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Vitiligo

VIPOC
In Vitiligo

5 Facts You Didn’t Know About Vitiligo

When cells that make pigment (color) in the skin are destroyed, it causes vitiligo. Vitiligo, also known as leukoderma, is a skin disorder in which white spots or patches appear on the skin. It is caused due to the weakening or destruction of the cells called melanocytes.

World Vitiligo Day is celebrated on 25th of June every year to spread awareness about this skin disorder, its causes and treatment. When cells that make pigment (color) in the skin are destroyed, it causes vitiligo. Vitiligo, also known as leukoderma, is a skin disorder in which white spots or patches appear on the skin. It is caused due to the weakening or destruction of the cells called melanocytes. Melanocytes produce a pigment called melanin. Loss of this pigment causes discoloration of the skin.
The true cause of vitiligo is still not known but it is said to be an autoimmune disease. It might occur when the immune system mistakenly attacks some part of your body. The skin then starts to get discolored with white patches replacing the natural skin color. Only the color of the skin gets affected, the texture and the quality remains the same. This skin condition cannot be reversed by medication and millions of people are affected by it worldwide. It is most likely to occur on the areas exposed to the sun. In many people it was observed to have occurred due to extreme stress such as an accident, sudden loss of a near and dear one, or severe sunburn. This condition is a common skin disorder; however, there may be some unknown facts to it.

vitiligo

True cause of vitiligo is still not known but it is said to be an autoimmune disease

Following are the things that you might not know about vitiligo:

1. Vitiligo is painless

Vitiligo is a condition which does not lead to any kind of physical pain in the person suffering from it. It affects the skin color, hair and sometimes the pupils which might cause some emotional and psychological trauma. People might suffer from depression due to their changing appearance and might need therapy to deal with the stress this condition brings with it.

depression

 

People might suffer from depression because of the change in appearance

2. Vitiligo is neutral to all

Vitiligo can happen to anyone; people of any race, color, sex or age, however, it is most likely to happen to people with certain immune system diseases. Vitiligo is not life-threatening and most people with vitiligo stay in a good health. Children might or might not get it if one of their parents suffers from vitiligo. Hence, vitiligo is a neutral skin condition which can affect anyone without a family medical history of the same.

3. Vitiligo is not contagious

It is a disorder which replaces the natural skin tone with white spots and patches. It is not contagious, that is, vitiligo cannot be spread from one person to another by direct or indirect contact. It is not transferable by touch, sharing personal items, sexual intercourse etc

4. Vitiligo is not caused by food intake

Some people believe that vitiligo can occur because of consuming white or citrus food items. However, there is no scientific evidence to prove the above myths. Vitiligo is not caused by the consumption of any food item; it is said to be an autoimmune skin condition. Patients suffering from it can eat and drink any food item unless their doctor tells them otherwise.

5. Not all white patches lead to vitiligo

Vitiligo is an exclusive skin disorder which is caused due to the loss of a pigment called melanin. Not all white spots or patches on the skin can be deemed as vitiligo. It is important to consult a doctor in case a white spot appears on the skin instead of self-diagnosis. There are several other conditions and diseases which begin from a white spot and are not vitiligo, these might be Nevus, post-burn skin, leprosy, fungal infections etc.

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VIPOC
In Vitiligo, Vitiligo research, vitiligo treatment

Anxiety and depression in pediatric patients with vitiligo and alopecia areata and their parents: A cross-sectional controlled study Part 2

Separated, n (%)                            4 (12.9)                                        4(13.8)                                                                                                               0

Number of siblings 1, n (%) 4 (12.9) 3(10.3) 4(13.3) .56
2, n (%) 12 (38.7) 17(58.6) 18(60)
3, n (%) 10 (32.3) 7(24.1) 6(20)
4, n (%) 3 (9.7) 2(6.9) 2(6.1)
5, n (%) 2 (6.5) 0 0

TABLE 2 Comparison of groups’ psychological test scores and presence of stressful life event

Groups P-value
                                             Alopecia areata                       Vitiligo                                          Controls AA-Vi                         AA-C                         Vi-C

Stressful life event, n (%)                        19 (61.3)                                      25 (86.2)                                      9 (30)                                                                               .041                                               .014                                         <.0001

RCADS-Child, mean ± SD

Separation Anxiety

 55.61 ± 12.94 50.21 ± 9.6 48.83 ± 9.9 .116 .026 .291
Generalized Anxiety 48.61 ± 11.37 45.14 ± 9.09 42.5 ± 7.41 .195 .021 .261
Panic 49.65 ± 12.3 47.31 ± 10.9 44.67 ± 8.17 .454 .177 .470
Social Phobia 46.19 ± 12.48 43.66 ± 8.72 39.93 ± 8.34 .625 .050 .069
Obsessive-Compulsive 48 ± 12.58 48.03 ± 11.56 46.93 ± 8.89 .935 .874 .952
Depression 49.68 ± 12.21 47.38 ± 14.3 41.07 ± 7.55 .314 .006 .162
Total Anxiety 49.03 ± 12.96 45.69 ± 10.5 42.43 ± 7.88 .287 .057 .295
Total 49.13 ± 12.9 45.86 ± 11.63 41.47 ± 7.95 .245 .010 .261

RCADS-Parent, mean ± SD

Separation Anxiety 57.55 ± 15.3 54.38 ± 9.8 51.03 ± 8.43 .700 .167 .181
Generalized Anxiety 54.81 ± 9.64 52.9 ± 11.55 51.6 ± 10.8 .415 .133 .660
Panic 55.06 ± 12.64 54.24 ± 11.82 48.57 ± 9.9 .795 .014 .030
Social Phobia 49.26 ± 12.09 49.45 ± 10.91 45.83 ± 8.47 .900 .291 .199
Obsessive-Compulsive 57.39 ± 11.18 55.86 ± 11.17 54.97 ± 11.18 .573 .422 .558
Depression 58.74 ± 14..95 56.24 ± 14.15 47.37 ± 8.23 .529 .001 .014
Total Anxiety 55.06 ± 10.92 53.9 ± 12.39 50.2 ± 10.65 .569 .041 .316
Total 56.32 ± 11.1 54.72 ± 12.24 49.43 ± 10.22 .428 .012 .074
Parents’ BAI, mean ± SD 11.71 ± 8.78 11.45 ± 10.21 8.97 ± 8.71 .667 .169 .235
Parents’ BDI, mean ± SD 10 ± 6.72 9.83 ± 5.79 7.53 ± 5.78 .906 .110 .093

Abbreviations: AA, Alopecia Areata; Vi, Vitiligo; C, Controls; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; RCADS-Child, Revised Child Anxiety and Depression Scales, Child Version; RCADS-Parent, Revised Child Anxiety and Depression Scales, Parent Version.

 

significant (P < .0001). Furthermore, this parameter was statistically significantly higher in the vitiligo group compared to the AA and control groups (P = .014 and P < .0001, respectively) (Table 2).

1.1                | Evaluation of the scales related to psychological parameters and QoL

The mean CDLQI score was 5.1 ± 5.13 (0-22) in the AA group and

2.76 ± 2.39 (0-8) in the vitiligo group; the mean DeFIS score was 12.19 ± 11 (0-54) in the AA group and 14.45 ± 9.33 (0-45) in the vitiligo group, indicating no significant difference (P = .245, P = .102, respectively).

In the AA group, the scores in the RCADS-C subscales of SAD

(P = .026), GAD (P = .021), SP (P = .049) and MDD (P = .006), and the total (P = .010) scores were significantly higher compared to the control group. According to the results of RCADS-P, the scores in the subscales of PD (P = .015) and MDD (P = .001), and the total anxiety (P = .041) and total (P = .012) scores were significantly higheramong the patients in the AA group compared to the control group (Table 2). While there was no significant difference in the vitiligo group in terms of the RCADS-C scale scores, according to RCADS-P, the PD (P = .030) and MDD (P = .014) subscores of the patients were significantly higher than the controls (Table 2). There was no significant difference between the AA and vitiligo groups in relation to the RCADS-C and RCADS-P scores. Similarly, no significant difference was observed between the AA, vitiligo, and control groups in terms of the parents’ BAI and BDI scores (Table 2).

