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Akl J, Lee S, Ju HJ, Parisi R, Kim JY, Jeon JJ, Heo YW, Eleftheriadou V, Hamzavi I, Griffiths CEM, Ashcroft DM, Mysore V, Gupta S, Parsad D, Lim H, Bae JM, Ezzedine K. Estimating the burden of vitiligo: a systematic review and modelling study. Lancet Public Health 2024; 9:e386-e396. [PMID: 38552651 DOI: 10.1016/s2468-2667(24)00026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Vitiligo is a chronic autoimmune disease characterised by depigmented skin patches, which can pose substantial psychosocial challenges particularly in individuals with dark skin tones. Despite its impact on quality of life, there is an absence of standardised global epidemiological data. We sought to address this gap with the present study. METHODS In this study we did a systematic review and modelling analysis to estimate the global, regional, and national prevalence and incidence of vitiligo. We did a comprehensive search of nine digital libraries (PubMed, Embase, Web of Science, Scientific Electronic Library Online, KCI Korean Journal Database, Russian Science Citation Index, Western Pacific Region Index Medicus, Informit, and Health Research and Development Information Network) from inception up to May 25, 2023. We included cross-sectional or cohort studies reporting the incidence rate or prevalence of vitiligo, or data from which incidence rate or prevalence could be calculated, in the general population of a country or area of a country. Summary estimate data were extracted. A main outcome was to estimate the worldwide, regional, and country-specific lifetime prevalence of vitiligo diagnosed by physicians or dermatologists among the general population and in adults and children (as per age groups defined in included studies). We used a Bayesian hierarchical linear mixed model to estimate prevalence, and calculated number of affected individuals using the UN population structure in 2022. In estimating lifetime prevalence, studies reporting point or period prevalence were excluded. Our other main outcome was to estimate incidence rates of vitiligo, but due to a small number of studies, the data on incidence were presented in a descriptive summary. This study was registered on PROSPERO, CRD42023390433. FINDINGS Our search identified 22 192 records, of which 90 studies met our inclusion criteria. Of these studies, six focused on the incidence of vitiligo, 79 reported on the prevalence of vitiligo, and five provided data on both incidence and prevalence. 71 studies reported on lifetime prevalence. In the most recent years studied, incidence rates in the general population ranged from 24·7 cases (95% CI 24·3-25·2) per 100 000 person-years in South Korea in 2019, to 61·0 cases (60·6-61·4) in the USA in 2017. In individual studies, incidence rates showed an increasing trend over the periods studied. The global lifetime prevalence of vitiligo diagnosed by a physician or dermatologist was estimated at 0·36% (95% credible interval [CrI] 0·24-0·54) in the general population (28·5 million people [95% CrI 18·9-42·6]), 0·67% (0·43-1·07) in the adult population (37·1 million adults [23·9-58·9]), and 0·24% (0·16-0·37) in the child population (5·8 million children [3·8-8·9]). Vitiligo prevalence was higher in adults than in children across all regions. Central Europe and south Asia reported the highest prevalence (0·52% [0·28-1·07] and 0·52% [0·33-0·82], respectively, in the general population). INTERPRETATION This study highlights the need for standardised epidemiological data collection globally to inform public health policies and improve vitiligo diagnosis and management. Emphasis on the impact on individuals with darker skin tones is crucial to reducing stigma and improving quality of life. Furthermore, our study highlights the need to conduct more research in regions and populations that have been historically under-represented, to effectively address the worldwide burden of vitiligo. FUNDING None.
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Affiliation(s)
- Jennifer Akl
- Department of Dermatology, EpiDermE, Henri Mondor Hospital, Université Paris-Est Créteil, Créteil, France; Department of Dermatology, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Solam Lee
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Hyun Jeong Ju
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Rosa Parisi
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Ji Yoon Kim
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Jae Joon Jeon
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Yeon-Woo Heo
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, South Korea
| | - Viktoria Eleftheriadou
- Vitiligo Clinic and Research, Walsall Healthcare NHS Trust and The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Iltefat Hamzavi
- Multicultural Dermatology Center and Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Christopher E M Griffiths
- Centre for Dermatological Research, University of Manchester, Manchester, UK; Department of Dermatology, King's College Hospital, King's College London, London, UK
| | - Darren M Ashcroft
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Venkataram Mysore
- Venkat Centre for Advanced Skin and Plastic Surgery and Postgraduate Training, Rajiv Gandhi University of Health Sciences, Bengaluru, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Davinder Parsad
- Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Henry Lim
- Multicultural Dermatology Center and Department of Dermatology, Henry Ford Health, Detroit, MI, USA
| | - Jung Min Bae
- Department of Dermatology, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Khaled Ezzedine
- Department of Dermatology, EpiDermE, Henri Mondor Hospital, Université Paris-Est Créteil, Créteil, France; Department of Dermatology, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France.
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Awal G, Kaur N, Singh G, Sharma N. Impact of Vitiligo on Quality of Life in Patients of Skin of Color and Its Correlation With Clinical Severity Assessment Scores Utilizing Disease Specific Scores: A Cross-Sectional Study. Dermatol Pract Concept 2024; 14:dpc.1402a75. [PMID: 38810078 PMCID: PMC11136000 DOI: 10.5826/dpc.1402a75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION Assessment of disease severity of vitiligo is exigent as it is a psychosomatic ailment. VIDA (vitiligo disease activity score) and VASI (vitiligo area severity index) were previously used for this evaluation. Recently, the introduction of two vitiligo specific tools, vitiligo impact scale (VIS)-22 and Vitiligo Quality of Life Index (VitiQoL) has aided in assessing the quality of life (QOL) in a pertinent manner. OBJECTIVES To measure the QOL in vitiligo using disease specific indices (VitiQoL and VIS-22), to assess their relationship with disease severity (VASI and VIDA) and to determine the correlation between QOL scores (VIS-22 and VitiQoL). METHODS This observational cross-sectional study included 195 patients with vitiligo, and their disease severity was calculated using VASI and VIDA scoring. Patients were asked to fill questionnaires for assessing the QOL using validated tools i.e. VIS-22 and VitiQoL. RESULTS Significant correlation was demonstrated between both QOL scores and VASI score (P value 0.001) with slightly higher values for VitiQoL (r = 0.824) than with VIS 22 (r = 0.693). Both scores exhibited a significant association with VIDA score (P value < 0.001). Moreover, statistically significant correlation was found between VIS-22 and VitiQoL, thereby proving the concordance between these scores. CONCLUSIONS The study infers that QOL seemed to be remarkably dependent on the clinical severity scores and that higher disease activity corresponds to poorer QOL. It is imperative to precisely assess burden of vitiligo and the impairments caused by it in order to aid multi-modality management and allow more standardized research.
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Affiliation(s)
- Guneet Awal
- Department of Dermatology,Venereology and Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Navleen Kaur
- Department of Dermatology,Venereology and Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Guramrit Singh
- Department of Dermatology,Venereology and Leprosy, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
| | - Nishant Sharma
- Department of Community Medicine, Sri Guru Ram Das Institute of Medical Sciences and Research, Amritsar, India
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Chivukula N, Ramesh K, Subbaroyan A, Sahoo AK, Dhanakoti GB, Ravichandran J, Samal A. ViCEKb: Vitiligo-linked Chemical Exposome Knowledgebase. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 913:169711. [PMID: 38160837 DOI: 10.1016/j.scitotenv.2023.169711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 12/23/2023] [Accepted: 12/25/2023] [Indexed: 01/03/2024]
Abstract
Vitiligo is a complex disease wherein the environmental factors, in conjunction with the underlying genetic predispositions, trigger the autoimmune destruction of melanocytes, ultimately leading to depigmented patches on the skin. While genetic factors have been extensively studied, the knowledge on environmental triggers remains sparse and less understood. To address this knowledge gap, we present the first comprehensive knowledgebase of vitiligo-triggering chemicals namely, Vitiligo-linked Chemical Exposome Knowledgebase (ViCEKb). ViCEKb involves an extensive and systematic manual effort in curation of published literature and subsequent compilation of 113 unique chemical triggers of vitiligo. ViCEKb standardizes various chemical information, and categorizes the chemicals based on their evidences and sources of exposure. Importantly, ViCEKb contains a wide range of metrics necessary for different toxicological evaluations. Notably, we observed that ViCEKb chemicals are present in a variety of consumer products. For instance, Propyl gallate is present as a fragrance substance in various household products, and Flutamide is used in medication to treat prostate cancer. These two chemicals have the highest level of evidence in ViCEKb, but are not regulated for their skin sensitizing effects. Furthermore, an extensive cheminformatics-based investigation revealed that ViCEKb chemical space is structurally diverse and comprises unique chemical scaffolds in comparison with skin specific regulatory lists. For example, Neomycin and 2,3,5-Triglycidyl-4-aminophenol have unique chemical scaffolds and the highest level of evidence in ViCEKb, but are not regulated for their skin sensitizing effects. Finally, a transcriptomics-based analysis of ViCEKb chemical perturbations in skin cell samples highlighted the commonality in their linked biological processes. Overall, we present the first comprehensive effort in compilation and exploration of various chemical triggers of vitiligo. We believe such a resource will enable in deciphering the complex etiology of vitiligo and aid in the characterization of human chemical exposome. ViCEKb is freely available for academic research at: https://cb.imsc.res.in/vicekb.
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Affiliation(s)
- Nikhil Chivukula
- The Institute of Mathematical Sciences (IMSc), Chennai, India; Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Ajay Subbaroyan
- The Institute of Mathematical Sciences (IMSc), Chennai, India; Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Ajaya Kumar Sahoo
- The Institute of Mathematical Sciences (IMSc), Chennai, India; Homi Bhabha National Institute (HBNI), Mumbai, India
| | | | - Janani Ravichandran
- The Institute of Mathematical Sciences (IMSc), Chennai, India; Homi Bhabha National Institute (HBNI), Mumbai, India
| | - Areejit Samal
- The Institute of Mathematical Sciences (IMSc), Chennai, India; Homi Bhabha National Institute (HBNI), Mumbai, India.
