. Physicians are also less likely to prescribe sunscreens for them. There is thus a clear need for better education on photodamage and for more efficient and suitable photoprotection in populations with skin of colour. However, this need has thus far only partially been met, and the development of sunscreen products designed to provide optimal photoprotection for people with skin of colour remains a challenge. Targeted sunscreens for individuals with skin of colour require optimal cosmetic appeal (leaving no white residue and not disrupting skin tone). They should include broad-spectrum [ultraviolet (UV)B/UVA] protection with high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light, as these wavelengths are capable of inducing or augmenting pigmentary disorders. They may also contain depigmenting agents for patients with pigmentary disorders.

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.

Current Debates on Etiopathogenesis and Treatment Strategies for Vitiligo

Vitiligo is an acquired, chronic, and progressive depigmentation or hypopigmentation characterized by the destruction of melanocytes and the occurrence of white patches or macules in the skin, mucosal surface of eyes, and ears. Melanocytes are the melanin pigment-producing cells of the skin which are destroyed in pathological conditions called vitiligo. Approximately 0.5 - 2.0% of the population is suffering from vitiligo, and a higher prevalence rate of up to 8.8% has been reported in India. It is caused by various pathogenic factors like genetic predisposition, hyperimmune activation, increased oxidative stress, and alteration in neuropeptides level. Genetic research has revealed a multi- genetic inheritance that exhibits an overlap with other autoimmune disorders. However, melanocytes specific genes are also affected (such as DDR1, XBP1, NLRP1, PTPN22, COMT, FOXP3, ACE, APE, GSTP1, TLR, SOD, and CTLA-4). A number of therapeutic options are employed for the treatment of vitiligo. The topical corticosteroids and immunomodulators are currently in practice for the management of vitiligo. Phototherapies alone and in combinations with other approaches are used in those patients who do not respond to the topical treatment. The main focus of this review is on the etiopathological factors, pharmacological management (phototherapy, topical, systemic, and surgical therapy), and herbal drugs used to treat vitiligo.

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.

Integrin Regulated Autoimmune Disorders: Understanding the Role of Mechanical Force in Autoimmunity

The pathophysiology of autoimmune disorders is multifactorial, where immune cell migration, adhesion, and lymphocyte activation play crucial roles in its progression. These immune processes are majorly regulated by adhesion molecules at cell–extracellular matrix (ECM) and cell–cell junctions. Integrin, a transmembrane focal adhesion protein, plays an indispensable role in these immune cell mechanisms. Notably, integrin is regulated by mechanical force and exhibit bidirectional force transmission from both the ECM and cytosol, regulating the immune processes. Recently, integrin mechanosensitivity has been reported in different immune cell processes; however, the underlying mechanics of these integrin-mediated mechanical processes in autoimmunity still remains elusive. In this review, we have discussed how integrin-mediated mechanotransduction could be a linchpin factor in the causation and progression of autoimmune disorders. We have provided an insight into how tissue stiffness exhibits a positive correlation with the autoimmune diseases’ prevalence. This provides a plausible connection between mechanical load and autoimmunity. Overall, gaining insight into the role of mechanical force in diverse immune cell processes and their dysregulation during autoimmune disorders will open a new horizon to understand this physiological anomaly.

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.

Evaluation of the Dermatological Life Quality Index, sexual dysfunction and other psychiatric diseases in patients diagnosed with vitiligo with and without genital involvement

BACKGROUND

Because skin lesions affect self-image, vitiligo affects an individual's emotional and psychological well-being, sexual life and relationships with other people. The literature contains a limited number of studies regarding the localization of vitiligo with respect to its effect on certain variables.

AIM

To investigate the effects of the presence or absence of genital involvement in vitiligo on sexual dysfunction, dermatological quality of life (QoL), and susceptibility to other psychiatric disorders such as anxiety and depression.

METHODS

In total, 90 patients who were admitted to the dermatology outpatient clinic of a tertiary university hospital; the patients included 30 patients with vitiligo with genital involvement, 30 patients with vitiligo without genital involvement and 30 controls (HCs). All groups were evaluated with the Dermatological Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HAD), Arizona Sexual Experience Scale (ASEX) and Golombok-Rust Inventory of Sexual Satisfaction (GRISS).

RESULTS

The HC groups exhibited lower total scores on the DLQI, HAD total score, ASEX and GRISS compared with the vitiligo groups (P < 0.05). No statistically significant difference was found between the vitiligo group with genital involvement and the vitiligo group without genital involvement in terms of DLQI, and total scores for HAD, ASEX and GRISS (P > 0.05).

CONCLUSION

The presence or absence of genital involvement in vitiligo did not have dissimilar effects on the individual's QoL, or their sexual and psychological state.

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.

Public Knowledge and Attitudes towards Vitiligo: A Survey in Mekelle City, Northern Ethiopia

Background

The overall well-being, sense of stigmatization, and treatment outcome of persons with vitiligo are largely dependent on their social acceptance and this is linked with perception and attitude of this disease in a given population. Therefore, this study assessed the knowledge and attitude of the public towards vitiligo.

Methods

A cross-sectional survey was carried out using a self-reported questionnaire distributed to adults living in Mekelle city, Northern Ethiopia from August to November 2019. Individuals who were 18 to 65 years of age and not suffering from vitiligo were included in the study. A self-administered questionnaire that contains a demographic, knowledge, and attitudes parts was used to collect data. Data were entered using Epi Data® version 3.1 and analyzed using SPSS® version 21.