Concerning the relationship between disease severity and total anxiety and depression scores, in the AA group, the SALT score had a positive correlation with RCADS-C depression (P = .014) and total anxiety (P = .032) and RCADS-P depression (P = .023) and total anxiety (P = .014) scores. However, in this group, no significant correlation was detected between the parents’ BAI (P = .321) and BDI (P = .161) scores. In the vitiligo group, there was no significant correlation between the VASI score and the total anxiety and depression scores, but the VASI score was found to be positively correlated with the RCADS-P SAD score (P = .048). There was no significant relationship between the parents’ BAI (P = .829) and BDI (P = .981) scores in the vitiligo group (Table 3).

In the AA group, the CDLQI score was positively correlated with the scores obtained from SALT (P = .008), RCADS-C depression (P = .012) and total anxiety (P = .041), DeFIS (P = .010), parental BAI (P = .011), and parental BDI (P = .022). In the vitiligo group, the CDLQI score had a positive correlation with the scores of RCADS-C depression (P = .001) and total anxiety (P = .007), and RCADS-P

TABLE 3 Correlation between SALT,

VASI, CDLQI, DeFIS, RCADS-C, RCADS-P, BAI, and BDI scores in patients with alopecia areata and vitiligo (Spearman rho)

Separation Anxiety .383* .271 .195 .256 .350 .489**
Generalized Anxiety .387* .307 .409* −.132 .299 .361
Panic .381* .342 .431* .104 .481** .377*
Social Phobia .236 .317 .313 −.114 .281 .162
Obsessive-Compulsive .428* .370* .330 .197 .571** .477**
Depression .438* .443* .377* .164 .589** .325
Total Anxiety .386* .370* .378* .067 .491** .455*
Total .448* .445* .425* .102 .570** .440*
RCADS-Parent

Separation Anxiety

 .292 .310 .242 .371* .230 .574**
Generalized Anxiety .455* .365* .495** .061 .318 .368*
Panic .157 .127 .372* .142 .310 .396*
Social Phobia .398* .169 .428* .096 .167 .203
Obsessive-Compulsive .382* .336 .482** .238 .344 .688**
Depression .407* .228 .400* −.003 .383* .394*
Total Anxiety .435* .309 .553** .144 .332 .462*
Total .454* .331 .522** .053 .389* .424*
Parents’ BAI .184 .452* .515** −.042 .169 .262
Parents’ BDI .258 .410* .643** −.005 .255 .185
SALT .466** .602**
VASI .048 .184
CDLQI .466** .455* .048 .130
DeFIS .602** .455* .184 .130

Abbreviations: BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; CDLQI, Children’s

Dermatology Life Quality Index; DeFIS, Dermatological Family Impact Scale; RCADS-Child, Revised Child Anxiety and Depression Scales, Child Version; RCADS-Parent, Revised Child Anxiety and Depression Scales, Parent Version; SALT, Severity of Alopecia Tool; VASI, Vitiligo Area Severity

Index.

*P < .05.

**P < .01.

depression (P = .040); however, CDLQI did not have a significant relationship with parental BAI (P = .379), parental BDI (P = .183), VASI (P = .804), and DeFIS (P = .500) (Table 3).

In the AA group, the DeFIS score had a positive correlation with the SALT score (P < .0001), the RCADS-C depression (P = .037) and total anxiety (P = .036) scores, the RCADS-P depression (P = .026) and total anxiety (P = .001) scores, the parental BAI score (P = .03), and the parental BDI score (P < .0001). In the vitiligo group, the DeFIS score was positively correlated with the scores of RCADS-C total anxiety (P = .013), and RCADS-P depression (P = .035) and total anxiety (P = .012); however, no significant correlation was observed between the DeFIS score and the parental BAI (P = .169), parental BDI (P = .337), and VASI (P = .340) scores (Table 3).

2       | DISCUSSION

Psychiatric symptoms are very common in dermatology patients, and an undetected psychiatric disorder can significantly reduce the patient’s QoL since it can delay treatment or recovery. We designed this study to better understand the impact of AA and vitiligo on children and their parents. Therefore, we have attempted to study the dimensions of anxiety disorders, that is, SAD, SP, GAD, OCD, and PD. Furthermore, in the current study, the anxiety and depression scales were directly evaluated in addition to the DeFIS scale, which indirectly measures the psychological status of the parents. Present results suggest differences between AA and vitiligo pediatric patients. The presence of stressful life events before the onset of both AA and vitiligo in the pediatric group and emphasized its greater importance for the latter. In addition, anxiety symptoms were more common in AA patients than those with vitiligo.

In a study by Bilgiç et al, AA was shown to have a positive correlation with higher state and trait anxiety and depression scores in children.11 In another study examining children with AA aged nine to 11 years, the patients were found to have significantly higher levels of psychopathology than the controls.7 In our study, we observed a significant difference between the pediatric patients with AA and the control group in terms of the RCADS-C subscales scores in SAD, GAD, SP, and depression, as well as the total scale score, which contributes to and supports previous research. In addition, PD and total anxiety scores were significantly higher in children with AA in the RCADS-P scale. While no significant difference was found in any of the subscales of RCADS-C in the evaluation of vitiligo patients, according to RCADS-P, the PD and depression scores of the patients in the vitiligo group were significantly higher compared to the control parents. The results of studies investigating depression and anxiety scores in patients with vitiligo are variable. In a study evaluating children and adolescents with vitiligo, depression scores were found to be higher than the control groups only in the children (8-12 years) group.16 In another study, children’s level of anxiety and depression symptoms did not significantly differ from the control group.15 However, Ucuz et al reported that the state and trait anxiety scores of children with vitiligo were different from those of the controls.17 The awareness that pediatric patients with alopecia areata and vitiligo are closely related to psychological factors is essential and psychiatric evaluation is important in the management of this population. Such patients should be directed to the child and adolescent psychiatrist, and treatment of the psychological condition can contribute to the medical treatment of dermatological disease.

In a recent study involving the parents of children with vitiligo, the depressive symptoms of the parents were higher than those of the control group, but the authors did not observe a similar link for anxiety symptoms.15 In another study evaluating depression and anxiety symptoms among the carers of patients with different types of dermatoses (vitiligo, atopic dermatitis, and psoriasis), higher levels of anxiety and depression were observed compared to the general population, but no difference was observed between disease groups.18 To the best of our knowledge, there is no study in the literature examining the psychiatric state of the parents of children with AA. In the current study, there was no difference between the anxiety and depression levels of the parents of the patients with AA and vitiligo and those in the control group. Similarly, no significant difference was observed between the vitiligo and AA groups in terms of the DeFIS scores, through which we evaluated the QoL of the parents.

A small number of studies related to the pediatric cases have shown the presence of stressful life events before the onset of AA as a potential trigger of the disease at a rate of 9.5% to 81%.31-34 In studies conducted with children with vitiligo, a history of stressful life events before the onset of the disease was reported at the rates of 48.8%15 and 77%.17 In our study, 61% of children with AA and 86.2% of children with vitiligo had a history of stressful life events in the year prior to the onset of the disease.

There is only one study in the literature that evaluated the severity of AA together with psychological state in children, and the results did not show a significant relationship.11 In contrast, in our study, there was an increase in the depression and anxiety scores of the patients with AA with the increasing severity of the disease, although a positive correlation of disease severity and anxiety and depression levels was not detected for the parents. In the evaluation of patients with vitiligo, Önen et al did not report a relationship between the severity of the disease and anxiety and depression scores in parents or children.15 In other studies in which children and adolescents were examined, no significant relationship was observed between vitiligo severity and anxiety16,17 and depression16 scores. In our study, only the level of SAD was increased with the increasing severity of vitiligo, but there was no positive correlation between disease severity and parental anxiety and depression levels.

In a previous study examining the effect of AA on QoL, it was shown that the QoL of the parents decreased as the severity of the disease increases in the child.35 In a study by Bilgiç et al, AA severity was shown to have a negative effect on the QoL of children.11 Similarly, in our study, impairment in the QoL of both patients and their parents increased with the increasing disease severity in the AA group. However, there are conflicting results in studies investigating the effect of the severity of vitiligo on QoL. For example, in one study, the severity of vitiligo in adolescents was observed to affect QoL negatively16 while two other studies including children and adolescents reported no relationship between QoL and the body surface area36 and vitiligo severity.15 According to another study in which the effect of childhood vitiligo on parents’ QoL was examined, as the area of involvement of vitiligo increased, the parental QoL decreased.37 In the current study, we found no correlation between disease severity and the QoL of patients or parents.