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Hollenbach L, Rogahn J, le Coutre P, Schulze S, Muegge LO, Geissler J, Gruen J, Junghanss C, Felser S. Physical exercise recommendations for patients with chronic myeloid leukemia based on individual preferences identified in a large international patient survey study of the East German Study Group for Hematology and Oncology (OSHO #97). Front Oncol 2024; 14:1345050. [PMID: 38450192 PMCID: PMC10915004 DOI: 10.3389/fonc.2024.1345050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 03/08/2024] Open
Abstract
Background Tyrosine kinase inhibitors (TKIs) have significantly lowered mortality of chronic myeloid leukemia (CML) patients adjusting life expectancy to that of the standard population. However, CML and its treatment with TKIs causes a high disease burden. Physical exercise (PE) could be a non-pharmacological approach to reducing these and improving quality of life. Purpose The aim of this study was to determine the individual disease burden as well as PE preferences of CML patients and to deduce thereof specific PE recommendations. Methods This multicenter survey was conducted in cooperation with the LeukaNET/Leukemia-patient network including CML patients aged ≥18 years (German Registry of Clinical Trials, DRKS00023698). The severity of selected symptoms was assessed using the adapted Myeloproliferative Neoplasms Symptom Assessment Form: 0 (absent), 1-30 (mild), 31-70 (moderate), or 71-100 (severe). Information about patients' PE needs and preferences depending on their motivation was recorded. Results A total of 212 questionnaires were analyzed (52% female, median age 54 years). The prevalence of moderate-to-severe symptoms was 49% for fatigue, 40% for musculoskeletal pain, and 37% for concentration problems. Other commonly reported symptoms included skin reactions (42%) and weight gain (24%). The proportion of overweight/obese patients was 52%. Half of all respondents requested more information regarding PE. Patients with CML preferred individual training (82%), located outdoors (71%), at home (47%), or in an indoor swimming pool (31%). Regarding the training frequency, sports-inactive patients preferred a frequency of 1-2 training sessions per week, whereas sports-active patients preferred 3-4 sessions per week (p <0.001). Sports-inactive patients preferred a training time of 15-45 minutes, while sports-active patients preferred 30-60 minutes (p = 0.002). Subsequently, PE recommendations were developed for patients with CML. Combined resistance and endurance training (moderate intensity twice per week for 30 minutes) was recommended for beginners. Obese patients should prioritize joint-relieving sports. To reduce the risk of skin reactions, direct sunlight and possibly water sports should be avoided, and UV protection should be used. Conclusion Counseling and motivation of CML patients to be physically active should be part of the standard of care as well as support for implementation.
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Affiliation(s)
- Lina Hollenbach
- Department of Internal Medicine, Clinic III – Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany
| | - Julia Rogahn
- Department of Internal Medicine, Clinic III – Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany
| | - Philipp le Coutre
- Department of Hematology, Oncology, and Cancer Immunology, Campus Virchow‐Klinikum, Charité ‐ Universitätsmedizin Berlin, Berlin, Germany
| | - Susann Schulze
- Krukenberg Cancer Center Halle, University Hospital Halle, Halle (Saale), Germany
- Department of Medicine, Medical Clinic II, Carl-von-Basedow-Klinikum, Merseburg, Germany
| | - Lars-Olof Muegge
- Department of Internal Medicine III, Heinrich Braun Klinikum Zwickau, Zwickau, Germany
| | - Jan Geissler
- LeukaNET/Leukemia-Online e. V., Riemering, Germany
| | - Julia Gruen
- Department of Internal Medicine, Clinic III – Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany
| | - Christian Junghanss
- Department of Internal Medicine, Clinic III – Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany
| | - Sabine Felser
- Department of Internal Medicine, Clinic III – Hematology, Oncology and Palliative Care, Rostock University Medical Center, Rostock, Germany
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Rasset P, Mange J, Montalan B, Stutterheim SE. Towards a better understanding of the social stigma of facial difference. Body Image 2022; 43:450-462. [PMID: 36345083 DOI: 10.1016/j.bodyim.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 10/10/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
Facial difference (FD) is not only an individual experience; it is inherently social, reflecting interactions between social norms and individual attitudes. Often FD is stigmatized. In this paper, we employ a widely used stigma framework, namely the social stigma framework put forth by Pryor and Reeder (2011), to unpack the stigma of FD. This framework posits that there are four forms of stigma: public stigma, self-stigma, stigma by association, and structural stigma. We first discuss the social and psychological literature on FD as it pertains to these various forms of stigma. We then describe coping approaches for FD stigma. Lastly, we delineate evidence-based methods for addressing the various forms of FD stigma, such that future efforts can more effectively tackle the stigma of facial difference.
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Affiliation(s)
- Pauline Rasset
- Laboratoire de Psychologie de Caen Normandie (LPCN EA 7452), Université de Caen Normandie, France.
| | - Jessica Mange
- Laboratoire de Psychologie de Caen Normandie (LPCN EA 7452), Université de Caen Normandie, France
| | - Benoît Montalan
- Centre de Recherche sur les Fonctionnements et Dysfonctionnements Psychologiques (CRFDP EA 7475), Université de Rouen Normandie, France
| | - Sarah E Stutterheim
- Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
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Nimkar P, Wanjari A. Vitiligo and the Role of Newer Therapeutic Modalities. Cureus 2022; 14:e31022. [DOI: 10.7759/cureus.31022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 11/02/2022] [Indexed: 11/05/2022] Open
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Sarwer DB, Siminoff LA, Gardiner HM, Spitzer JC. The psychosocial burden of visible disfigurement following traumatic injury. Front Psychol 2022; 13:979574. [PMID: 36110275 PMCID: PMC9468754 DOI: 10.3389/fpsyg.2022.979574] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 12/15/2022] Open
Abstract
Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation (VCA) procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types (skin, muscle, bone, nerves, and blood vessels) as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures.
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Affiliation(s)
- David B. Sarwer
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
- *Correspondence: David B. Sarwer,
| | - Laura A. Siminoff
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
| | - Heather M. Gardiner
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, United States
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Khojah HMJ, Alharbi AG, Alshaeri AA, Alahmadi YM, Elbadawy HM. Impact of narrow-band ultraviolet B radiation therapy on the quality of life of patients with vitiligo. J Taibah Univ Med Sci 2021; 16:843-848. [PMID: 34899128 PMCID: PMC8626815 DOI: 10.1016/j.jtumed.2021.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives Patients with vitiligo experience emotional and psychological stress as they undergo long-term therapy. The debilitating psychosocial effects of this disease on patients' quality of life is well-documented. This study evaluates the effect of the introduction of narrow-band ultraviolet-B (NB-UVB) therapy on the quality of life of patients with vitiligo in Almadinah Almunawwarah, KSA. Methods Thirty-eight patients from the main dermatology center of Ohud Hospital, Almadinah Almunawwarah, were interviewed between June 2017 and March 2019 using the Dermatology Life Quality Index (DLQI) questionnaire. The interviews were conducted before and one year after the course of NB-UVB therapy, which was added as a new treatment modality to the basic therapeutic regimen of topical medications. Results The patients' response to vitiligo therapy was positive. The overall patient satisfaction score regarding the NB-UVB therapy was as high as 9.1 out of 10. The initial overall DLQI score (5.67 ± 0.90) markedly decreased after the NB-UVB therapy (3.08 ± 0.56), indicating a significant improvement. The patients' adherence to the follow-up visits also improved. Conclusion NB-UVB therapy is effective in alleviating psychological stress and improving the quality of life of patients with vitiligo.
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Affiliation(s)
- Hani M J Khojah
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Almadinah Almunawwarah, KSA
| | - Assaf G Alharbi
- Department of Dermatology, Ohud Hospital, Almadinah Almunawwarah, KSA
| | | | - Yaser M Alahmadi
- Department of Clinical and Hospital Pharmacy, College of Pharmacy, Taibah University, Almadinah Almunawwarah, KSA
| | - Hossein M Elbadawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Almadinah Almunawwarah, KSA
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Ranjkesh MR, Partovi MR, Pashazadeh M. The Study of Serum Level of Interleukin-2, Interleukin-6, and Tumor Necrosis Factor-alpha in Stable and Progressive Vitiligo Patients from Sina Hospital in Tabriz, Iran. Indian J Dermatol 2021; 66:366-370. [PMID: 34759394 PMCID: PMC8530078 DOI: 10.4103/ijd.ijd_300_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Vitiligo is an acquired depigmenting disorder characterized by the loss of functional melanocytes from the epidermis. Although the etiology of vitiligo is unknown, over the last few years, substantial data from clinical research have greatly supported the "Autoimmune theory." Vitiligo has two major forms: progressive and stable. As cytokines are important mediators of immunity, the most important of them are IL-2, IL-6, and tumor necrosis factor-α (TNF-α). Objectives: We aimed to study the serum level of IL-2, IL-6, and TNF-α in stable and progressive vitiligo and compared them to find a useful lab test to determine the form of vitiligo for diagnose and treatment. Materials and Methods: Serum IL-2, IL-6, and TNF-α were done by the indirect enzyme-linked immunosorbent assay (ELISA) in 40 cases of stable and progressive vitiligo. Results: Twenty patients had progressive vitiligo and 20 patients were stable vitiligo. In every group, there were seven male patients. Twenty-one patients had a positive family history of vitiligo and four patients had other autoimmune diseases. The average age and familial history between two groups and two genders were not meaningful. The mean serum TNF-α level was significantly higher in progressive than stable vitiligo. No significant difference was observed in the serum levels of IL-2, IL-6 between stable and progressive vitiligo. The mean serum IL-6 and TNF-α had higher levels in male patients. Conclusion: Analysis of TNF-α levels in every age or gender can show us the type of vitiligo, stable or progressive and we can choose the best form of treatment for patients.
