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Pandya AG, Amoloja T, Bibeau K, DiBenedetti D, Kosa K, Butler K, Kornacki D, Ezzedine K. Assessing Participants' Experiences with Vitiligo from Patient Interviews. Dermatol Ther (Heidelb) 2024; 14:2467-2478. [PMID: 39103672 PMCID: PMC11393220 DOI: 10.1007/s13555-024-01241-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/16/2024] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION Vitiligo is an autoimmune disease, causing skin depigmentation. Individuals with vitiligo incur substantial psychosocial burden and have expressed frustration with their treatments. Here, we describe the burden of vitiligo and opinions on what constitutes meaningful change among participants of two qualitative interview studies. METHODS Qualitative interviews were conducted with a subgroup of adolescent and adult participants with vitiligo from two pivotal phase 3 clinical trials of ruxolitinib cream (Study 1) and a real-world panel (Study 2). Participants were asked about their disease burden, treatment goals, importance of facial/body improvement (treatment satisfaction: scale range 0-10), and meaningfulness of change (yes/no). RESULTS A total of 36 participants from Study 1 and 23 from Study 2 were interviewed. In Study 1, the highest degree of impact was on reduced self-esteem (facial lesions, 62.5%; body lesions, 55.6%), social inhibition (facial lesions, 65.6%; body lesions, 61.1%), and sun sensitivity (facial lesions, 31.3%; body lesions, 55.6%). Most participants (83.3%) reported that facial improvement was equally (36.1%) or more important (47.2%) than body improvement, with mean treatment satisfaction of 8.1 and 6.9, respectively. Meaningful change was reported by 83.3% and 92.9% of participants with 50-74% and ≥ 75% improvement per the facial Vitiligo Area Scoring Index, respectively, and by 82.6% of participants with ≥ 25% improvement per the total Vitiligo Area Scoring Index per Study 1 outcomes at Week 24. In Study 2, most (82.6%) participants felt that the noticeability of their vitiligo affected their behavior. Nearly all (87.0%) said that an ideal treatment would repigment or return natural color to their facial skin; 56.5% considered ≥ 50% facial repigmentation to be the smallest meaningful improvement. CONCLUSIONS Participants from both qualitative interviews expressed substantial psychosocial burden. Repigmentation in both facial and body vitiligo were important, with meaningful change determined to be ≥ 50% facial repigmentation and ≥ 25% body repigmentation.
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Affiliation(s)
- Amit G Pandya
- Palo Alto Foundation Medical Group, Suunyvale, CA, USA.
- Department of Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | | | | | - Dana DiBenedetti
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Katherine Kosa
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | | | | | - Khaled Ezzedine
- Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris, France
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Eleftheriadou V, Delattre C, Chetty-Mhlanga S, Lee C, Girardat-Rotar L, Khan I, Mathew A, Thompson AR. Burden of disease and treatment patterns in patients with vitiligo: findings from a national longitudinal retrospective study in the UK. Br J Dermatol 2024; 191:216-224. [PMID: 38534198 DOI: 10.1093/bjd/ljae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND UK studies examining vitiligo burden and vitiligo-related healthcare resource utilization (HCRU) are lacking. OBJECTIVE To describe the incidence and prevalence of vitiligo, the demographic and clinical characteristics of patients with vitiligo, vitiligo burden, HCRU, incidence of mental health comorbidities and management strategies, including treatment patterns. METHODS This retrospective study used UK Clinical Practice Research Datalink and Hospital Episode Statistics databases to analyse patients with vitiligo from 1 January 2010 to 31 December 2021. RESULTS Among 17 239 incident patients, mean incidence of vitiligo was 0.16 (2010-2021) per 1000 person-years [PY; range 0.10 (2020-COVID-19) to 0.19 (2010/2013/2018)]; among 66 217 prevalent