The main limitation of this study is the small sample size and cross-sectional design, and the lack of a structured interview and psychiatric evaluation can be considered as another limitation.

The results of the study indicated that the presence of stressful life events was more common in pediatric patients with vitiligo than those with AA. On the other hand, anxiety symptoms were more prevalent in patients with AA than those with vitiligo. While the severity of AA was correlated with the QoL of the affected children and their parents, there was no such correlation in vitiligo. The QoL of the patients affected the anxiety and depression levels of their parents in the AA group, but not in the vitiligo group. It is important to identify pediatric patients with alopecia areata and vitiligo who need extra psychological support and refer them to the child and adolescent psychiatrist. In conclusion, providing a psychological evaluation and support for both patients and their parents will not only help them better cope with chronic dermatoses that cause cosmetic disorders such as vitiligo and AA but also contribute to the improvement of their QoL.

ACKNOWLEDGMENTS

We thank Esma İnan Yüksel, MD, for her valuable contribution.

DATA AVAILABILITY STATEMENT

Data openly available in a public repository that issues datasets with DOIs.

ORCID

Sevil Savaş Erdoğan               https://orcid.org/0000-0002-4392-4671

Tuğba Falay Gür              https://orcid.org/0000-0002-3233-9610

Bilal Doğan              https://orcid.org/0000-0002-0855-5209

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Source

VIPOC
In Vitiligo, Vitiligo research, vitiligo treatment

Factors affecting quality of life in patients with vitiligo Part 2

Patients and methods

Participants and settings

A nationwide questionnaire-based study was conducted in 21 hospitals and clinics in Korea from July 2015 to June 2016. All patients aged ≥ 20 years diagnosed with vitiligo by dermatologists, and who provided written informed consent prior to the survey were enrolled. We restricted the participants to adult patients, because different questionnaires should be applied to children and adults. We explored demographic characteristics and vitiligo phenotypes and determined Skindex-29 scores. All patients first completed the questionnaires in paper-and-pencil format, and dermatologists then confirmed the clinical profiles after interviewing and examining the patients. The study protocol was designed in accordance with the Declaration of Helsinki and was approved by the institutional review board of each hospital.

Demographic characteristics

Demographic characteristics recorded included age, sex, marital status (single or married) and educational background (elementary school graduate, middle school graduate, high school graduate or college graduate).

Vitiligo phenotypes

The vitiligo phenotypes included subtype (segmental or nonsegmental), disease duration (< 1, 1–4, 5–9 or ≥ 10 years), affected body surface area (BSA; < 05, 05–09, 1–4, 5–9, 10–19 or ≥ 20%), involvement of visible body parts (yes or no) and the particular body parts involved (face and neck, scalp, upper extremities, lower extremities, trunk and genital area).

The Skindex-29 questionnaire

QoL was assessed using the Korean version of Skindex-29. This instrument is employed extensively to measure the effects of skin disease on a patient’s life;8,9 the Korean version was cross-culturally adapted by Ahn et al.10 The semantic equivalence of all back-translated items has been confirmed,10 and the Korean version has been validated by several previous studies.11–13 The questionnaire contains 29 items exploring the influence of skin disease on daily life using a five-point scale: 0 (never), 1 (rarely), 2 (sometimes), 3 (often) and 4 (all the time). The responses were transformed into linear scores varying from 0 (no effect) to 100 (effect always experienced). Each item belongs to one of three domains (symptoms, functioning and emotions); the scores of the three domains were calculated as the mean score of the items included in each domain.

The major items affecting patients with vitiligo

The proportions of patients affected by each item (sometimes, often and all the time) were calculated. The items of most concern were identified based on the answers.

Quality-of-life impairment

The outcomes of the study were mild or severe impairment of QoL, as determined by each domain (symptoms, functioning and emotions) of Skindex-29. Mild and severe QoL impairments were defined using the cut-off scores suggested by Prinsen et al.:14,15 ≥ 39 (mild) and ≥ 52 (severe) for symptoms, ≥ 21 (mild) and ≥ 37 (severe) for functioning, and ≥ 24 (mild) and ≥ 39 (severe) for emotions.

Statistical analyses

Absolute and percentage frequencies were determined for categorical variables, and position (mean and median) and scattering (SD, range) were described for continuous variables. Univariate and multivariate logistic regression analyses were sequentially performed to identify the factors independently associated with QoL impairment in each domain of Skindex29. All analyses were performed using R 3.3.1 (R Foundation for Statistical Computing, Vienna, Austria).

Results

In total, 1123 patients with vitiligo were recruited from 21 hospitals and clinics. Of the participants, 609 (542%) were male and 514 female (458%), with a mean age of 498  152 years (range 20–84). The median duration of disease was 30 years (range 0–60). The detailed clinical characteristics of the enrolled patients are summarized in Table 1.

The results of Skindex-29

The Skindex-29 items of most concern to patients with vitiligo were as follows: no. 13: I worry that my skin condition may get worse (746% of patients); no. 3: I worry that my skin condition may be serious (629%); no. 22: My skin condition is a problem for the people I love (556%); and no. 6: My skin condition makes me feel depressed (535%) (Table 2).

Impaired quality of life and associated factors in terms of the symptoms domain

Of the patients with vitiligo, 146% (164 of 1123) had mild and 52% (58 of 1123) had severe QoL impairment in terms of the symptoms domain (Fig. 1). On multivariate logistic

Table 1 The clinical characteristics of the 1123 patients with vitiligo included in the present study

 

 

 

 

 

 

regression modelling, the involvement of visible body parts (OR 153) and a larger affected BSA (compared with < 05%; 5–9%: OR 278, 10–19%: OR 284 and ≥ 20%: OR 469) were associated with mild symptom impairment (Table 3). A larger affected BSA was also associated with severe symptom impairment (compared with < 05%; ≥ 20%: OR 810).

Impaired quality of life and associated factors in terms of the functioning domain

Of the patients with vitiligo, 488% (548 of 1123) had mild and 282% (317 of 1123) had severe QoL impairment in terms of the functioning domain. The factors associated with

Table 2 The Skindex-29 items that affected > 25% of patients with vitiligo

Affected

Items (in order of frequency)                        patients     Domain

13. I worry that my skin condition may          746%         Emotions get worse

3. I worry that my skin condition may            629%         Emotions be serious

22. My skin condition is a problem for          556%                Functioning the people I love

6. My skin condition makes me feel               535%         Emotions depressed

9. I worry about getting scars from my           498%         Emotions skin condition

12. I am ashamed of my skin condition        497%       Emotions

28. I am annoyed by my skin condition        476%       Emotions

5. My skin condition affects my social           450%                Functioning life

15. I am angry about my skin condition        448%       Emotions

24. My skin is sensitive                                 433%          Symptoms

4. My skin condition makes it hard to            427%                Functioning work or do hobbies

21. I am embarrassed by my skin 410%         Emotions condition

19. My skin is irritated                                  379%          Symptoms

23. I am frustrated by my skin condition      356%       Emotions

20. My skin condition affects my 354%         Functioning interactions with others

11. My skin condition affects how close       328%       Functioning

I can be with those I love

17. My skin condition makes showing           305%                Functioning affection difficult

26. I am humiliated by my skin    296%         Emotions condition

10. My skin itches                                         291%          Symptoms

14. I tend to do things by myself  275%         Functioning because of my skin condition

30. My skin condition makes me tired          264%       Functioning

8. I tend to stay at home because of my          263%                Functioning skin condition

 

Source

 

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In the upside of skin condition, Vitiligo, Vitiligo stories

Painful process and rebirth of turning ‘white’

Seeing the upside of skin condition, vitiligo

STRUGGLE: Moleboheng Molebatsi, 22, suffers from vitiligo and spent years being alone and bullied.

ONE MORNING when Moleboheng Molebatsi was a teenager, she woke up at 5 am and went to stand naked in the bushes and allowed her uncle to smear her skin with a mixture of ashes and saliva.