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Affiliation(s)
| | | | - Mehrdad Pashazadeh
- Department of Immunology, Faculty of Medicine, Tabriz University, Tabriz, Iran
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Ezzedine K, Eleftheriadou V, Jones H, Bibeau K, Kuo FI, Sturm D, Pandya AG. Psychosocial Effects of Vitiligo: A Systematic Literature Review. Am J Clin Dermatol 2021; 22:757-774. [PMID: 34554406 PMCID: PMC8566637 DOI: 10.1007/s40257-021-00631-6] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration PROSPERO (CRD42020162223). Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00631-6.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, Paris, France.
| | | | | | | | | | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Mountain View, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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11
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Abdullahi U, Mohammed TT, P Musa BO. Quality of life impairment amongst persons living with vitiligo using disease specific vitiligo quality of life index: A Nigerian perspective. Niger Postgrad Med J 2021; 28:169-174. [PMID: 34708702 DOI: 10.4103/npmj.npmj_579_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. This condition can affect the patients' psychology, leading to an impairment of quality of life (QOL). Recently, much attention is been given to the emotional and psychological issues in the affected subjects. Aim of the Study This was to assess the QOL impairment among Nigerian patients with vitiligo using a disease-specific quality of life index questionnaire (VitiQoL). Materials and Methods Seventy seven adults aged 18 years and above with vitiligo attending the Dermatology Clinic of a tertiary health center were included in this cross-sectional study. The QOL was assessed using the vitiligo quality of life questionnaire (VitiQoL). Disease severity was assessed using Vitiligo Area Severity Index (VASI). Results The mean age of the study participants was 38.97 ± 13.2 years, comprising of 32 (41.6%) and 45 (58.4%) females. Almost half of the vitiligo patients belong to the lower socioeconomic class, 37 (48.1%). The mean age of first onset of vitiligo was 33.5 ± 14.84 years, with 32 (41.6%) of the participants having age of first onset between 24 and 42 years. The mean VitiQoL score was 30.51 ± 15.74 (range 3-64). There was a significant relationship between VASI score and VitiQoL (P = 0.036, r = 0.517). Other factors such as age, gender, socioeconomic status, disease activity, family history of vitiligo, duration of the disease and educational attainment were significantly associated with VitiQoL score (P < 0.05). Conclusion QOL is impaired significantly in Nigerian patients with vitiligo. Focusing on patient's QOL is an essential aspect in the management of patients with vitiligo.
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Affiliation(s)
- Umar Abdullahi
- Department of Medicine, Dermatology Unit, Ahmadu Bello University, Zaria, Nigeria
| | | | - Bolanle O P Musa
- Department of Medicine, Immunology Unit, Ahmadu Bello University, Zaria, Nigeria
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12
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Translation, cross-cultural adaptation and validation of the vitiligo-specific health-related quality of life instrument (VitiQoL) into Polish. Postepy Dermatol Alergol 2021; 38:636-643. [PMID: 34658707 PMCID: PMC8501421 DOI: 10.5114/ada.2021.108896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/12/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Vitiligo is an acquired chronic depigmenting disorder of the skin, predominantly asymptomatic. Although vitiligo does not cause direct physical impairment, it is commonly believed that it can produce an important psychosocial burden. Aim To translate, cross-culturally adapt and validate the vitiligo-specific health-related quality of life instrument (VitiQoL) into Polish. Material and methods The study was conducted online on 97 patients with vitiligo from our private outpatient departments in Gdynia and Gdansk, Poland from May 2018 to December 2019. Results There was a significant correlation between VitiQoL and DLQI (r = 0.90, p < 0.001) and also between VitiQoL-PL and subjects' assessment of the severity of their disease (r = 0.94, p < 0.001). We also found a good correlation between the total DLQI and subjects' assessment of the severity of their disease (r = 0.87, p < 0.001). Conclusions The physicians treating this disease still do not have a specific instrument for assessing patients' QoL in Poland. They have to administer other non-vitiligo specific questionnaires to do so. A Polish version of a specific index for estimating quality of life of patients with vitiligo was validated and implemented through an online survey.
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13
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Nasser MAEM, Raggi El Tahlawi SM, Abdelfatah ZA, Soltan MR. Stress, anxiety, and depression in patients with vitiligo. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00120-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Vitiligo has a significant effect on patients’ quality of life; they feel stigmatized and disturbed by their condition. A lot of vitiligo patients, according to reports, suffer from psychological disturbances. The aim of the study is to find the relation between vitiligo and stress, anxiety, and depression and to measure how vitiligo affects the quality of life index. This study included 50 vitiligo patients and 50 matched healthy control groups. All patients were assessed by the Depression Anxiety Stress Scale (DASS) to determine the severity of anxiety, depression, and stress symptoms and the Dermatology Life Quality Index (DLQI) scale to evaluate their quality of life while the control group underwent only the Depression Anxiety Stress Scale.
Results
The prevalence of stress was 76% (n=38), anxiety was 78% (n=39), and depression was 80% (n=40); the difference was statistically significant between patient group and control group regarding stress, anxiety, and depression. Gender had a significant relationship with stress, anxiety, and depression (p < 0.05) (female affected more than male). Also, there was a statistically significant relation between the degree of vitiligo and anxiety (p < 0.05). Vitiligo has a moderate to very severe effect on the quality of life index. There was a statistically significant positive correlation between stress and feeling of embarrassment from vitiligo and clothes choice.
Conclusion
Vitiligo is a psychcutaneous disease that does not only affect the patient’s physical status, but also his mental and psychological status.
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14
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Jaladat AM, Amiri-Ardekani E, Ramezani PS, Boroughani M, Emami Alorizi M, Parvizi MM. Correlation between gastrointestinal symptoms and adherence to traditional Persian medicine dietary recommendations in patients with vitiligo; a cross-sectional study. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 18:813-820. [PMID: 33818030 DOI: 10.1515/jcim-2020-0192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Vitiligo is a chronic disease associated with the depigmentation of regions of the skin secondary to structural or functional damage to melanocytes. This damage results from interactions between the immune system and oxidative stress. In traditional Persian medicine (TPM), the concept of 'Barass' or 'Pissi' encompasses a group of skin diseases including vitiligo, for which there has been an emphasis on the preventive and therapeutic role of dietary modifications. METHODS In this cross-sectional study, 200 vitiligo patients and 200 controls were enrolled with a random sampling method. The participants included patients with vitiligo referred to the Dermatology Clinic of Shahid Faghihi Hospital (Shiraz, Iran), with the control group being comprised individuals who referred to this clinic for cosmetic purposes. Questionnaires comparing the severity of gastrointestinal symptoms and the rate of adherence to TPM dietary recommendations were filled by all participants. Data were analyzed using SPSS version 24.0. RESULTS The case group was significantly less adherent to TPM recommendations than the control group (8.25 ± 27.16 vs. 31.8 ± 10.47; p<0.001). However, there was no significant difference between both groups in the Gastrointestinal Symptom Rating Scale (GSRS) scores (14.09 ± 14.84 vs. 12.62 ± 11.71; p = 0.105). In the case group, the level of adherence to the recommendations of TPM was significantly lower among patients with lower education levels (R=-0.194; p=0.017). Furthermore, there was a significant negative relationship between the length of the disease and adherence to TPM dietary recommendations (R=-0.247; p=0.002). CONCLUSIONS In this study, the level of adherence to TPM recommendations was significantly lower among patients with vitiligo than the control group. Hence, further studies are suggested to identify the probable role of dietary habits in the pathogenesis of vitiligo.
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Affiliation(s)
- Amir Mohammad Jaladat
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ehsan Amiri-Ardekani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Phytopharmaceuticals (Traditional Pharmacy), Shiraz University of Medical Sciences, Shiraz, Iran.,Student Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohadese Boroughani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Phytopharmaceuticals (Traditional Pharmacy), Shiraz University of Medical Sciences, Shiraz, Iran.,Student Association of Indigenous Knowledge, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Morteza Emami Alorizi
- Research Center for Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Department of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Mahdi Parvizi
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Ip A, Muller I, Geraghty AWA, Platt D, Little P, Santer M. Views and experiences of people with acne vulgaris and healthcare professionals about treatments: systematic review and thematic synthesis of qualitative research. BMJ Open 2021; 11:e041794. [PMID: 33526498 PMCID: PMC7853035 DOI: 10.1136/bmjopen-2020-041794] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES The objective of this study was to systematically review and synthesise qualitative papers exploring views and experiences of acne and its treatments among people with acne, their carers and healthcare professionals (HCPs). DESIGN Systematic review and synthesis of qualitative papers. METHODS Papers were identified through Medline, EMBASE, PubMed, PsychINFO and CINAHL on 05 November 2019, forward and backward citation searching, Google Scholar and contacting authors. Inclusion criteria were studies reporting qualitative data and analysis, studies carried out among people with acne, their carers or HCPs and studies comprising different skin conditions, including acne. The title and abstracts of papers were independently screened by three researchers. Appraisal was carried out using the adapted Critical Appraisal Skills Programme tool. Thematic synthesis was used to synthesise findings. RESULTS A total of 20 papers were included from six countries. Papers explored; experiences living with acne, psychosocial impact of acne, views on causation of acne, perceptions of acne treatments, ambivalence and ambiguity in young people's experience of acne and HCPs' attitudes towards acne management. Findings suggest that people often viewed acne as short-term and that this had implications for acne management, particularly long-term treatment adherence. People often felt that the substantial impact of acne was not recognised by others, or that their condition was 'trivialised' by HCPs. The sense of a lack of control over acne and control over treatment was linked to both psychological impact and treatment adherence. Concerns and uncertainty over acne treatments were influenced by variable advice and information from others. CONCLUSIONS People need support with understanding the long-term management of acne, building control over acne and its treatments, acknowledging the impact and appropriate information to reduce the barriers to effective treatment use. PROSPERO REGISTRATION NUMBER CRD42016050525.