patients, prevalence increased from 0.21% (2010) to 0.38% (2021). The most common comorbidities recorded after vitiligo diagnosis were diabetes (19.4%), eczema (8.9%), thyroid disease (7.5%) and rheumatoid arthritis (6.9%). Mental health diagnoses recorded at any time included depression and/or anxiety (24.6%), depression (18.5%), anxiety (16.0%) and sleep disturbance (12.7%), and recorded after vitiligo diagnosis in 6.4%, 4.4%, 5.5% and 3.9%, respectively. Mental health comorbidities were more common in White (e.g. depression and/or anxiety 29.0%) than in Black (18.8%) and Asian (16.1%) patients. In adolescents, depression and/or anxiety was most commonly diagnosed after a vitiligo diagnosis than before (7.4% vs. 1.8%). Healthcare resources were used most frequently in the first year after vitiligo diagnosis (incident cohort), typically dermatology-related outpatient appointments (101.9/100 PY) and general practitioner consultations (97.9/100 PY). In the year after diagnosis, 60.8% of incident patients did not receive vitiligo-related treatment (i.e. topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids or phototherapy), increasing to 82.0% the next year; median time from diagnosis to first treatment was 34.0 months (95% confidence interval 31.6-36.4). Antidepressants and/or anxiolytics were recorded for 16.7% of incident patients in the year after diagnosis. In 2019, 85.0% of prevalent patients did not receive vitiligo-related treatments. CONCLUSION Most patients were not on vitiligo-related treatments within a year of diagnosis, with the time to first treatment exceeding 2 years, suggesting that vitiligo may be dismissed as unimportant. New effective treatments, early initiation and psychological intervention and support are needed to reduce the vitiligo burden on patients.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrew R Thompson
- Cardiff and Vale University Health Board and Cardiff University, South Wales Clinical Psychology Training Programme, Cardiff, UK
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Li J, Zeng X, Chen S, Tang L, Zhang Q, Lv M, Lian W, Wang J, Lv H, Liu Y, Shen J, Uyama T, Wu F, Wu J, Xu J. The Treatment of Refractory Vitiligo With Autologous Cultured Epithelium Grafting: A Real-World Retrospective Cohort Study. Stem Cells Transl Med 2024; 13:415-424. [PMID: 38513284 DOI: 10.1093/stcltm/szae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/11/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Surgical intervention is the main therapy for refractory vitiligo. We developed a modified autologous cultured epithelial grafting (ACEG) technique for vitiligo treatment. Between January 2015 and June 2019, a total of 726 patients with vitiligo underwent ACEG in China, with patient characteristics and clinical factors being meticulously documented. Using a generalized linear mixed model, we were able to assess the association between these characteristics and the repigmentation rate. RESULTS ACEG demonstrated a total efficacy rate of 82.81% (1754/2118) in treating 726 patients, with a higher repigmentation rate of 64.87% compared to conventional surgery at 52.69%. Notably, ACEG showed a better response in treating segmental vitiligo, lesions on lower limbs, age ≤ 18, and stable period > 3 years. A keratinocyte:melanocyte ratio below 25 was found to be advantageous too. Single-cell RNA sequencing analysis revealed an increase in melanocyte count and 2 subclusters of keratinocytes after ACEG, which remained higher in repigmented sites even after 1 year. CONCLUSIONS ACEG is a promising therapy for refractory vitiligo. Patient age, clinical type, lesion site, and stability before surgery influence repigmentation in ACEG. The mechanism of repigmentation after ACEG treatment is likely not confined to the restoration of melanocyte populations. It may also involve an increase in the number of keratinocytes that support melanocyte function within the affected area. These keratinocytes may aid the post-transplant survival and function of melanocytes by secreting cytokines and extracellular matrix components. TRIAL REGISTRATION registered with Chictr.org.cn (ChiCTR2100051405).