This was not part of some ritual but one of the desperate things Molebatsi, 22, did in an effort to cure vitiligo, which affects her skin.

At the time, Molebatsi was struggling to accept the condition that afflicts her.

Another desperate measure she took was to drink concoctions sold as purporting to cure all diseases. Her grandfather even suggested the family change her name to Pulane because the ancestors might not be happy she wasn’t named after anyone.

“Everyone called me Pulane for a while but my mother never liked it. Eventually, they forgot and just continued using my real name. Calling me with the new name didn’t help the condition,” she chuckles.

Molebatsi’s vitiligo started when she was about two years old and when she was 19, she stopped taking treatment like topical cream and that’s when it spread all over her body.

When she first got the condition, her skin had patches of her original dark skin colour and very light ones caused by the condition.

For years, she went through phototherapy light treatment for vitiligo but that didn’t help her. After the treatment, her skin appeared sunburnt and doctors recommended she stop. She then tried micro-pigmentation which involves implanting small particles of natural pigment under the skin in a similar way to getting a tattoo. Molebatsi’s body rejected the procedure as well.

“Some lady said I must use a wine cork. Burn it and apply it to my body. At that time I was tired, and I didn’t use it,” Molebatsi remembers. She was so tired that she stopped taking any treatment and began a journey of self-love. Now, all her pigmentation is gone and she has turned completely light-skinned.

“I am just glad I am alive. I tried almost everything. Even before I turned completely white, I started going out and taking pictures. Turning completely white was like being born again. I was relieved, that I am now one skin tone,” she said.

According to dermatologist Dr Robert Weiss, vitiligo is an autoimmune disease where the immune system is confusing and attacks pigment cells for unknown reasons. “The actual cause is not known,” he said.

Weiss said in some cases, there might be several people in a family with the condition but it is not necessarily hereditary.

Molebatsi is the only person in her family with the condition.

She also says her skin is not painful or itchy as long as she uses sunscreen every day.

Though Molebatsi has completely accepted her condition, she still has to deal with people who don’t understand it and call her names.

“There are still challenges even now. People tend to think I bleached my skin. They still call me names like Khanyi Mbau or even a fake white person.

“People look at me and assume I am albino. The stigma is almost the same as it was the same as when I had patches. At school, it was the worst. They thought if they touched me they would be like me. I was a lonely child at school,” she says.

Weiss said there are differences between albinism and vitiligo. “Vitiligo is an acquired condition that appears at any time after birth. The areas of hypopigmentation are usually in patterns but it doesn’t usually affect the whole body, and never affects the eyes. Albinism is a hereditary condition with the condition present at birth. The entire skin and eyes are affected as well as hair. It is a genetic condition,” Weiss said.

After years of being stigmatised, Molebatsi has now started the Beautiligo Foundation to help those living with the condition understand it and receive support.

“I have always felt alone. I feel like if somebody had started this organisation when I was young I would have dealt with it so much better,” she said.

The foundation hosts workshops at schools and offers support groups for families.

Follow Moleboheng Molebatsi

(@MolebohengMol11) / Twitter

Moleboheng Molebatsi | Facebook

(@mo_molebatsi) | Instagram

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In Vitiligo, Vitiligo stories

Disability is not an Inability

These are the 10 Fun Facts about Julie Nasuju You didn’t know as below.

In The research done by Maya Clinic and Oxford University Medical science, vitiligo is a condition in which the pigment is lost from areas of the skin, causing whitish patches, often with no clear cause. In our article we shall look at a living testimony of a vitiligo victim and what she is today;

Julie Nasuju is a Kenyan Model at Model management.com, MC, Deejay, Actress, Motivational speaker who lives with a skin pigment (vitiligo) since her childhood.

Fun Facts 1. Good vibes ambassador.

2. I love my skin.

3. Mother of four.

4. Loves cooking and eating.

5. Sometimes I’m mistaken as either Nazizi or Fena look alike.

6. Once featured as the main model on a Sauti Sol music video.

7. Was a dancer back in the days.

8. Was once a lead singer in a worship team.

9. Was a handball goalkeeper.

10. My life journey is inspiring.

She is also a member of Royal Patches, a platform of the Vitiligo Society of Kenya that organizes meetings and empowerment sessions for vitiligo living Kenyans this is because, In June, a friend of theirs, a 20-year-old girl suffering from vitiligo, committed suicide. That proved it is necessary to reach other vitiligans, support and encourage them.

I kindly welcome your thoughts, comment, likes and shares about the above content on the beautiful living Kenyan Model With vitiligo.

 

You can follow her Instagram page @royal_patches

Source

 

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In Vitiligo, Vitiligo stories

The fight against stigmatization

By Sista Akos

Enam Honya Heikeens a pretty Ghanaian nurse who had her nice-looking black skin completely being dominated by a skin illness known as vitiligo which she has to live with since age 7.

In an up-close with Enam, now the director for Vitiligo Ghana Foundation mentioned that she assists people to fight against the stigma people with vitiligo have to endure because of their situation and indicates that it has never been easy.

In the entire life of Enam, she has had to endure the strange looks people give her and to some extent refrain from any form of contact with her as if she had a communicable disease.

“People are always asking questions about my skin. They always stare at me and there have been instances when community folks don’t want to board the same bus with you or have their kids befriend you because they think the condition is contagious” she added.

Enam had her basic education at Keta State School. She continued to Keta Business Senior High School and later went to Keta Nursing and Midwifery training college all in the Volta region. As stated by Enam, her interest is to keep encouraging people with vitiligo and develop plans to put a limit to the stigma attached to the condition.

You can follow Enam on Instagram @vitiligo_ghana

Source

 

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In Non classé, Vitiligo, Vitiligo research, vitiligo treatment

Anxiety and depression in pediatric patients with vitiligo and alopecia areata and their parents: A cross-sectional controlled study Part 1

Department of Dermatology, University of

Health Sciences, Sultan Abdulhamid Han

Training and Research Hospital, Istanbul,

Turkey

Correspondence

Sevil Savaş Erdoğan, Department of

Dermatology, Sultan Abdulhamid Han Training and Research Hospital, Tıbbiye Street., 34668, Usküdar, Istanbul, Turkey. Email: doktorsevilsavas@gmail.com

2232  |   © 2020 Wiley Periodicals LLC                                                       wileyonlinelibrary.com/journal/jocd       J Cosmet Dermatol. 2021;20:2232–2239.

 

1       | INTRODUCTION

Anxiety and depressive disorders are the most common psychopathologies in children and adolescents.1 Alopecia areata (AA) is a common hair disorder characterized by a sudden-onset non-cicatricial but has a great negative effect on cosmetic appearance. Several studies have estimated the prevalence of AA worldwide to be 1%-2%, and in the majority, the first patch presents before the age of 20 years.2 Vitiligo is characterized by the partial or complete absence of melanocytes that cause the development of white macules or patches in various parts of the body.3,4 The worldwide prevalence of vitiligo is estimated to be 0.5%-2%, and approximately 50% of patients experience vitiligo before the age of 20 years.5,6 Since their visibility, chronic and disfiguring nature, and lack of curative therapy, AA and vitiligo may have high psychosocial effects on patients. AA and vitiligo are associated with various psychiatric comorbidities. In different studies, high anxiety and depressive disorder rates have been reported in children and adolescents with AA.7-11 Studies have shown that vitiligo patients suffer more from depression and anxiety.12-14 However, there are only a limited number of studies investigating the relationship between vitiligo and psychiatric state in children and adolescents.15-17

Skin diseases have a negative effect on family life,18-20 and the care of a child with AA or vitiligo may be associated with higher anxiety and depression in their parents than that of healthy children. Unlike other studies, in the current work, children and adolescents with AA and vitiligo and their parents were compared with each other and also with the healthy control group. Therefore, we aimed to identify psychiatric findings in children and adolescent groups with AA and vitiligo and to evaluate the levels of anxiety and depression in their parents. We also aimed to investigate the quality of life (QoL) of patients, and the impact of the disease on their parents.

2       | MATERIAL AND METHOD

2.1      | Study design and subjects

This is a prospective cross-sectional study conducted in our dermatology outpatient clinic between October 2018 and December 2019. The study was approved by the institutional ethical committee and carried out in accordance with the principles of the Declaration of Helsinki. Patients, controls, and their parents, who agreed to participate in the study, provided informed consent.