Results

Of the total 368 subjects, 300 completed the questionnaires giving 81.5% response rate. The mean age was 30 ± 8.3 years and the male-to-female ratio was 1.14 : 1. Friends or families were reported as the most common source of information (70%) about vitiligo. The overall vitiligo knowledge was sufficient in 68.3% of the participants. Higher vitiligo-related knowledge scores were recorded by people older than 30 and below 50, those of secondary school graduated or more, urban-dwellers, persons who had heard about vitiligo, and persons having families or friends affected by vitiligo. Attitudes towards vitiligo were positive in 43.3% of participants. This was more prevalent among employed persons, those of secondary school graduated or more, and persons having families or friends affected by vitiligo. Moreover, sufficient knowledge was significantly related to positive attitudes towards the disease (p < 0.0001).

Conclusion

Even though the majority of the respondents had sufficient knowledge, we still found misconceptions and negative attitudes towards vitiligo. Therefore, it is still crucial to educate the public about vitiligo to ultimately improve the well-being of patients with vitiligo.

Vitiligo: Patient stories, self-esteem, and the psychological burden of disease

Vitiligo is a relatively common disorder that is characterized by depigmented patches of skin. Multiple studies characterize the overwhelming psychological burden that is experienced by many patients around the globe. This review examines personal patient stories and the impacts of age, culture, sex, race, and ethnicity in relationship to altered self-esteem and quality of life in patients who live with vitiligo.

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.

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.

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.

Chronic diseases among vitiligo patients. A case control study

OBJECTIVES

To identify the proportion and risk of chronic diseases in vitiligo patients in a tertiary hospital in Riyadh, Kingdom of Saudi Arabia (KSA). Methods: A retrospective case-control study included 61 vitiligo patients and 61 normal non-dermatology controls in King Abdulaziz Medical City, Riyadh, KSA between January and September 2016. Age, gender and  co-morbid diseases including hypertension, diabetes, dyslipidemia, obesity and hypothyroidism were retrieved from participants' charts and medical records. Proportion and mean were used to describe the variables, and odds ratio (OR) was used to test the data. Results: A total of 122 participants (34 males, 88 females) equally divided in cases and controls. The mean age was 45±19 years for the case and 40±17 years for the control group. The proportion of diabetes (51%) was higher in the case group than the control (33%) (OR: 0.47; 95% confidence interval [CI]: 0.23-0.98; p=0.04). Dyslipidemia was significantly associated with vitiligo (67%) compared with the control group (48%) (OR: 0.44; 95% CI: 0.21-0.92; p=0.03). Vitiligo participants had a significantly increased risk of having hypothyroidism (26%) compared with the control group (10%) (OR: 0.31; 95% CI: 0.11-0.85; p=0.02). Conclusion: There is an increased risk of chronic diseases among vitiligo patients including diabetes, dyslipidemia, hypothyroidism, renal injuries, and obesity.

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.

Suicide in India: Distinct Epidemiological Patterns and Implications

Suicide is a societal crisis which also deeply impacts the personal and family realms. Indian suicidal data present distinctive epidemiological patterns when we compare it with the global suicide rates and trends. Higher proportions of young individuals are resorting to suicide compared to any other country in the world, and Indian suicide rates, especially South Indian rates, are one of the highest in the world. In this article, we present various historical aspects and theories of Indian suicide and review of available Indian research from various sources such as community, hospitals, schools and forensic settings. We discuss our findings which reveal the distinctiveness of Indian data when we compare these with global data and draw implications for practice and policy.

Social Anxiety and Quality of Life in Vitiligo and Acne Patients with Facial Involvement: A Cross-Sectional Controlled Study

BACKGROUND

Vitiligo and acne vulgaris, commonly affecting the face, have significant psychological effects and impair the quality of life of the affected individuals. Because of their negative effect on physical appearance, these conditions may act as a potential barrier to social relationships and cause social anxiety.

OBJECTIVE

The objective of the study was to investigate the social anxiety, quality of life, anxiety, and depression levels of acne and vitiligo patients with facial involvement and compare these levels with healthy controls.

METHODS

Thirty-seven vitiligo and 37 acne patients, aged older than 18 years, with facial involvement and 74 age- and sex-matched healthy control subjects were included in the study. The patients and healthy controls were asked to complete the Liebowitz Social Anxiety Scale, the Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. Disease severity was evaluated both objectively by the physician and subjectively by the patients using a visual analog scale.

RESULTS

Social anxiety, depression, and anxiety levels of vitiligo and acne patients were significantly higher than healthy controls (p < 0.05). Quality of life was impaired in both patient groups (Dermatology Life Quality Index scores for vitiligo: 5.6 ± 5.1; acne: 6.4 ± 6.2). There was no correlation between psychiatric scale scores and disease severity. Quality of life was negatively correlated with social anxiety and depression levels in both patient groups in our study.

CONCLUSION

Vitiligo and acne patients had higher levels of social anxiety, anxiety, and depression compared with healthy control subjects. Considering that increased psychosocial morbidity was regardless of age, sex, and disease severity and was correlated with quality of life impairment, evaluation of the psychosocial morbidity, in particular social anxiety, may be valuable in all vitiligo and acne patients.

Erratum: psychiatric morbidity and quality of life in vitiligo patients: erratum

[This corrects the article on p. 302 in vol. 36, PMID: 25035556.].