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Affiliation(s)
- Jian Li
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Xuanhao Zeng
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Shujun Chen
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Luyan Tang
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Qi Zhang
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Minzi Lv
- Centre of Evidence Medicine, Fudan University, Shanghai, People's Republic of China
| | - Weiling Lian
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jinqi Wang
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Haozhen Lv
- Department of Dermatology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Yating Liu
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Jiayi Shen
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
| | - Taro Uyama
- ReMed Regenerative Medicine Clinical Application Institute, Shanghai, People's Republic of China
| | - Fuyue Wu
- ReMed Regenerative Medicine Clinical Application Institute, Shanghai, People's Republic of China
| | - Jinfeng Wu
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
- The Shanghai Institute of Dermatology, Shanghai, People's Republic of China
| | - Jinhua Xu
- Department of Dermatology, Huashan Hospital of Fudan University, Shanghai, People's Republic of China
- The Shanghai Institute of Dermatology, Shanghai, People's Republic of China
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Fakih A, Tannous R, Lajnef M, Seneschal J, Andreu N, Tran VT, Ezzedine K. Stigma in vitiligo: associated factors and severity strata of the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) score. Br J Dermatol 2024; 190:712-717. [PMID: 38234050 DOI: 10.1093/bjd/ljae020] [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: 06/20/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed. OBJECTIVES To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D) for patients with vitiligo. METHODS We conducted a cross-sectional study in ComPaRe Vitiligo, an e-cohort of adult patients with vitiligo. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata for the PUSH-D. RESULTS In total, 318 patients participated (mean age 49.7 years; 73.9% women). Fitzpatrick skin phototype IV-VI, severe facial involvement (high Self-Assessment Vitiligo Extent Score of the face) and depression (high Patient Health Questionnaire-9 score) were positively -associated with a higher stigmatization score, although this association was weak [r = 0.24 (P < 0.001) and r = 0.30 (P < 0.001), respectively]. PUSH-D cutoff values that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23 (κ = 0.622, 95% confidence interval 0.53-0.71). CONCLUSIONS Our study is the first to use a skin-specific stigmatization tool to assess stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.
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Affiliation(s)
- Ali Fakih
- Department of Dermatology, Hôpital Nord, Centre Hospitalier Universitaire, Université Jean Monnet, Saint Etienne, France
| | - Rim Tannous
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
| | - Mohamed Lajnef
- Inserm U955 IMRB, Translational Neuropsychiatry Laboratory and Paris-Est Créteil University, Créteil, France
| | - Julien Seneschal
- Department of Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, Bordeaux, France
| | - Nicolas Andreu
- Department of Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, Bordeaux, France
| | - Viet-Thi Tran
- Center for Clinical Epidemiology, Hôtel-Dieu Hospital (AP-HP), Paris, France
- Centre de Recherche Épidémiologie et Statistiques (CRESS), Université de Paris, INSERM UMR1153, Paris, France
| | - Khaled Ezzedine
- Department of Dermatology, Hôpital Henri Mondor, Université Paris-Est Créteil Val de Marne-Université Paris, Paris, France
- EpidermE, Université Paris-Est Créteil (UPEC), Créteil, 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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Londoño-Garcia A, Arango Salgado A, Orozco-Covarrubias MDLL, Jansen AM, Rico-Restrepo M, Riviti MC, Velásquez-Lopera MM, Castro C. The landscape of vitiligo in Latin America: a call to action. J DERMATOL TREAT 2023; 34:2164171. [PMID: 36594681 DOI: 10.1080/09546634.2022.2164171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Vitiligo is a chronic pigmentary condition and severely impacts patient quality of life (QoL). It is an underrecognized burden for patients, healthcare systems, and society in Latin America (LA). This paper examines the journey of a vitiligo patient in LA and assesses the disease landscape. Americas Health Foundation (AHF) assembled a panel of six Argentine, Brazilian, Colombian, and Mexican vitiligo experts. On 10-12 May 2022, they met in a virtual meeting. Each panelist wrote a short paper on barriers to vitiligo diagnosis and treatment in LA before the meeting. AHF staff moderated as the panel reviewed and modified each paper over three days. The panel approved the recommendations based on research, professional opinion, and personal experience. The panel agreed that lack of disease awareness and research, social ostracization, and limited therapeutic options hinder patients in their quest for diagnosis and treatment. In addition to the medical and psychological difficulties associated with vitiligo, problems connected to the Latin American healthcare system may negatively impact diagnosis, prognosis, and treatment. Access to timely diagnosis and treatment is crucial for improving outcomes. Governments, medical societies, academics, patient organizations, industry, and the public must unite to eliminate these challenges.