The study included children and adolescents aged seven to 17 years and their parents. Of the patients, 31 had AA and 29 had vitiligo. In addition, 30 age- and gender-matched healthy controls without any dermatological disease and their parents with a similar education level to that of the patients’ parents were included as a reference group. The following exclusion criteria were used for both the patient and control groups: systemic treatment (systemic steroid, cyclosporin and/or neuropsychiatric drugs) within the last three months prior to the study and any other chronic disease.

2.2      | Demographic variables and clinical severity

Demographic data (patient age and gender, and parental age and education level) and medical information (disease duration, disease severity, and presence of stressful life events within the past year from the onset of disease) were noted in separate forms for the patients. In addition, through a clinical examination, the Severity of Alopecia Tool (SALT) score21 was calculated for the patients with AA, and the Vitiligo Area Severity Index (VASI)22 for those with vitiligo.

The questionnaires explained below were administered in a single interview. The patients and controls completed the Revised Child Anxiety and Depression Scales-Child version (RCADS-C), and their parents completed the parent version (RCADS-P) to support the results of the child version. The parents also completed the Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI). Lastly, the Children’s Dermatology Life Quality Index (CDLQI) scale was completed by the patients, and the Dermatological Family Impact Scale (DeFIS) by their parents.

2.3      | Scales on psychological parameters and QoL

CDLQI is a four-point Likert scale that evaluates the state of the patients and can be used in children aged four to 17 years. Higher scores indicate a greater level of deterioration in QoL. In this study, we used the Turkish version of this scale, for which validity and reliability studies have been previously conducted.23

RCADS-C and RCADS-P are self-report questionnaires, each containing 47 items designed to assess DSM-IV depression and anxiety disorders in children and adolescents. Response options are based on four-point Likert scales. Both versions have six subscales [separation anxiety disorder (SAD), social phobia (SP), obsessive-compulsive disorder (OCD), panic disorder (PD), generalized anxiety disorder (GAD), and major depressive disorder (MDD)] and provide a total anxiety score (sum of the score in five anxiety scales) and a total internalizing score (sum of the six scores in subscales).24 In this study, we used the Turkish versions of these questionnaires. The validity and reliability studies of the Turkish versions have been previously conducted.25,26

DeFIS is a 15-item, five-choice response scale to investigate how the family QoL of patients with chronic dermatosis has been affected within the last month and produces a score of 0-4. Higher scores indicate greater impairment in QoL. The scale was developed for the Turkish society by Turan et al, and the validity and reliability studies have been undertaken by the same authors.27

BAI is a 21-item self-report scale that was used to measure parents’ anxiety levels in this study. The items include symptoms of anxiety and higher total scores indicating greater anxiety levels. BAI was previously adapted to the Turkish society, and the Turkish version of the scale was in the current study.28

BDI is a 21-item self-report scale that was used to measure the level of depression in parents. There are four statements for each symptom, and a higher total score indicates a higher level of depression. The validity and reliability studies of the Turkish adaptation of the 1979 version of BDI have been undertaken.29,30

2.4      | Statistical analysis

As the statistical method, descriptive analyses (frequency distributions, percentage, mean, and standard deviation) were used. For the analysis of continuous data, conformance to normal distribution was checked using the Kolmogorov-Smirnov test. For the data that were normally distributed, the comparison of more than two groups was undertaken with ANOVA and the post hoc Bonferroni test and the comparison of two groups using the t-test.

In the absence of normal distribution, Kruskal-Wallis and MannWhitney U tests were performed, the chi-square test was used for discrete data, and Fisher’s exact test was conducted depending on the data compatibility. Relationships were investigated by the

TABLE 1 Characteristics of patients and controls

Spearman rho correlation coefficient. The results were evaluated at the 95% confidence interval and P < .05 significance level.

3       | RESULTS

3.1                | Demographic and clinical characteristics of the study groups

Thirty-one patients with AA, 29 patients with vitiligo, and 30 age- and gender-matched controls were included in the study. The mean (± standard deviation) ages of the in the AA, vitiligo, and control groups were 12.5 ± 3.6, 13 ± 3, and 12.6 ± 3.1 years, respectively. There was no statistically significant difference between the patient and control groups in terms of age, gender, number of siblings, parental education level, and parental marital status (Table 1). All patients with AA had the patchy type, and their mean SALT score was 6.3 ± 13.1. In the vitiligo group, the type of disease was vulgaris in 51.7% (n = 15), focal in 44.8% (n = 13), and segmental in 3.4% (n = 1). The mean VASI score of the vitiligo group was 3.6 ± 7.4. The mean disease duration was 6.5 ± 15.5 (range, 1-84) months in the AA group and 31.4 ± 35.5 (range, 2-132) months in the vitiligo group.

The difference between the AA, vitiligo, and control groups in terms of the presence of stressful life events was statistically

 

Groups

Alopecia areata

 Vitiligo Controls P-value
Age, mean ± SD 12.54 ± 3.56 13 ± 3.03 12.6 ± 3.06 .85
Sex Female, n (%) 14 (45.16) 13(44.82) 14(46.66) .98
Male, n (%) 17 (54.83) 16(55.17) 16(53.33)
Mother’s educational level Illiterate, n (%) 1 (3.2) 3(10.3) 0 .56
Primary school, n (%) 12 (38.7) 9(31) 12(40)
Middle School, n (%) 5 (16.1) 5(17.2) 8(26.7)
High school, n (%) 9 (29) 6(20.7) 7(23.3)
University, n (%) 4 (12.9) 6(20.7) 3(10)
Father’s educational level Illiterate, n (%) 11 (35.5) 6(20.7) 13(43.3) .6
Primary school, n (%) 5 (16.1) 6(20.7) 4(13.3)
Middle School, n (%) 8 (25.8) 11(37.9) 9(30)
High school, n (%) 7 (22.6) 5(17.2) 4(13.3)
University, n (%) 0 1(3.4) 0

Parental marital status                                         Married, n (%)                                 27 (87.1)                                   25(86.2)                       30(100)                                                                    .11

Separated, n (%)                            4 (12.9)                                        4(13.8)                                                                                                               0

Number of siblings 1, n (%) 4 (12.9) 3(10.3) 4(13.3) .56
2, n (%) 12 (38.7) 17(58.6) 18(60)
3, n (%) 10 (32.3) 7(24.1) 6(20)
4, n (%) 3 (9.7) 2(6.9) 2(6.1)
5, n (%) 2 (6.5) 0 0

TABLE 2 Comparison of groups’ psychological test scores and presence of stressful life event

Groups P-value
                                             Alopecia areata                       Vitiligo                                          Controls AA-Vi                         AA-C                         Vi-C

Stressful life event, n (%)                        19 (61.3)                                      25 (86.2)                                      9 (30)                                                                               .041                                               .014                                         <.0001

RCADS-Child, mean ± SD

Separation Anxiety

 55.61 ± 12.94 50.21 ± 9.6 48.83 ± 9.9 .116 .026 .291
Generalized Anxiety 48.61 ± 11.37 45.14 ± 9.09 42.5 ± 7.41 .195 .021 .261
Panic 49.65 ± 12.3 47.31 ± 10.9 44.67 ± 8.17 .454 .177 .470
Social Phobia 46.19 ± 12.48 43.66 ± 8.72 39.93 ± 8.34 .625 .050 .069
Obsessive-Compulsive 48 ± 12.58 48.03 ± 11.56 46.93 ± 8.89 .935 .874 .952
Depression 49.68 ± 12.21 47.38 ± 14.3 41.07 ± 7.55 .314 .006 .162
Total Anxiety 49.03 ± 12.96 45.69 ± 10.5 42.43 ± 7.88 .287 .057 .295
Total 49.13 ± 12.9 45.86 ± 11.63 41.47 ± 7.95 .245 .010 .261