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Affiliation(s)
- Athena Ip
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, Surrey, UK
| | - Ingrid Muller
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Adam W A Geraghty
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Duncan Platt
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Paul Little
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Miriam Santer
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
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16
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Germain N, Augustin M, François C, Legau K, Bogoeva N, Desroches M, Toumi M, Sommer R. Stigma in visible skin diseases - a literature review and development of a conceptual model. J Eur Acad Dermatol Venereol 2021; 35:1493-1504. [PMID: 33428316 DOI: 10.1111/jdv.17110] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 12/11/2020] [Indexed: 11/26/2022]
Abstract
The burden of visible skin diseases (VSDs) includes not only physical symptoms but also psychosocial consequences such as depression, anxiety, impaired quality of life and low self-esteem. Stigmatization was shown to play a major role in people with skin diseases. The aim of the study was to review the evidence for the components, drivers and impacts of (self-)stigma, and to organize the data into a series of conceptual models. A targeted literature search was conducted to identify studies on (self-)stigma in relation to VSD. Conceptual models of stigma in VSDs were developed from existing generic conceptual models for VSD and of generic conceptual models of stigma and were refined after discussion with a board of experts, patient advocacy groups, clinicians and researchers. A total of 580 references were identified, of which 56 references were analysed and summarized. Two conceptual models of stigma were identified: one with external stigma and self-stigma dimensions, the other for self-stigma in mental health. These models were adapted to allow a complete description of stigma in VSDs. For this, a distinction was made between 'discrimination' and 'impact'. Finally, five models were developed: macro-overview; stigma, impact and socio-demographics; stigma, impact and disease characteristics; stigma, impact and quality of life; and stigma, impact and coping. Gaps were identified in available quantitative evidence. To our knowledge, this is the first conceptual model of stigma in VSDs. The model will help to standardize evaluation of stigma and to enhance empirical evaluation of anti-stigma interventions in VSDs. Further research should be conducted to develop a more complete model in stigma due to significant gaps in existing evidence, particularly including the stigma in others (external stigma) and also to cover a broader range of VSDs as their impact on particular dimensions of stigma differs.
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Affiliation(s)
- N Germain
- HEOR, Creativ-Ceutical, Paris, France
| | - M Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - K Legau
- LEO Pharma, Kopenhagen, Denmark
| | - N Bogoeva
- HEOR, Creativ-Ceutical, Sofia, Bulgaria
| | | | - M Toumi
- Public Health Department, Aix-Marseille University, Marseilles, France
| | - R Sommer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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17
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Thomas KS, Batchelor JM, Akram P, Chalmers JR, Haines RH, Meakin GD, Duley L, Ravenscroft JC, Rogers A, Sach TH, Santer M, Tan W, White J, Whitton ME, Williams HC, Cheung ST, Hamad H, Wright A, Ingram JR, Levell NJ, Goulding JMR, Makrygeorgou A, Bewley A, Ogboli M, Stainforth J, Ferguson A, Laguda B, Wahie S, Ellis R, Azad J, Rajasekaran A, Eleftheriadou V, Montgomery AA. Randomized controlled trial of topical corticosteroid and home-based narrowband ultraviolet B for active and limited vitiligo: results of the HI-Light Vitiligo Trial. Br J Dermatol 2020; 184:828-839. [PMID: 33006767 DOI: 10.1111/bjd.19592] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Evidence for the effectiveness of vitiligo treatments is limited. OBJECTIVES To determine the effectiveness of (i) handheld narrowband UVB (NB-UVB) and (ii) a combination of potent topical corticosteroid (TCS) and NB-UVB, compared with TCS alone, for localized vitiligo. METHODS A pragmatic, three-arm, placebo-controlled randomized controlled trial (9-month treatment, 12-month follow-up). Adults and children, recruited from secondary care and the community, aged ≥ 5 years and with active vitiligo affecting < 10% of skin, were randomized 1 : 1 : 1 to receive TCS (mometasone furoate 0·1% ointment + dummy NB-UVB), NB-UVB (NB-UVB + placebo TCS) or a combination (TCS + NB-UVB). TCS was applied once daily on alternating weeks; NB-UVB was administered on alternate days in escalating doses, adjusted for erythema. The primary outcome was treatment success at 9 months at a target patch assessed using the participant-reported Vitiligo Noticeability Scale, with multiple imputation for missing data. The trial was registered with number ISRCTN17160087 on 8 January 2015. RESULTS In total 517 participants were randomized to TCS (n = 173), NB-UVB (n = 169) and combination (n = 175). Primary outcome data were available for 370 (72%) participants. The proportions with target patch treatment success were 17% (TCS), 22% (NB-UVB) and 27% (combination). Combination treatment was superior to TCS: adjusted between-group difference 10·9% (95% confidence interval 1·0%-20·9%; P = 0·032; number needed to treat = 10). NB-UVB alone was not superior to TCS: adjusted between-group difference 5·2% (95% CI - 4·4% to 14·9%; P = 0·29; number needed to treat = 19). Participants using interventions with ≥ 75% expected adherence were more likely to achieve treatment success, but the effects were lost once treatment stopped. Localized grade 3 or 4 erythema was reported in 62 (12%) participants (including three with dummy light). Skin thinning was reported in 13 (2·5%) participants (including one with placebo ointment). CONCLUSIONS Combination treatment with home-based handheld NB-UVB plus TCS is likely to be superior to TCS alone for treatment of localized vitiligo. Combination treatment was relatively safe and well tolerated but was successful in only around one-quarter of participants.
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Affiliation(s)
- K S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - J M Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - P Akram
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - J R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - R H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - G D Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - L Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - T H Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - W Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - J White
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
| | - M E Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - H C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - S T Cheung
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - H Hamad
- Cannock Chase Hospital and New Cross Hospital, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - A Wright
- St Luke's Hospital, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - J R Ingram
- Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - N J Levell
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - J M R Goulding
- Solihull Hospital, University Hospitals of Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Makrygeorgou
- West Glasgow Ambulatory Care Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - A Bewley
- Barts Health NHS Trust and Queen Mary University London, London, UK
| | - M Ogboli
- Birmingham Children's Hospital, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - J Stainforth
- York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - A Ferguson
- Royal Derby Hospital and the London Road Community Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - B Laguda
- Chelsea and Westminster Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - S Wahie
- University Hospital of North Durham, County Durham and Darlington NHS Foundation Trust, Durham, UK
| | - R Ellis
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - J Azad
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | - A Rajasekaran
- Birmingham City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | | | - A A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, UK
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18
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Kussainova A, Kassym L, Akhmetova A, Glushkova N, Sabirov U, Adilgozhina S, Tuleutayeva R, Semenova Y. Vitiligo and anxiety: A systematic review and meta-analysis. PLoS One 2020; 15:e0241445. [PMID: 33170870 PMCID: PMC7654800 DOI: 10.1371/journal.pone.0241445] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Vitiligo is an acquired depigmenting skin disease which is often accompanied by mental distress. There are numerous studies dedicated to local and global prevalence of depression in patients with vitiligo but anxiety has not been recognized as a major mental problem within named population. We aimed to evaluate the prevalence of anxiety among patients with vitiligo from different countries and to compare it with patients suffering from eczema, psoriasis, and acne. METHODS In November 2019, we conducted a systematic search for observational studies that examined the prevalence of anxiety in vitiligo patients. Fifteen studies comprising 1176 patients with vitiligo were included to our systematic review. RESULTS The general prevalence of anxiety among vitiligo patients was equal to 35.8%. Statistically significant difference in anxiety rates was found among female and male patients (47.32% vs 42.4%) (P = 0.03), but the clinical relevance of this issue remains arguable. In addition, the pooled odds ratio among vitiligo and non-vitiligo patients did not indicate a statistical significance among patients coming from different continents. CONCLUSIONS The pooled prevalence of anxiety among vitiligo patients worldwide was comparable to other severe skin disorders. This finding accentuates the necessity of anxiety awareness in management of patients with skin diseases.
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Affiliation(s)
- Assiya Kussainova
- Department of Dermatovenerology and Cosmetology, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Laura Kassym
- Nazarbayev University School of Medicine, Nur-Sultan, Republic of Kazakhstan
- * E-mail:
| | - Almira Akhmetova
- Department of Dermatovenerology and Cosmetology, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Natalya Glushkova
- Department of Epidemiology, Evidence-Based Medicine and Biostatistics, Kazakhstan Medical University Higher School of Public Health, Almaty, Republic of Kazakhstan
| | - Ulugbek Sabirov
- Republican Specialized Scientific and Practical Medical Center of Dermatovenerology and Cosmetology, Tashkent, Republic of Uzbekistan
| | - Saltanat Adilgozhina
- Department of Family Medicine, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Raikhan Tuleutayeva
- Department of Pharmacology Department, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
| | - Yuliya Semenova
- Department of Neurology, Ophthalmology, Otorhinolaryngology, NJSC "Semey Medical University", Semey, Republic of Kazakhstan
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Founta O, Adamzik K, Tobin AM, Kirby B, Hevey D. Psychological Distress, Alexithymia and Alcohol Misuse in Patients with Psoriasis: A Cross-Sectional Study. J Clin Psychol Med Settings 2020; 26:200-219. [PMID: 30206746 DOI: 10.1007/s10880-018-9580-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This study investigates (a) the prevalence of psychological distress, alexithymia and alcohol misuse in psoriasis patients; and (b) the relationship between psoriasis severity, alexithymia, alcohol and psychological distress in patients with psoriasis. A cross-sectional study was conducted. Outpatients (n = 184) with moderate to severe psoriasis completed a psychological screening battery. Measures included the Hospital Anxiety and Depression Scale, the Penn State Worry Questionnaire, the twenty-item Toronto Alexithymia Scale, the Dermatology Life Quality Index, the Psoriasis Area and Severity Index, the Self-Administered Psoriasis Area and Severity Index, and the Alcohol Use Disorders Identification Test. Demographic, clinical details and information on knowledge of psychosocial issues, alcohol and confidence on coping with distress and talking to others about psoriasis was also gathered. Alexithymia was associated with anxiety, depression and worry; subjective psoriasis severity was associated with worry. Alcohol misuse was related to anxiety and worry, but not to depression. Appropriate identification and treatment of alcohol difficulties and psychological distress of patients with psoriasis is needed.