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Affiliation(s)
| | | | | | | | | | - María Cecilia Riviti
- Dermatology Department, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Margarita María Velásquez-Lopera
- Dermatology Section, Facultad de Medicina, Center for Dermatology Investigation CIDERM, Universidad de Antioquia, Medellin, Colombia
| | - Carla Castro
- Hospital Universitario Austral, Buenos Aires, Argentina
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Ezzedine K, Seneschal J, Da Silva A, Préaubert N, Lamblin A, Delattre C, Emery C, Nevoret C, Finzi J, Bouée S, Passeron T. Vitiligo patient population and disease burden in France: VIOLIN study results from the CONSTANCES cohort. J Eur Acad Dermatol Venereol 2023; 37:2249-2258. [PMID: 37605309 DOI: 10.1111/jdv.19447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Vitiligo is a chronic autoimmune disease resulting in skin depigmentation. OBJECTIVES This study assessed the prevalence, disease burden and treatment of vitiligo in France. METHODS VIOLIN was a cross-sectional study nested in the national CONSTANCES cohort, which consists of randomly selected adults aged 18-69 years in France. In VIOLIN, longitudinal data were collected prospectively from 158,898 participants during 2012-2018 and linked to the National Health Data System (SNDS), a healthcare utilization database. Patients with physician-diagnosed vitiligo were matched (1:3) with control participants based on age, sex, geographic region, year of inclusion and skin phototype. Patients completed a questionnaire in 2022 to collect disease characteristics, disease burden and quality-of-life (QoL) data. RESULTS Vitiligo prevalence was 0.71% (681/95,597) in 2018. The mean age in the vitiligo population was 51.2 years; 51.4% were women. Most patients (63%) were diagnosed before age 30 years, mainly by dermatologists (83.5%). Most patients (81.1%) had visible lesions (i.e. on face, hands). Vitiligo was limited to <10% of the body surface area (BSA) in 85.8% of patients. Comorbidities including thyroid disease (18.0% vs. 9.0%), psoriasis (13.7% vs. 9.7%), atopic dermatitis (12.4% vs. 10.3%), depression (18.2% vs. 14.6%) and alopecia areata (4.3% vs. 2.4%) were significantly more common in patients with vitiligo versus matched controls (n = 2043). QoL was significantly impaired in patients with >5% BSA involvement or visible lesions, particularly with ≥10% facial involvement. Vitiligo-specific instruments (i.e. Vitiligo Impact Patient scale and Vitiligo-specific QoL instrument) were more sensitive to QoL differences among subgroups versus general skin instruments, and generic instruments were least sensitive. Most patients (83.8%) did not receive any prescribed treatment. CONCLUSIONS Patients with vitiligo in France have a high disease burden, particularly those with visible lesions or higher BSA involvement. Most patients are not receiving treatment, highlighting the need for new effective treatments and patient/physician education.