RCADS-Parent, mean ± SD

Separation Anxiety 57.55 ± 15.3 54.38 ± 9.8 51.03 ± 8.43 .700 .167 .181
Generalized Anxiety 54.81 ± 9.64 52.9 ± 11.55 51.6 ± 10.8 .415 .133 .660
Panic 55.06 ± 12.64 54.24 ± 11.82 48.57 ± 9.9 .795 .014 .030
Social Phobia 49.26 ± 12.09 49.45 ± 10.91 45.83 ± 8.47 .900 .291 .199
Obsessive-Compulsive 57.39 ± 11.18 55.86 ± 11.17 54.97 ± 11.18 .573 .422 .558
Depression 58.74 ± 14..95 56.24 ± 14.15 47.37 ± 8.23 .529 .001 .014
Total Anxiety 55.06 ± 10.92 53.9 ± 12.39 50.2 ± 10.65 .569 .041 .316
Total 56.32 ± 11.1 54.72 ± 12.24 49.43 ± 10.22 .428 .012 .074
Parents’ BAI, mean ± SD 11.71 ± 8.78 11.45 ± 10.21 8.97 ± 8.71 .667 .169 .235
Parents’ BDI, mean ± SD 10 ± 6.72 9.83 ± 5.79 7.53 ± 5.78 .906 .110 .093

Abbreviations: AA, Alopecia Areata; Vi, Vitiligo; C, Controls; BAI, Beck Anxiety Inventory; BDI, Beck Depression Inventory; RCADS-Child, Revised Child Anxiety and Depression Scales, Child Version; RCADS-Parent, Revised Child Anxiety and Depression Scales, Parent Version.

 

significant (P < .0001). Furthermore, this parameter was statistically significantly higher in the vitiligo group compared to the AA and control groups (P = .014 and P < .0001, respectively) (Table 2).

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In impact of vitiligo on children and their parents, Vitiligo, Vitiligo research

Parental Stress and Quality of Life in Chronic Childhood Dermatoses Part 1

by DEBATRI DATTA, MD; RASHMI SARKAR, MD, MNAMS; and INDRASHIS PODDER, MD, DNB

Dr. Datta is a consultant dermatologist at Oliva Skin Clinic, in Kolkata, West Bengal, India. Dr. Sarkar is with the Department of Dermatology, LHMC and associated KSCH and SSK Hospital in New Delhi, India. Dr. Podder is with the Department of Dermatology, College of Medicine and Sagore Dutta Hospital in Kolkata, West Bengal, India.

Vitiligo, urticaria, and acne vulgaris, can 1 J Clin Aesthet Dermatol. 2021;14(9 Suppl 1):S19–S23 Chronic childhood dermatoses, such as atopic dermatitis, psoriasis, ichthyosis, require frequent dermatologic consultations and have a profound impact on a pediatric patient’s quality of life. Demand for social and psychological support increases as these children grow up and integrate into society, and children with severe disease may need around-the-clock care for years. Studies have shown that parents caring for children with chronic disorders often experience negative changes in psychosocial status, which can negatively impact adherence to treatment for the child, resulting in worsening of the condition.1–3

Although research exists for chronic systemic illnesses, such as epilepsy, asthma, cancer, and diabetes, to our knowledge, literature is scarce regarding the eff ect that caring for a child with a chronic dermatosis can have on the parent.2 Here we explore the existing literature to better understand the impact that caring for a child with a chronic dermatosis can have on the parent/caregiver’s mental health (e.g., stress) and quality of life.

MATERIALS AND METHODS

We undertook a comprehensive English literature search across multiple databases including PubMed (MEDLINE database), Scopus, and Cochrane using the keywords (alone and in combination) and MeSH items “chronic childhood dermatoses” OR “atopic dermatitis” OR “vitiligo” OR “psoriasis” OR “acne” OR “urticaria,” AND “parental stress” OR

“caregiver stress” OR “parent quality of life” OR “caregiver quality of life” OR “family quality of life” to obtain relevant articles, priority being given to prospective, randomized, controlled trials and those concerning chronic dermatological disorders and parental or caregiver stress. Additional data were obtained from the reference lists of selected articles.

RESULTS

Overall we obtained three review articles (1 foused on atopic dermatitis) and 20 clinical studies (5: atopic dermatitis, 4: vitiligo, 4: psoriasis, 1: psoriasis and atopic dermatitis, 1: epidermolysis bullosa, 5: chronic childhood dermatoses, 1: alopecia areata). We analyzed these articles and prepared the current manuscript along with a relevant review of literature.

DISCUSSION

Although there have been several studies concerning parental stress in chronic childhood morbidities, such as bronchial asthma, cancer, epilepsy, juvenile rheumatoid arthritis, and sickle cell anaemia,2 data specifi ally on chronic dermatoses are scarce. Among the available relevant literature, the majority of

 

FUNDING: No funding was provided for the preparation of this article.

DISCLOSURES: The authors have no confl icts of interest relevant to the content of this article.

CORRESPONDENCE: Indrashis Podder, MD, DNBD; Email: ipodder88@gmail.com

TABLE 1. Potential causes of increased stress in parents/caregivers of children with chronic skin diseases
IMPORTANT REASONS OF INCREASED PARENTAL STRESS POSSIBLE EXPLANATION
Child’s behaviour • Affected children suffering for a long time may become clingy and needy.

•         Psychiatric disorders such as depression and anxiety may develop.

•         Severe disease may cause more behavioural problems.
Parent-child relationship •         Parents may become stressed by their child’s need for constant attention.

•         Social isolation of the child (possibly into adolescence) may affect the parents.
Psychosocial functioning of parents •         Parents/caregivers can suff er from worry, emotional lability, depression, anxiety, and embarrassment.

•         Parents/caregivers can feel guilt, shame, and anxiety over the consequences faced by children.

•         Parents/caregivers may be overprotective of their children and/or give in to their children’s demands due to emotional exhaustion.
Marital relationships •         Marital discord may arise due to unnecessary self- or partner-blaming for familial diseases.

•         Partners may develop feelings of jealousy over lack of intimate time.7
Sleep disturbance in parents •       Nocturnal caring of children can disturb sleep pattern of caregivers.
Diet and meal preparation •       Adjustments, if any, required for the children’s diet can cause stress.
Environmental factors •       Adjustments in home environment, like changing and washing sheets regularly or cleaning up after the sick child, can cause stress.
Financial burden •         Regular cost of medicines, multiple doctor visits, transport, etc. can eat into the family budget.

•         Time contributed to patient care can aff ect employment of the caregiver.
Sibling problems •       Yet unstudied–attention given to sick children can stress siblings and cause familial discord.

with atopic dermatitis were more anxious and depressed, compared to controls.22 However, educational interventions and behavioural modifi cations have been shown to reduce the severity of disease in the child and help both child and parent/caregiver improve psychologically.23

A study using the Infants’ Dermatitis Quality of Life Index (IDQOL) and Dermatitis Family Impact (DFI) to measure the quality of life in families with children with atopic dermatitis noted tiredness and sleep deprivation in parents/caregivers due to the children taking a long time to fall asleep.24 In a study by Sarkar et al,25 researchers reported increased stress and submissive personality traits in mothers of Indian children with atopic dermatitis, which appeared to increase psychological disturbances in their children. In addition to emotional stress, the need for cleanliness to avoid environmental allergens, as well as the imposed fi nancial burden as a result of long-term treatment and care, were reported to further increase stress in parents and caregivers of such children.25

articles we found pertained to childhood atopic dermatitis, followed by psoriasis.1–3 Our analysis of the available data revealed that chronic childhood dermatoses can affect the parental/ caregiver’s quality of life and induce stress for several possible reasons, which are highlighted in

Table 1.4–10

Scales to assess parental/

caregiver stress. A vital problem in assessing parent/caregiver stress is the paucity of scales to document its presence and severity. Such documentation is necessary, not only for academic purposes but also to assess the role of therapy in such individuals. Over the years, several scales and instruments have been designed to measure the impact of dermatological diseases on families and caregivers (Table 2).7,11–20

 Atopic dermatitis. Atopic dermatitis is one of the most studied childhood dermatoses in relation to familial stress. A study of American children with atopic dermatitis reported that parents experienced self-blame and guilt on observing their children suffer.5 As the disease persisted into adolescent years, resultant social isolation of the child often prolonged and aggravated parental stress.5 In a Chinese study,21 mothers spent more time with their children with atopic eczema, compared to other caregivers, and reported more suffering (i.e., negative effects on mental and physical well-being due to difficulty in simultaneously managing childcare responsibilities with other household responsibilities.5 Another study reported that mothers caring for children

Vitiligo. Vitiligo is an acquired depigmenting disease that destroys melanocytes, aff ecting one or multiple regions of the body.26 Childhood vitiligo is common—50 percent of vitiligo patients note onset before 20 years of age, amd 25 percent have onset before the age of 10. There is female preponderance for vitiligo and segmental distribution (i.e., distributed along a dermatome).26 Though vitiligo does not cause physical limitations, the cosmetic disfigurement can result in social discrimination and ostracization of the child, which can negatively impact the psychosocial status of the child, the child’s parent/caregiver, and other members of the child’s family.