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Affiliation(s)
- Ourania Founta
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland.
| | - Karoline Adamzik
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Anne-Marie Tobin
- Dermatology Department, The Adelaide & Meath Hospital, Tallaght, Dublin 24, Ireland
| | - Brian Kirby
- Dermatology Department, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Charles Department of Dermatology, St Vincent's University Hospital and School of Health Sciences, UCD, Dublin 4, Ireland
| | - David Hevey
- Research Centre for Psychological Health, School of Psychology, Trinity College Dublin, Dublin 2, Ireland
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20
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Pell C. What to Do When People Stare: A Workshop to Teach Individuals With Disfiguring Conditions to Contend With Staring and Improve Control of Social Interactions. J Burn Care Res 2019; 40:743-751. [DOI: 10.1093/jbcr/irz117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Facial disfigurement due to any congenital or acquired condition is a social disability that can impede communication, contribute to awkward social interactions, and cause individuals with differences to be isolated and rejected. Yet, few interventions have been developed to address the psychosocial consequences of living with a visible difference, despite research indicating that the more visible the disfigurement is to others, the greater the social implication and challenge for the affected individual. This article reviews the impact of the “What to Do When People Stare” social and communication workshop, including its theoretical basis (drawn from anthropological research and theory pertaining to disfigurement), the phenomenon of staring, and the experience of being the target of a stare. The review highlights feedback from 46 individuals with disfiguring conditions caused by burns, dermatological conditions, and craniofacial conditions who completed a Workshop Evaluation Survey. The instructor, who has a facial difference, reviewed the science of staring, the role and influence of the media and beauty in society, myths associated with disfigurement, social and communication skills, and asked specific questions to elicit feelings and beliefs about why people stare, and how it feels to be the object of a stare. After completing the workshop, 80% of participants reported that they felt better prepared to cope with staring, and 83% reported a better understanding about the motives of staring. The workshop demonstrates the need to increase awareness of visible differences and to teach individuals with visible differences and the general public appropriate social skills for engaging with one another. The workshop’s success to date highlights the need for similar programs addressing the psychosocial communicative dimensions related to staring. Collaborations with burn centers and other nonprofit organizations that treat and assist individuals with psychosocial issues related to visible difference could strengthen content and assessment data.
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Abstract
PURPOSE OF REVIEW The effects of skin disease on stigmatization are important but understudied in the pediatric population. Given the highly visible nature of dermatologic conditions, stigmatization is a common problem that requires significant attention in patients with skin diseases. In this review, we examine the recent literature addressing stigmatization of patients suffering from common dermatologic diseases with the goal to increase clinician awareness of these issues and identify new avenues for future research. RECENT FINDINGS A number of studies have examined the impact of skin disease on psychosocial well being and quality of life. Although some skin diseases are often overlooked medically and considered to be primarily cosmetic issues, the long-term consequences of skin diseases on psychosocial health, especially in pediatric patients, can be profound. SUMMARY The precipitating factors for stigma vary widely depending on age, sex, and culture. In order to effectively reduce the impact of pediatric skin diseases on psychosocial health, physicians should be able to identify specific characteristics that may increase risks for stigmatization in chidlren. Carefully monitoring psychosocial development in pediatric patients with dermatological conditions in addition to proactively guiding patients and families to appropriate resources can benefit the child's development and overall long-term well being.
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Affiliation(s)
- Julie H Wu
- Baylor College of Medicine, Houston, Texas
| | - Bernard A Cohen
- Department of Pediatrics.,Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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22
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Smith MP, Ly K, Thibodeaux Q, Bhutani T, Nakamura M. Home phototherapy for patients with vitiligo: challenges and solutions. Clin Cosmet Investig Dermatol 2019; 12:451-459. [PMID: 31388308 PMCID: PMC6607222 DOI: 10.2147/ccid.s185798] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/07/2019] [Indexed: 12/31/2022]
Abstract
Vitiligo is a chronic autoimmune condition involving selective dysfunction and destruction of melanocytes in the skin, hair, or both. The typical presentation is well-demarcated depigmented skin patches. Given vitiligo is the most common cause of depigmentation worldwide and early disease responds best to treatment, prompt diagnosis and proactive management of vitiligo are critical. While a wide variety of treatments has demonstrated variable effectiveness in treating vitiligo, phototherapy remains standard of care because of its proven efficacy and favorable side effect profile. However, many patients with vitiligo are unable to access affordable, consistent, or convenient phototherapy. To address these issues, home-based phototherapy has emerged as a patient-centered alternative. The purpose of this review is to discuss management of vitiligo with a specific focus on access to home-based phototherapy (HBPT) for patients with this condition. Key challenges to HBPT include misperceptions around safety and efficacy, inadequate physician education and training, insurance and financial barriers, and appropriate patient selection. Solutions to these challenges are presented, such as approaches to improve physician education and increasing the evidence surrounding the effectiveness and safety of this treatment for vitiligo. In addition, various practical considerations are discussed to guide dermatologists on how to approach HBPT as a treatment option for patients with vitiligo.
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Affiliation(s)
- Mary Patricia Smith
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Karen Ly
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Quinn Thibodeaux
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Tina Bhutani
- Department of Dermatology, University of California San Francisco, San Francisco, CA, USA
| | - Mio Nakamura
- Department of Dermatology, University of Michigan, Ann Arbor, MI, USA
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23
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Hartung F, Jamrozik A, Rosen ME, Aguirre G, Sarwer DB, Chatterjee A. Behavioural and Neural Responses to Facial Disfigurement. Sci Rep 2019; 9:8021. [PMID: 31142792 PMCID: PMC6541618 DOI: 10.1038/s41598-019-44408-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/15/2019] [Indexed: 11/12/2022] Open
Abstract
Faces are among the most salient and relevant visual and social stimuli that humans encounter. Attractive faces are associated with positive character traits and social skills and automatically evoke larger neural responses than faces of average attractiveness in ventral occipito-temporal cortical areas. Little is known about the behavioral and neural responses to disfigured faces. In two experiments, we tested the hypotheses that people harbor a disfigured is bad bias and that ventral visual neural responses, known to be amplified to attractive faces, represent an attentional effect to facial salience rather than to their rewarding properties. In our behavioral study (N = 79), we confirmed the existence of an implicit 'disfigured is bad' bias. In our functional MRI experiment (N = 31), neural responses to photographs of disfigured faces before treatment evoked greater neural responses within ventral occipito-temporal cortex and diminished responses within anterior cingulate cortex. The occipito-temporal activity supports the hypothesis that these areas are sensitive to attentional, rather than reward properties of faces. The relative deactivation in anterior cingulate cortex, informed by our behavioral study, may reflect suppressed empathy and social cognition and indicate evidence of a possible neural mechanism underlying dehumanization.
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Affiliation(s)
- Franziska Hartung
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA.
- Penn Center for Neuroaesthetics Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA.
| | - Anja Jamrozik
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
| | - Miriam E Rosen
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
| | - Geoffrey Aguirre
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
| | - David B Sarwer
- Center for Obesity Research and Education College of Public Health, Department of Social and Behavioral Sciences, Temple University 1301 Cecil B. Moore Avenue, 19122, Philadelphia, PA, USA
| | - Anjan Chatterjee
- Center for Cognitive Neuroscience Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
- Penn Center for Neuroaesthetics Department of Neurology at the School of Medicine, University of Pennsylvania Goddard Laboratory 3710, Hamilton Walk, 19104, Philadelphia, PA, USA
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24
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Bidaki R, Majidi N, Moghadam Ahmadi A, Bakhshi H, Sadr Mohammadi R, Mostafavi SA, Kazemi Arababadi M, Hadavi M, Mirzaei A. Vitiligo and social acceptance. Clin Cosmet Investig Dermatol 2018; 11:383-386. [PMID: 30046249 PMCID: PMC6054323 DOI: 10.2147/ccid.s151114] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM Vitiligo is a chronic skin disease characterized by a total or partial loss of melanocytes from the epidermis and other tissues of the skin. It is placed in the class of secondary psychiatric disorders and can also lead to psychological problems. The main aim of this study was to assess social acceptance in vitiligo patients. METHODS This cross-sectional study was conducted on all of the patients (n=150) with vitiligo who were referred to dermatology clinics in Rafsanjan, Iran. The patients completed a social acceptability questionnaire (Marlowe-Crowne Social Desirability Scale), and information regarding their demographic characteristics was also collected. Data were gathered and analyzed with descriptive and inferential statistics using SPSS-19 software. RESULTS The mean age of the patients was 27.56±10.53 years and 65.9% were female. Mean score of social acceptance among the patients was 13.51±7.08. The results showed that the mean scores of social acceptance were significantly lower in women, in those with single marital status, in those with face and neck lesions, and in those with disease duration less than 5 years. CONCLUSION The results showed that certain groups of patients with vitiligo are at greater risk of experiencing lower social acceptance.
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Affiliation(s)
- Reza Bidaki
- Research Center of Addiction and Behavioral Sciences, Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Niloofar Majidi
- Department of Psychiatry, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Moghadam Ahmadi
- Department of Neurology, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hamid Bakhshi
- Continuing Medical Education Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Rezvan Sadr Mohammadi
- Department of Psychiatry, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Seyed-Ali Mostafavi
- Psychiatry Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kazemi Arababadi
- Department of Laboratory Sciences, Faculty of Paramedicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Maryam Hadavi
- Department of Anesthesiology, Paramedical Faculty, Molecular Medicine Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran,
| | - Afshin Mirzaei
- Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Haines RH, Thomas KS, Montgomery AA, Ravenscroft JC, Akram P, Chalmers JR, Whitham D, Duley L, Eleftheriadou V, Meakin G, Mitchell EJ, White J, Rogers A, Sach T, Santer M, Tan W, Hepburn T, Williams HC, Batchelor J. Home interventions and light therapy for the treatment of vitiligo (HI-Light Vitiligo Trial): study protocol for a randomised controlled trial. BMJ Open 2018; 8:e018649. [PMID: 29615444 PMCID: PMC5893933 DOI: 10.1136/bmjopen-2017-018649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Vitiligo is a condition resulting in white patches on the skin. People with vitiligo can suffer from low self-esteem, psychological disturbance and diminished quality of life. Vitiligo is often poorly managed, partly due to lack of high-quality evidence to inform clinical care. We describe here a large, independent, randomised controlled trial (RCT) assessing the comparative effectiveness of potent topical corticosteroid, home-based hand-held narrowband ultraviolet B-light (NB-UVB) or combination of the two, for the management of vitiligo. METHODS AND ANALYSIS The HI-Light Vitiligo Trial is a multicentre, three-arm, parallel group, pragmatic, placebo-controlled RCT. 516 adults and children with actively spreading, but limited, vitiligo are randomised (1:1:1) to one of three groups: mometasone furoate 0.1% ointment plus dummy NB-UVB light, vehicle ointment plus NB-UVB light or mometasone furoate 0.1% ointment plus NB-UVB light. Treatment of up to three patches of vitiligo is continued for up to 9 months with clinic visits at baseline, 3, 6 and 9 months and four post-treatment questionnaires.The HI-Light Vitiligo Trial assesses outcomes included in the vitiligo core outcome set and places emphasis on participants' views of treatment success. The primary outcome is proportion of participants achieving treatment success (patient-rated Vitiligo Noticeability Scale) for a target patch of vitiligo at 9 months with further independent blinded assessment using digital images of the target lesion before and after treatment. Secondary outcomes include time to onset of treatment response, treatment success by body region, percentage repigmentation, quality of life, time-burden of treatment, maintenance of response, safety and within-trial cost-effectiveness. ETHICS AND DISSEMINATION Approvals were granted by East Midlands-Derby Research Ethics Committee (14/EM/1173) and the MHRA (EudraCT 2014-003473-42). The trial was registered 8 January 2015 ISRCTN (17160087). Results will be published in full as open access in the NIHR Journal library and elsewhere. TRIAL REGISTRATION NUMBER ISRCTN17160087.