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Affiliation(s)
- Khaled Ezzedine
- Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris, France
| | - Julien Seneschal
- Department of Dermatology and Pediatric Dermatology, National Reference Center for Rare Skin Disorders, Hôpital Saint André, CNRS, UMR-5164, ImmunoConcEpT, Bordeaux, France
| | | | | | - Anne Lamblin
- Association Française du Vitiligo, Paris, France
| | | | | | | | | | | | - Thierry Passeron
- Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
- INSERM U1065, C3M, Université Côte d'Azur, Nice, France
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Bibeau K, Ezzedine K, Harris JE, van Geel N, Grimes P, Parsad D, Tulpule M, Gardner J, Valle Y, Tlhong Matewa G, LaFiura C, Lindley A, Ren H, Hamzavi IH. Mental Health and Psychosocial Quality-of-Life Burden Among Patients With Vitiligo: Findings From the Global VALIANT Study. JAMA Dermatol 2023; 159:1124-1128. [PMID: 37647073 PMCID: PMC10469285 DOI: 10.1001/jamadermatol.2023.2787] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/22/2023] [Indexed: 09/01/2023]
Abstract
Importance Patients with vitiligo often have impaired quality of life (QOL) and experience substantial psychosocial burden. Objective To explore the global association of vitiligo with QOL and mental health from the patient perspective. Design, Setting, and Participants This qualitative study of the cross-sectional population-based Vitiligo and Life Impact Among International Communities (VALIANT) study was conducted from May 6, 2021, to June 21, 2021. Potential participants for this qualitative study were recruited from an online panel in 17 countries. Of 5859 surveyed adults (aged ≥18 years) who reported a vitiligo diagnosis, 3919 (66.9%) completed the survey, and 3541 (60.4%) were included in the analysis. Exposures Patients were asked questions regarding their emotional well-being, including QOL and mental health. Main Outcomes and Measures Reported analyses are descriptive and hypothesis generating. Vitiligo Impact Patient scale (VIPs) scores ranged from 0 to 60, with higher scores indicating more psychosocial burden. Results The median age of the 3541 patients was 38 years (range, 18-95 years), and 1933 (54.6%) were male; 1602 patients (45.2%) had more than 5% affected body surface area (BSA; Self-Assessment Vitiligo Extent Score assessed), and 1445 patients (40.8%) had Fitzpatrick skin types IV to VI (ie, darker skin). The mean (SD) global short-form VIPs score was 27.3 (15.6) overall; patients from India (mean [SD], 40.2 [14.1]) reported the highest scores (ie, most burden). The QOL burden according to the scale was profound for patients with more than 5% affected BSA (mean [SD] score, 32.6 [14.2]), darker skin (mean [SD] score, 31.2 [15.6]), and lesions on the face (mean [SD] score, 30.0 [14.9]) or hands (mean [SD], 29.2 [15.2]). At least 40% of patients globally reported that vitiligo frequently affected aspects of their daily lives, including choosing clothes to wear (1956 of 3541 [55.2%]). Most patients (2103 of 3541 [59.4%]) reported concealing their vitiligo frequently. More than half of patients (2078 of 3541 [58.7%]) reported diagnosed mental health conditions, including anxiety (1019 of 3541 [28.8%]) and depression (866 of 3541 [24.5%]). The Patient Health Questionnaire-9 depression screener showed that 55.0% of patients (1948 of 3541) had moderate to severe depressive symptoms; the highest rates were in India (271 of 303 [89.4%]) and among patients with more than 5% affected BSA (1154 of 1602 [72.0%]) and darker skin (987 of 1445 [68.3%]). Conclusions and Relevance This qualitative study found that, globally, patients with vitiligo reported being substantially affected in their emotional well-being, daily lives, and psychosocial health; the burden was typically greatest among patients with more than 5% affected BSA, darker skin types, and lesions on the face or hands. Survey findings suggest that patients reported having altered their behavior, expressed clear discontent, and have symptoms consistent with depression, which may be underdiagnosed.
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Affiliation(s)
| | - Khaled Ezzedine
- Henri Mondor University Hospital, Paris, France
- Université Paris-Est Créteil Val de Marne, Paris, France
| | | | | | - Pearl Grimes
- Vitiligo & Pigmentation Institute of Southern California, Los Angeles
| | - Davinder Parsad
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Yan Valle
- Vitiligo Research Foundation, New York, New York
| | | | | | | | - Haobo Ren
- Incyte Corporation, Wilmington, Delaware
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Picardo M, Huggins R, Jones H, Marino R, Ogunsola M, Seneschal J. The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes. J Eur Acad Dermatol Venereol 2022; 36:1507-1523. [PMID: 35366355 PMCID: PMC9790455 DOI: 10.1111/jdv.18129] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/04/2022] [Indexed: 12/30/2022]
Abstract
Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.