Studies in children and adolescents with vitiligo have assessed its impact on patient quality of life, and a greater incidence of childhood depression has been reported.27,28 Interestingly, the decreased quality of life appeared to be dependent on the patient’s apprehensions and psychosocial adjustments, rather than actual clinical severity.29 However, very few studies are available regarding the stress of parents, caregivers, and families in regard to their children with vitiligo.

A study by Amer et al included 50 children with vitiligo and their parents and 50 healthy

 

S20          The Journal of Clinical and Aesthetic Dermatology • September 2021 • Volume 14 • Number 9 • Supplement 1

 

controls.30 The Self-rated Health Measurement Scale (SRHMS) and the Dermatitis Family Impact Questionnaire (DFI) were used to assess the impact of vitiligo on the life of the patients and their families. Investigators reported greater psychological distress and feelings of embarrassment among parents of patients with vitiligo. Parents of children with generalized, progressive disease were more severely aff ected. The mothers were more aff ected than fathers, reporting exhaustion, self-blame, and disappointment regarding disease prognosis.30

A Brazilian study assessing anxiety and depression in caregivers of pediatric dermatology patients noted anxiety and depression in 42 percent and 26 percent of participants, respectively.31 The extent of visible body surface area affected correlated with degree of anxiety in caregivers. An Indian study noted parents of children with vitiligo reported being worried about the children developing low self-esteem and difficulty in arranging marriages for them.32 This parental anxiety was reported to conversely aff ect the children psychologically, in that the children became concerned over their parents distress. Another hospital-based Indian study on immediate caregivers (parents and grandparents) of pediatric patients with vitiligo, using the Family Dermatology Life Quality Index (FDLQI), detected emotional distress in caregivers and impaired quality of life in female patients and those with longer duration of disease. The researchers recommended psychiatric counseling for the patient and family members.33

TABLE 2. Important scales that assess stress and quality of life in parents/caregivers of children with chronic dermatoses
SCALE INFORMATION DISEASE
Family Dermatology Life Quality Index (FDLQI)12 Semi-structured interviews with family members Any skin disease
Dermatitis Family Index (DFI)7 Widespread, available in many languages Atopic dermatitis
The Parents’ Index of Quality of Life in Atopic Dermatitis (PIQoLAD)13 28 items; change of 2–3 points is meaningful Childhood atopic dermatitis
Measure of Quality of Life in Primary Caregivers of Children with Atopic Dermatitis (QPCAD)14 Self-report questionnaire for past 1 week for caregivers Childhood atopic dermatitis
Childhood Atopic Dermatitis Impact Scale (CADIS)15 Eff ect on quality of life of children <6 years and families Childhood atopic dermatitis
Psoriasis Family Index (PFI)16 14 questions to measure impact on quality of life of family members Psoriasis
VIPOC
In Vitiligo, Vitiligo research

Factors affecting quality of life in patients with vitiligo Part 1

Correspondence

Gwang Seong Choi.

E-mail: garden@inha.ac.kr

Accepted for publication

4 April 2017

Funding sources

This study was supported by the Vitiligo Research Grant of the Korean Dermatological Association.

Conflicts of interest

None declared.

*Plain language summary available online

DOI 10.1111/bjd.15560

 Background Little is known about factors affecting the quality of life (QoL) of patients with vitiligo, and previous studies have shown conflicting results. Objectives To explore the QoL of patients with vitiligo and to identify factors affecting QoL.

Methods A nationwide questionnaire-based study was conducted with 1123 patients with vitiligo recruited from 21 hospitals in Korea from July 2015 to June 2016. Data were collected using a structured questionnaire for demographic information and the Skindex-29 instrument. Mild or severely impaired QoL in patients with vitiligo was assessed according to each domain (symptoms, functioning and emotions) of Skindex-29. Multivariate logistic regression analyses were performed to determine the factors associated with QoL.

Results Of the enrolled participants, 609 were male and 514 female, with a mean age of 498 years (range 20–84). The median duration of disease was 30 years (range 0–60). Using multivariate logistic regression modelling, the involvement of visible body parts and a larger affected body surface area were consistently associated with QoL impairment in all three domains of Skindex-29. Additionally, the QoL of patients aged 20–59 years, who potentially had a more active social life than older patients, was associated with functional impairment. Furthermore, a higher educational background was associated with emotional impairment.

238              British Journal of Dermatology (2018) 178, pp238–244

Conclusions A multitude of factors significantly influence the QoL of patients with vitiligo. A better appreciation of these factors would help the management of these patients.

What’s already known about this topic?

  • Quality of life is highly impaired in patients with vitiligo.

What does this study add?

  • The involvement of visible body parts and a larger affect6ed body surface area were consistently associated with impaired symptoms, functioning and emotions.
  • Vitiligo with nonvisible lesions also considerably compromises quality of life; vitiligo should not be regarded as a cosmetic problem.
  • Patients aged 20–59 years experienced significant functional impairment, and those with a higher educational background had more impairment in their emotions.

 

Vitiligo is a chronic depigmentation disorder characterized by well-demarcated white macules and patches, reflecting selective melanocyte destruction. The condition affects 05–2% of the population and remains a major challenge in dermatology.1 Although vitiligo is generally asymptomatic, it profoundly impacts quality of life (QoL).2 Many patients with vitiligo experience stigmatization, low self-esteem and social isolation; even normal daily living may be compromised by the unusual appearance of patients.3 Nevertheless, vitiligo is often regarded as a cosmetic issue, and impairment of QoL tends to be underestimated.4

Major effort should be made to induce repigmentation in patients with vitiligo; however, treatment is not always successful.5,6 Furthermore, the clinical course is unpredictable, and patients frequently encounter recurrence and spread throughout their lifespan.7 Therefore, it is also important to manage the psychosocial impact of the disease, and clinicians should understand the factors associated with QoL impairment when treating patients with vitiligo.

Although a number of studies have already shown that QoL is highly impaired in patients with vitiligo, the factors influencing QoL have rarely been investigated in large populations. We conducted a nationwide questionnaire-based survey of QoL in patients with vitiligo. The factors associated with QoL impairment were examined from the viewpoints of symptoms, functioning and emotions.

Patients and methods

Participants and settings

A nationwide questionnaire-based study was conducted in 21 hospitals and clinics in Korea from July 2015 to June 2016. All patients aged ≥ 20 years diagnosed with vitiligo by dermatologists, and who provided written informed consent prior to the survey were enrolled. We restricted the participants to adult patients, because different questionnaires should be applied to children and adults. We explored demographic characteristics and vitiligo phenotypes and determined Skindex-29 scores. All patients first completed the questionnaires in paper-and-pencil format, and dermatologists then confirmed the clinical profiles after interviewing and examining the patients. The study protocol was designed in accordance with the Declaration of Helsinki and was approved by the institutional review board of each hospital.

Demographic characteristics

Demographic characteristics recorded included age, sex, marital status (single or married) and educational background (elementary school graduate, middle school graduate, high school graduate or college graduate).

Vitiligo phenotypes

The vitiligo phenotypes included subtype (segmental or nonsegmental), disease duration (< 1, 1–4, 5–9 or ≥ 10 years), affected body surface area (BSA; < 05, 05–09, 1–4, 5–9, 10–19 or ≥ 20%), involvement of visible body parts (yes or no) and the particular body parts involved (face and neck, scalp, upper extremities, lower extremities, trunk and genital area).