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Affiliation(s)
- Rachel H Haines
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Kim S Thomas
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Alan A Montgomery
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Jane C Ravenscroft
- Department of Paediatric Dermatology, Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Perways Akram
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Joanne R Chalmers
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Diane Whitham
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham Health Science Partners, Queen's Medical Centre, Nottingham, UK
| | - Lelia Duley
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham Health Science Partners, Queen's Medical Centre, Nottingham, UK
| | | | - Garry Meakin
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Eleanor J Mitchell
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Jennifer White
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Andy Rogers
- Department of Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tracey Sach
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Miriam Santer
- Primary Care and Population Sciences, University of Southampton, Southampton, UK
| | - Wei Tan
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Trish Hepburn
- Nottingham Clinical Trials Unit, University of Nottingham, Queen's Medical Centre, Nottingham, UK
| | - Hywel C Williams
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Jonathan Batchelor
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
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26
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Grimes PE, Miller MM. Vitiligo: Patient stories, self-esteem, and the psychological burden of disease. Int J Womens Dermatol 2018; 4:32-37. [PMID: 29872674 PMCID: PMC5986114 DOI: 10.1016/j.ijwd.2017.11.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/23/2017] [Accepted: 11/23/2017] [Indexed: 12/26/2022] Open
Abstract
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.
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Affiliation(s)
- P E Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles, CA
- Division of Dermatology, David Geffen School of Medicine, University of California, Los Angeles, CA
| | - M M Miller
- Keck School of Medicine, University of Southern California, Los Angeles, CA
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27
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Teasdale E, Muller I, Abdullah Sani A, Thomas KS, Stuart B, Santer M. Views and experiences of seeking information and help for vitiligo: a qualitative study of written accounts. BMJ Open 2018; 8:e018652. [PMID: 29330174 PMCID: PMC5781159 DOI: 10.1136/bmjopen-2017-018652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Vitiligo is a relatively common autoimmune condition causing loss of skin pigment. Around 1 in 100 people in the UK develop vitiligo. It can have a significant impact on quality of life for many of those affected. How people access information and help for vitiligo may influence how they manage such impact. We aimed to explore people's views and experiences of seeking health information and help for vitiligo. DESIGN Qualitative analysis of free-text responses to four open-ended questions in an online survey. SETTING Online survey conducted in the UK between February and March 2016. PARTICIPANTS A survey link was emailed to 675 members of The Vitiligo Society, a UK-based charity providing information and support for people with vitiligo. One hundred and sixty-one members responded to the survey (24%). RESULTS Many participants wrote extensive free text, often reporting frustration with help-seeking. They perceived general practitioners (GP) as their primary source of advice but felt that GPs had low awareness of available treatments. Where GPs appeared sympathetic or signposted towards further information this was appreciated, even where people felt their GP had not seemed knowledgeable. Many felt that vitiligo was dismissed by health professionals including GPs and dermatologists as 'cosmetic', which upset those who experienced substantial impact. Participants expressed concerns about the credibility of online information on vitiligo and the need for reliable, detailed information, as well as a desire for support with managing its psychosocial impact. CONCLUSIONS Information and help-seeking needs of people with vitiligo currently appear to be poorly met, even among members of The Vitiligo Society, who are likely to have received more information than others. People with vitiligo would welcome greater health professional awareness of available vitiligo treatments. Acknowledging the psychosocial impacts of vitiligo and signposting towards credible information are also welcomed.
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Affiliation(s)
- Emma Teasdale
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Ingrid Muller
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Academic Unit of Psychology, Faculty of Social and Human Sciences, University of Southampton, Southampton, UK
| | - Amirah Abdullah Sani
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Kim S Thomas
- Centre for Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Beth Stuart
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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28
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Morrison B, Burden-Teh E, Batchelor J, Mead E, Grindlay D, Ratib S. Quality of life in people with vitiligo: a systematic review and meta-analysis. Br J Dermatol 2017; 177:e338-e339. [DOI: 10.1111/bjd.15933] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- B. Morrison
- Medical School; University of Nottingham; Nottingham U.K
| | - E. Burden-Teh
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham U.K
| | - J.M. Batchelor
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham U.K
| | - E. Mead
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham U.K
| | - D. Grindlay
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham U.K
| | - S. Ratib
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham U.K
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29
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Abstract
Vitiligo is a chronic common skin disease. The asymptomatic hypopigmented cutaneous lesions are considered by many health care professionals as a cosmetic problem only; however, vitiligo can have a major psychosocial impact on patients' lives. We review some of the factors responsible for this impact, such as the general public's wrong perception of the disease, feelings and emotional responses from patients, how stressful events can act as triggers of the disease, stigmatization experiences suffered by the patients, the prevalence of psychiatric morbidity, the effects on relationships and sex life, how quality of life in adults and children is impaired, and how treatment can improve it.
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Affiliation(s)
- Felipe Cupertino
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | - João Paulo Niemeyer-Corbellini
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcia Ramos-E-Silva
- Sector of Dermatology and Post-Graduation Course, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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30
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Hedayat K, Karbakhsh M, Ghiasi M, Goodarzi A, Fakour Y, Akbari Z, Ghayoumi A, Ghandi N. Quality of life in patients with vitiligo: a cross-sectional study based on Vitiligo Quality of Life index (VitiQoL). Health Qual Life Outcomes 2016; 14:86. [PMID: 27267598 PMCID: PMC4897932 DOI: 10.1186/s12955-016-0490-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vitiligo is a multi-factorial pigmentary skin disorder. Recently, the importance of emotional and psychological issues is proposed in incidence, progression, relapse and remission of vitiligo. There are limited studies conducted in developing countries, which assess life quality of patients with vitiligo. The aim of this study was the application and evaluation of a disease-specific quality of life index in Iranian patients, for the first time. METHODS This cross-sectional biphasic study was conducted on 25 patients as a pilot and another 173 patients as the main study group, in Razi Hospital, Tehran, Iran, 2013-2014. Persian version of Vitiligo Quality of Life index (VitiQoL) was developed with backward-forward method. Based on the pilot study, the validity and reliability were assessed. The Vitiligo Area and Score Index (VASI), VitiQoL, and their relationship, demographic and clinical characteristic of patients were measured. RESULTS The Mean and standard deviation of the VitiQoL score was 30.5 ± 14.5 (range 0-60 in Persian version). There was a significant relationship between VASI score and VitiQoL (p = 0.015, r = 0.187). Confirmatory factor analysis revealed three important factors within VitiQoL: participation limitation, stigma, and behavior. In subscale analysis based on behavior factor, female patients had poorer quality of life (p = 0.02). Concomitant psychiatric problems, e.g. anxiety and depression, were not associated with QOL; however, they were near to being meaningful (p = 0.06, r = 0.14). CONCLUSION VitiQoL is a valid index in estimating life quality of vitiligo patients and has proper relation to disease severity. Focusing on patient's life quality is an important entity in the management of vitiligo patients; relevant supportive group-based consultations and therapies are also important arms when approaching vitiligo.
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Affiliation(s)
- Kosar Hedayat
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojgan Karbakhsh
- Department of Community and Preventive Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghiasi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Fakour
- Department of Psychology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Akbari
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Ghayoumi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Narges Ghandi
- Autoimmune Bullous Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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31
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The Vitiligo Impact Patient Scale (VIPs): Development and Validation of a Vitiligo Burden Assessment Tool. J Invest Dermatol 2016; 136:52-8. [PMID: 26763423 DOI: 10.1038/jid.2015.398] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 07/14/2015] [Accepted: 07/29/2015] [Indexed: 12/24/2022]
Abstract
Vitiligo has a major impact on health-related quality of life. Although a few vitiligo-specific quality of life instruments exist, there is no specific vitiligo burden tool. We developed and validated a specific vitiligo burden tool according to skin phototype. In total, 301 patients completed 35 items of the Vitiligo Impact Patient scale, of whom 235 were of skin phototype I to III and 66 of phototype IV to VI. The dimensionality of the items was evaluated using factor analyses, with results suggesting three factors in fair- and dark-skinned patients ("Psychological effects on daily life," "Relationships and Sexuality," and "Economic Constraints, Care & Management of Disease"). Unidimensionality was confirmed by higher order factor analysis. Cronbach's α were high-and intradimensional coherences all demonstrated good reliability (α > 0.8). The final instrument consists of 29 items (19 items common to all patients, 3 specific to fair skin, and 7 to dark skin). The test-retest reliability demonstrated very good reproducibility. The intraclass correlation of each dimension was greater than 0.90 for each population. External validity was confirmed by the correlation coefficients and Bland and Altman plots of the Vitiligo Impact Patient scale-Fair Skin and Vitiligo Impact Patient scale-Dark Skin versus the Short-Form-12, PVC Metra, Body Image States Scale, and Daily Life Quality Index assessment tools.
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32
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Matterne U, Apfelbacher C. Peer-relationship-problems account for quality of life impairments in pediatric psoriasis. J Psychosom Res 2016; 84:31-36. [PMID: 27095156 DOI: 10.1016/j.jpsychores.2016.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/03/2016] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Most research on HRQoL-impairments in psoriasis has been conducted in adult patients, small pediatric patient samples or samples not representative of the pediatric population at large. We thus aimed to comprehensively describe HRQoL in pediatric psoriasis compared to psoriasis-free children and adolescents, identify domains most commonly affected and analyze its impact on HRQoL while controlling for important other predictors of HRQoL in a representative pediatric sample. METHODS The impact of lifetime-prevalence of psoriasis on total and subscale HRQoL was analyzed by complex sample general linear models alone and adjusted for sociodemographic and clinical variables in a population-based sample (n=6518) of children and adolescents aged 11-17. RESULTS Total HRQoL and the physical domain were significantly affected by lifetime-psoriasis in univariate analysis. In multivariate analyses, lifetime-psoriasis significantly impacted on total HRQoL and the subscale 'quality of relationships with friends/peers'. Although substantial amounts of variance in HRQoL were explained by mental health, independent effects of lifetime-psoriasis remained after adjustment for this covariate. Total explained variance in total HRQoL was 20%. CONCLUSION Our findings suggest psoriasis to be a significant burden as it affects HRQoL even when controlling for mental health. Most of this effect appears to be driven by perceived impairments in the quality of relationship with friends/peers. How this exactly occurs needs to be explored in future research. Meanwhile clinicians need to be more attentive to this effect of psoriasis.
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Affiliation(s)
- Uwe Matterne
- Department of Clinical Social Medicine, Occupational and Environmental Dermatology and Health Services Research, University Hospital Heidelberg, University of Heidelberg, Germany; Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany
| | - Christian Apfelbacher
- Medical Sociology, Institute of Epidemiology and Preventive Medicine, University of Regensburg, Germany.
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33
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Donigan JM, Pascoe VL, Kimball AB. Psoriasis and herpes simplex virus are highly stigmatizing compared with other common dermatologic conditions: A survey-based study. J Am Acad Dermatol 2015; 73:525-6. [PMID: 26282802 DOI: 10.1016/j.jaad.2015.06.035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jessica M Donigan
- Clinical Unit for Research Trials and Outcomes in Skin, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vanessa L Pascoe
- Clinical Unit for Research Trials and Outcomes in Skin, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts
| | - Alexa B Kimball
- Clinical Unit for Research Trials and Outcomes in Skin, Department of Dermatology, Massachusetts General Hospital, Boston, Massachusetts; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts
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34
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Tarlé RG, Nascimento LMD, Mira MT, Castro CCSD. Vitiligo--part 1. An Bras Dermatol 2014; 89:461-70. [PMID: 24937821 PMCID: PMC4056705 DOI: 10.1590/abd1806-4841.20142573] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 05/25/2013] [Indexed: 12/27/2022] Open
Abstract
Vitiligo is a chronic stigmatizing disease, already known for millennia, which
mainly affects melanocytes from epidermis basal layer, leading to the
development of hypochromic and achromic patches. Its estimated prevalence is
0.5% worldwide. The involvement of genetic factors controlling susceptibility to
vitiligo has been studied over the last decades, and results of previous studies
present vitiligo as a complex, multifactorial and polygenic disease. In this
context, a few genes, including DDR1, XBP1 and NLRP1 have been
consistently and functionally associated with the disease. Notwithstanding,
environmental factors that precipitate or maintain the disease are yet to be
described. The pathogenesis of vitiligo has not been totally clarified until now
and many theories have been proposed. Of these, the autoimmune hypothesis is now
the most cited and studied among experts. Dysfunction in metabolic pathways,
which could lead to production of toxic metabolites causing damage to
melanocytes, has also been investigated. Melanocytes adhesion deficit in
patients with vitiligo is mainly speculated by the appearance of Köebner
phenomenon, recently, new genes and proteins involved in this deficit have been
found.
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Ingordo V, Cazzaniga S, Medri M, Raone B, Digiuseppe MD, Musumeci ML, Romano I, Fai D, Pellegrino M, Pezzarossa E, Di Lernia V, Peccerillo F, Battarra VC, Sirna R, Patrizi A, Naldi L. To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index. Dermatology 2014; 229:240-7. [PMID: 25358871 DOI: 10.1159/000363407] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/05/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is believed that vitiligo has an impact on the overall patient quality of life (QoL). OBJECTIVE To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire. METHODS One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire. RESULTS The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset. CONCLUSIONS The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.
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Affiliation(s)
- Vito Ingordo
- Outpatient Department of Dermatology, District No. 6, Health Local Unit, Taranto, Italy
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Mishra N, Rastogi MK, Gahalaut P, Agrawal S. Dermatology Specific Quality of Life in Vitiligo Patients and Its Relation with Various Variables: A Hospital Based Cross-sectional Study. J Clin Diagn Res 2014; 8:YC01-3. [PMID: 25121050 DOI: 10.7860/jcdr/2014/8248.4508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/28/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Vitiligo is an acquired, idiopathic skin disease characterized by progressive loss of the inherited skin color. Vitiligo has a special significance to patients in our country because depigmentation is obvious on dark skin and due to the enormous stigma that the disease carries. MATERIALS AND METHODS One hundred vitiligo patients aged more than 18 years were included in our hospital based study depending on inclusion and exclusion criteria. All the patients were asked to fill a validated Hindi version of DLQI questionnaire. DLQI scores and its interpretation were recorded separately. correlation of DLQI Scores with different variables like age, body surface area, duration of disease and socioeconomic status were studied using Pearson's correlations. Mean DLQI scores were also compared between different groups. RESULTS Male and female patient were statistically similar in all variables, like their age, BSA of the involvement and DLQI score. DLQI interpretation showed that out of 100 patients of vitiligo, 16 felt no effect of vitiligo on their quality of life while 84 patients reported small to very large effect on their quality of life. Out of this 84, 37 felt small effects, 21 felt moderate effect and rest 26 felt very large effect on their quality of life. There was no significant difference among the different groups mentioned except very large effect on quality of life seen significantly more in unmarried patients compared to married one. CONCLUSION Vitiligo although a cosmetic disease without any symptoms, it carry a significant social stigma especially in Indian society. Data interpretation in this study indicates that vitiligo affects QOL in majority of vitiligo patients and such patients require more aggressive and empathic attitude from a dermatologist to cure/improve this so called chronic cosmetic disease.
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Affiliation(s)
- Nitin Mishra
- Associate Professor, Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences , Bareilly, (UP), India
| | - Madhur K Rastogi
- Assistant Professor, Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences , Bareilly, (UP), India
| | - Pratik Gahalaut
- Professor, Department of Dermatology, Shri Ram Murti Smarak Institute of Medical Sciences , Bareilly, (UP), India
| | - Shikha Agrawal
- Junior Resident, Department of Psychiatry, Deva Mental Health Care , Durgakund, Varanasi, India
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Quality of life in family members of vitiligo patients: a questionnaire study in Saudi Arabia. Am J Clin Dermatol 2013; 14:489-95. [PMID: 23839260 DOI: 10.1007/s40257-013-0037-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Many dermatologic disorders are known to adversely affect quality of life (QoL) in close relatives or partners of patients; however, it is unknown whether vitiligo impacts the QoL of family members. OBJECTIVE The aim of this study was to identify the level and domains in which the QoL of partners/relatives of patients with vitiligo are affected by the disease. METHODS A total of 141 patients with vitiligo, along with their family members, were recruited to complete validated QoL questionnaires, including the Dermatology Life Quality Index (DLQI) and the Family Dermatology Life Quality Index (FDLQI). RESULTS Family member QoL was affected in 129 (91.5 %) of subjects. Mean FDLQI score was 10.3 ± 6.4 standard deviation. Higher FDLQI score (greater impairment in QoL) was significantly associated with male patients, a shorter duration of disease, and higher educational levels in family members. The most affected FDLQI items in order of decreasing incidence were emotional impact, burden of care, impact on the physical well-being of the family member, problems due to the reaction of others in response to the patient's skin appearance and effect on social life. Overall FDLQI score and the number of items affected correlated with overall patient DLQI score (p < 0.001, r = 0.56 and p < 0.001, r = 0.53, respectively). CONCLUSIONS Vitiligo has a major impact on the QoL of family members of patients and often significantly impairs many aspects of their lives. Educational and supportive programs are recommended for family members of vitiligo patients who are at an increased risk for QoL impairments.
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Noh S, Kim M, Park CO, Hann SK, Oh SH. Comparison of the psychological impacts of asymptomatic and symptomatic cutaneous diseases: vitiligo and atopic dermatitis. Ann Dermatol 2013; 25:454-61. [PMID: 24371393 PMCID: PMC3870214 DOI: 10.5021/ad.2013.25.4.454] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 11/08/2022] Open
Abstract
Background Vitiligo and atopic dermatitis (AD) are common dermatological disorders which may cause significant psychological and social distress leading to impaired quality of life (QoL) in patients. Objective We evaluated the degree of psychological stress and impairment of QoL in vitiligo patients as compared with AD patients and normal controls (NCs). Methods A total of 60 patients from each group and 60 NCs were enrolled. Five questionnaires on depression (Beck depression inventory, BDI), state anxiety (SA) and trait anxiety (TA), interaction anxiousness (IAS), private body consciousness (PBC) and dermatologic QoL were used. Results The vitiligo patients had a significantly higher level of TA (p<0.01), PBC (p<0.001) and impaired QoL (p<0.001) than NCs, but not BDI, SA and IAS. The AD patients had significantly higher scores for all five questionnaire items compared with NCs. In the comparison between the AD and vitiligo groups, all of the indexes except body consciousness were higher in AD patients than in vitiligo patients: BDI (p<0.01), SA (p<0.05), TA (p<0.001), IAS (p<0.01) and impaired QoL (p<0.001). Exposure of vitiligo lesions was not a significant variable in the analysis of the contribution of clinical variables of vitiligo on psychological stress and QoL. Conclusion Vitiligo, which is not accompanied by any symptoms, involves less psychological impact than AD, which is accompanied by itching. Compared to NCs, however, the elevated general anxiety and body consciousness in patients with vitiligo suggests that they may be more concerned with the aggravation of hypopigmented patches than difficulties in social interactions.