The Skindex-29 questionnaire

QoL was assessed using the Korean version of Skindex-29. This instrument is employed extensively to measure the effects of skin disease on a patient’s life;8,9 the Korean version was cross-culturally adapted by Ahn et al.10 The semantic equivalence of all back-translated items has been confirmed,10 and the Korean version has been validated by several previous studies.11–13 The questionnaire contains 29 items exploring the influence of skin disease on daily life using a five-point scale: 0 (never), 1 (rarely), 2 (sometimes), 3 (often) and 4 (all the time). The responses were transformed into linear scores varying from 0 (no effect) to 100 (effect always experienced). Each item belongs to one of three domains (symptoms, functioning and emotions); the scores of the three domains were calculated as the mean score of the items included in each domain.

The major items affecting patients with vitiligo

The proportions of patients affected by each item (sometimes, often and all the time) were calculated. The items of most concern were identified based on the answers.

Quality-of-life impairment

The outcomes of the study were mild or severe impairment of QoL, as determined by each domain (symptoms, functioning and emotions) of Skindex-29. Mild and severe QoL impairments were defined using the cut-off scores suggested by Prinsen et al.:14,15 ≥ 39 (mild) and ≥ 52 (severe) for symptoms, ≥ 21 (mild) and ≥ 37 (severe) for functioning, and ≥ 24 (mild) and ≥ 39 (severe) for emotions.

Statistical analyses

Absolute and percentage frequencies were determined for categorical variables, and position (mean and median) and scattering (SD, range) were described for continuous variables. Univariate and multivariate logistic regression analyses were sequentially performed to identify the factors independently associated with QoL impairment in each domain of Skindex29. All analyses were performed using R 3.3.1 (R Foundation for Statistical Computing, Vienna, Austria).

 

Source

VIPOC
In Vitiligo, Vitiligo research

Transcultural assessment of the quality of life in patients with vitiligo

To the Editor: Vitiligo is associated with significant negative psychologic effects, which have been found
to be worse in Eastern cultures than in Western cultures, likely due to the stigma associated with the
disease.1-3 We sought to assess differences in the quality of life (QoL) of South Asian patients according
to the degree of acculturation in the Western culture to determine if integration into the Western
culture is associated with an improved QoL.

South Asian patients with vitiligo, aged 18 years and above, were recruited from a tertiary care
academic dermatology clinic in this institutional review board-exempted study. African American
patients with vitiligo and matching skin types were recruited as controls. South Asian patients from
Hyderabad, India, were also recruited from a vitiligo specialty clinic. The severity of vitiligo was determined using body surface area measurement. All the patients completed the Dermatology Life Quality
Index questionnaire and the 36-Item Short Form survey (SF-36). The South Asian patients were also
given an acculturation questionnaire with the authors’ permission.4 The degree of integration of
South Asians into the Western culture of the United States of America (USA) was assessed using a series
of questions, including the frequency of the use of native language, consumption of native foods,
observation of native cultural or religious holidays, and cultural self-identification. All subjects who
scored 50% or greater were designated as acculturated. The Chi-square or Fisher’s exact test was used
to compare the ethnic groups based on sex and the presence of acculturation. The Dermatology Life
Quality Index, as well as the component and domain scores of the SF-36, were analyzed using 2-way analysis of variance.

The patients’ demographics are presented in Table I. There were no differences between the
groups in terms of the Dermatology Life Quality Index scores or the SF-36 general health domain.
Regarding the SF-36 physical component scores, women in the USA-acculturated group had significantly higher (better QoL) scores than women from Hyderabad. Men scored significantly higher than women, and the USA-acculturated group scored significantly higher than the Hyderabad group
(Table II). The means were significantly higher in African Americans than in the Hyderabad group for
the physical functioning domain, higher in the USAacculturated group than in the Hyderabad group for
the role physical domain, and higher in men than in women for the bodily pain domain (Supplemental
Tables I to III available via Mendeley at https://doi.org/10.17632/fhfzrwnvmx). For the mental component domain scores, men had significantly higher means than women in the vitality domain.

Our results suggest that patients with greater integration into the South Asian culture experience
a more negative effect on QoL, likely due to the stigma associated with vitiligo. There was a significant
QoL impairment seen in the patients from Hyderabad compared with that in the South Asian
patients in the USA, indicating that moving to the USA may have conferred a protective effect. This
effect was the most significant in acculturated South Asian patients integrated into the American culture.
Furthermore, women perceived greater impairment compared with men. The limitations of this study
include its small sample size, recruitment from only 2 centers, and a referral bias because the patients were recruited from specialty clinics. Future, larger studies on acculturation should be performed to confirmour findings. The results of our study suggest that individuals with vitiligo integrated into the South Asian culture, particularly women, experience an increased burden from their disease. Understanding these differences may help providers in managing South Asian patients with vitiligo.

Demographic characteristics African American South Asian, nonacculturated South Asian acculturated South Asian from

Hyderabad, India
Total 20 31 21 30
Men, n (%) 8 (40%) 12 (39%) 13 (62%) 13 (43%)
Mean age in years 50.4 42 40.2 34.4
Median age in years 41.5 41 41 30
Mean duration of vitiligo in years 10.8 8.65 12.66 10.33
Median duration of vitiligo in years 7.0 4.0 10.0 4.5
Nonsegmental type, n (%) 20 (100%) 29 (94%) 18 (86%) 27 (90%)
Median BSA, % (IQR) 7.05 (0.44, 16.25) 1.00 (0.25, 3.00) 1.88 (0.48, 5.00) 0.70 (0.25, 2.98)

 

Table II. SF-36 physical component scores based on sex and ethnic groups
Ethnicity Sex n Mean 95% confidence interval

Lower bound

 Upper bound ANOVA model P values
Ethnicity Sex Interaction of ethnicity and sex
USA-acculturated Male 13 55.05 51.49 58.61 .030 .034 .025
Female 8 59.79 55.26 64.33
USA-nonacculturated Male 12 56.49 52.79 60.19
Female 19 51.14 48.20 54.09
African American Male 8 57.05 52.51 61.58
Female 12 51.79 48.09 55.49
Hyderabad Male 13 54.53 50.97 58.09
Female 17 48.92 45.81 52.03

 

interaction: women in USA-acculturated group versus women in Hyderabad group, P ¼ .0046; P values \.05 were statistically significant.

ANOVA, Analysis of variance; SF-36, 36-item short form survey; USA, United States of America.

 

recruited from specialty clinics. Future, larger studies on acculturation should be performed to confirm our findings. The results of our study suggest that individuals with vitiligo integrated into the South Asian culture, particularly women, experience an increased burden from their disease. Understanding these differences may help providers in managing South Asian patients with vitiligo.

Amrita Hans, MD,a Keerthi A. Reddy, MD,a Samantha M. Black, BS,a Jamael Thomas, MD, MPH,a Orlando Martinez-Luna, BSA,a Jacqueline McKesey, MD, MS,a Linda S. Hynan, PhD,b and Amit G. Pandya, MDa

From the Department of Dermatology, University of Texas Southwestern Medical Centera and Departments of Population & Data Sciences (Biostatistics) and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas.b

Funding sources: None.

IRB approval status: This study was reviewed by the Institutional Review Board of the University of Texas Southwestern Medical Center, Dallas, Texas, and determined to be exempt from review.

Reprints not available from the authors.

Correspondence     to:     Amit     G.      Pandya,      MD,

Department of Dermatology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-9069

E-mail: amit.pandya@utsouthwestern.edu

Conflicts of interest None disclosed.

REFERENCES

  1. Parsad D, Pandhi R, Dogra S, Kanwar AJ, Kumar B. Dermatology life quality index score in vitiligo and its impact on the treatment outcome. Br J Dermatol. 2003;148(2):373-374.
  2. Thompson AR, Clarke SA, Newell RJ, Gawkrodger DJ. Vitiligo linked to stigmatization in British South Asian women: a qualitative study of the experiences of living with vitiligo. Br J Dermatol. 2010;163(3):481-486.
  3. Ongenae K, Van Geel N, De Schepper S, Naeyaert JM. Effect of vitiligo on self-reported health-related quality of life. Br J Dermatol. 2005;152(6):1165-1172.
  4. Bharmal N, Hays RD, McCarthy WJ. Validity of temporal measures as proxies for measuring acculturation in Asian Indian survey respondents. J Immigr Minor Health. 2014;16(5): 889-897.

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