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Affiliation(s)
- Seongmin Noh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Miri Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Chang Ook Park
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seung-Kyung Hann
- Korea Institute of Vitiligo Research and Drs. Woo and Hann's Skin Center, Seoul, Korea
| | - Sang Ho Oh
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Ruiz-Argüelles A, García-Carrasco M, Jimenez-Brito G, Sánchez-Sosa S, Pérez-Romano B, Garcés-Eisele J, Camacho-Alarcón C, Reyes-Núñez V, Sandoval-Cruz M, Mendoza-Pinto C, López-Colombo A. Treatment of vitiligo with a chimeric monoclonal antibody to CD20: a pilot study. Clin Exp Immunol 2013; 174:229-36. [PMID: 23815517 PMCID: PMC3828826 DOI: 10.1111/cei.12168] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2013] [Indexed: 12/14/2022] Open
Abstract
Five patients with active disseminated vitiligo were given 1g of a chimeric (murine/human) monoclonal antibody to CD20 in a single intravenous infusion and followed-up for 6 months. Three of the patients showed an overt clinical and histological improvement of the disease, one presented slight improvement and the remaining patient showed no changes. Improvement was neither associated with changes in laboratory parameters nor to a specific human leucocyte antigen D-related (HLA-DR) phenotype. We believe that these preliminary results are encouraging, and further clinical trials should be undertaken. An important aim should be the finding of a marker with a good response to this therapeutic approach.
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Affiliation(s)
- A Ruiz-Argüelles
- Laboratorios Clínicos de Puebla, Puebla, Mexico; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
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Lilly E, Lu PD, Borovicka JH, Victorson D, Kwasny MJ, West DP, Kundu RV. Development and validation of a vitiligo-specific quality-of-life instrument (VitiQoL). J Am Acad Dermatol 2013; 69:e11-8. [DOI: 10.1016/j.jaad.2012.01.038] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 11/22/2011] [Accepted: 01/29/2012] [Indexed: 11/30/2022]
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Psychiatric morbidity in pemphigus and psoriasis: a comparative study from India. Asian J Psychiatr 2013; 6:151-6. [PMID: 23466113 DOI: 10.1016/j.ajp.2012.10.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 09/29/2012] [Accepted: 10/08/2012] [Indexed: 11/21/2022]
Abstract
AIM This study was designed to examine the prevalence of psychiatric morbidity and its psychosocial and psychopathological correlates in patients with pemphigus in comparison to those with psoriasis. MATERIALS AND METHODS Patients with pemphigus (n=50), group matched for demography, with those with psoriasis (n=30), and healthy controls (n=30), were subjected to cross-sectional assessment for duration, severity, and impact of dermatological disorder, attitude to appearance, social support, coping strategies, disability, quality of life, and psychiatric morbidity and diagnosis. RESULTS The pemphigus group recorded the psychiatric morbidity rates at 40% by GHQ-12 and 26% by ICD-10; the ICD-10 diagnoses included adjustment disorder (16%), depressive episode (8%), and acute and transient psychosis (2%). This comorbidity was not very different from that of the psoriasis group at 46.7% by GHQ-12 and 36.7% by ICD-10; the ICD-10 diagnoses including adjustment disorder (13.3%), depressive episode (10.0%), alcohol dependence (6.6%), paranoid schizophrenia (3.3%), and delusional disorder plus severe depressive episode with psychotic symptoms (3.3%). The pemphigus group scored higher on disability, despite the dermatological severity and psychosocial profile being similar. Dermatological severity, psychopathology, and certain psychosocial variables were correlated in the pemphigus group, as also in the psoriasis group. CONCLUSIONS The high psychiatric and psychosocial morbidity in pemphigus and other chronic and severe dermatologic disorders indicates a need for more studies on the psychosocial aspect of these disorders and for sensitization by the dealing physicians with this aspect.
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Peuvrel L, Quéreux G, Brocard A, Saint-Jean M, Vallet C, Mère A, Labetoulle G, Le Fol C, Dréno B. Evaluation of Quality of Life after a Medical Corrective Make-Up Lesson in Patients with Various Dermatoses. Dermatology 2012; 224:374-80. [DOI: 10.1159/000339478] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Accepted: 05/14/2012] [Indexed: 11/19/2022] Open
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Wang KY, Wang KH, Zhang ZP. Health-related quality of life and marital quality of vitiligo patients in China. J Eur Acad Dermatol Venereol 2011; 25:429-35. [PMID: 20666878 DOI: 10.1111/j.1468-3083.2010.03808.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Vitiligo can adversely affect the quality of life and sexual relationships of patients. Combination of the DLQI with the generic SF-36 and ENRICH may give further insight in the evaluation of the burden in vitiligo patients. OBJECTIVE We sought to assess the health-related quality of life (HRQoL) and marital quality of Chinese vitiligo patients and to identify the relevant clinical and socio-demographic determinants. METHODS A total of 101 vitiligo patients and 126 healthy controls completed the questionnaires. HRQoL was measured using DLQI and SF-36, and marital quality was measured using the ENRICH marital inventory. RESULTS Patients with vitiligo experienced significantly impaired health-related quality of life and unstable marital relationships. Gender, distribution pattern of vitiligo and disease severity were independent predictors of DLQI, SF-36 and ENRICH in this cohort. CONCLUSIONS Vitiligo is associated with impairment of HRQoL and marital quality among Chinese patients. Alongside the medical interventions, the psychological and sociocultural assessment and intervention should be an essential part of the management of these cases.
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Affiliation(s)
- K-Y Wang
- Department of Dermatology, Qilu Hospital of Shandong University, Jinan, China
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Abstract
Treatment of hyperpigmentation disorders can be a lengthy process. There are several topical treatment options and hydroquinone is the most frequently used. Both combination and monotherapy are employed. These treatment options apply primarily to epidermal hyperpigmentation disorders. Dermal hyperpigmentation disorders cannot yet be effectively managed with currently available therapeutic approaches. Cosmetic disfigurement caused by hypomelanosis, especially vitiligo, can constitute a serious impairment for the patient. So far there is no definitive remedy. Better cosmetic results are generally reported for combination therapies.
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Leibovici V, Canetti L, Yahalomi S, Cooper-Kazaz R, Bonne O, Ingber A, Bachar E. Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study. J Eur Acad Dermatol Venereol 2010; 24:897-903. [DOI: 10.1111/j.1468-3083.2009.03542.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. The burden of skin disease is a multidimensional concept that encompasses psychological, social and financial consequences of the skin disease on the patients, their families and on society. Chronic and incurable skin diseases, such as psoriasis and eczema, are associated with significant morbidity in the form of physical discomfort and impairment of patients' quality of life; whereas malignant diseases, such as malignant melanoma, carry substantial mortality. With the availability of a wide range of health status and quality-of-life measures, the effects of most skin diseases on patients' lives can be measured efficiently. The aim of this review is to present some of the published data in order to highlight the magnitude of the burden associated with some common skin diseases and also to suggest ways to quantify this burden of skin disease.
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Affiliation(s)
- Mohammad K A Basra
- Department of Dermatology, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK.
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Kostopoulou P, Jouary T, Quintard B, Ezzedine K, Marques S, Boutchnei S, Taieb A. Objective vs. subjective factors in the psychological impact of vitiligo: the experience from a French referral centre. Br J Dermatol 2009; 161:128-33. [PMID: 19298280 DOI: 10.1111/j.1365-2133.2009.09077.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo affects around 0.5% of the population. The burden of disease perceived by patients seems to be underestimated by the medical community. OBJECTIVES To analyse the impact of objective and psychological factors on the quality of life (QoL) and self-body image of patients with vitiligo. METHODS Demographic data, medical information and psychological factors (perceived severity, trait anxiety, trait depression, trait self-esteem, body image and QoL) were prospectively collected for all patients. RESULTS Forty-eight patients with a mean age of 43.9 years were included in the study. Vitiligo caused overall a moderate effect on patients' QoL with a 7.17 Dermatology Life Quality Index (DLQI) mean score (out of 30) without correlation with gender. According to distribution, no or minimal (DLQI 0-1), mild (2-5), moderate (6-11) and severe (12-20) impairment of QoL was found in five (10%), 14 (29%), 18 (38%) and 11 (23%) patients, respectively. The mean perceived severity evaluated by the patients was 4.91 based on visual analogue scale from 0 to 10. The self-body image was influenced by gender, perceived severity and disease characteristics. Perceived severity and patient personality were predictors of QoL impairment. Perceived severity of vitiligo was explained mainly by the patients' personality and less significantly by objective criteria. CONCLUSIONS Subjective as well as objective factors should be included in the assessment of disease severity and follow-up of patients with vitiligo. A simple perceived severity scale is useful in clinical practice.
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Affiliation(s)
- P Kostopoulou
- Centre de Référence des Maladies Rares de la Peau, Service de Dermatologie, Hôpital Saint André, Bordeaux 33075, France
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Magin PJ, Adams J, Heading GS, Pond CD. Patients with skin disease and their relationships with their doctors: a qualitative study of patients with acne, psoriasis and eczema. Med J Aust 2009; 190:62-4. [DOI: 10.5694/j.1326-5377.2009.tb02276.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2008] [Accepted: 06/25/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Parker J Magin
- Discipline of General Practice, University of Newcastle, Newcastle, NSW
| | - Jon Adams
- Discipline of Social Science, School of Population Health, University of Queensland, Brisbane, QLD
| | | | - C Dimity Pond
- Discipline of General Practice, University of Newcastle, Newcastle, NSW
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Nordlund JJ. The significance of depigmentation. PIGMENT CELL RESEARCH 2008; Suppl 2:237-41. [PMID: 1409425 DOI: 10.1111/j.1600-0749.1990.tb00378.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- J J Nordlund
- University of Cincinnati College of Medicine, Department of Dermatology, Ohio 45221
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