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Affiliation(s)
- M. Picardo
- San Gallicano Dermatological Institute IRCCSRomeItaly
| | | | - H. Jones
- Incyte CorporationWilmingtonDEUSA
| | | | | | - J. Seneschal
- Department of Dermatology and Pediatric DermatologyNational Reference Center for Rare Skin DisordersHôpital Saint‐AndréCNRS, UMR‐5164, ImmunoConCept, F‐33000BordeauxFrance
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Ning X, Zhang Y, Wang W, Yan H, Xia Y. Evaluation of the Behavioral and Psychological Symptoms in Patients with Vitiligo in China. Psychol Res Behav Manag 2022; 15:2107-2116. [PMID: 35979226 PMCID: PMC9377344 DOI: 10.2147/prbm.s370445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background Vitiligo is a common, acquired depigmenting disorder. The pathogenesis is not clear, neuropsychological factors may be involved. Vitiligo will affect the individual’s physical and psychological health, leading to different levels of psychological behavior problems. However, there are few research on psychological symptoms in patients with vitiligo in China. Methods Adult patients with vitiligo were selected in convenient sampling method from March 2019 to November 2019 from the dermatology clinic. They were evaluated by the DLQI (Dermatology Life Quality Index), SCL-90 (Symptom Checklist-90), SADS (Social Avoidance and Distress Scale) and MCMQ (Medical Coping Modes Questionnaire). Results The DLQI score was 7.56 ± 6.11, which was in the third level. The SCL-90 score of patients with vitiligo was 136.44 ± 39.19, significantly higher than the Chinese norms (P < 0.05), and it mainly manifested as interpersonal sensitivity, depression, anxiety and phobia, which may be affected by the patient’s gender, marital status, severity of disease, stage and location of skin lesions. The total score of SADS in patients was 10.30 ± 6.38. The total score and scores in all dimensions of SADS were significantly higher than the Chinese norms (all P < 0.05), which were related with the patient’s gender, educational attainment, severity, type and stage of skin lesions. For MCMQ, the facing score was significantly lower than the Chinese norms (P < 0.05), and the avoiding and yielding scores were significantly higher than the Chinese norms (all P < 0.05). Conclusion In China, vitiligo affects the patient’s quality of life to varying degrees, resulting in a series of psychological and behavioral problems. We should actively concern and improve the psychological health status and behavior of patients, and multidisciplinary treatment strategies and education about vitiligo should be given to the patients.
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Affiliation(s)
- Xiaoying Ning
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yanfei Zhang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Wei Wang
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Huling Yan
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
| | - Yumin Xia
- Department of Dermatology, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, People's Republic of China
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11
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Bibeau K, Pandya AG, Ezzedine K, Jones H, Gao J, Lindley A, Harris JE. Vitiligo Prevalence and Quality of Life Among Adults in Europe, Japan, and the United States. J Eur Acad Dermatol Venereol 2022; 36:1831-1844. [PMID: 35611638 PMCID: PMC9544885 DOI: 10.1111/jdv.18257] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background Vitiligo, an autoimmune disorder characterised by skin depigmentation, is associated with reduced quality of life (QoL). Vitiligo may be under‐reported, in part because of misconceptions that it is a cosmetic disease. Objectives This survey sought to characterise vitiligo prevalence and explore the relationship between sociodemographic and clinical characteristics with QoL in a population‐based, multinational study. Methods Participants aged ≥18 years were recruited via an online panel in Europe, Japan and the USA to answer questions regarding skin disorders they may have experienced. Those reporting vitiligo (diagnosed or undiagnosed) or vitiligo signs (experiencing loss of skin colour but unaware of vitiligo and not diagnosed) were included in the analyses of vitiligo prevalence. Participants who self‐reported physician‐diagnosed vitiligo were given a broader survey to characterise disease progression, management and QoL (as measured with the Vitiligo‐specific QoL [VitiQoL] instrument). Results The total estimated vitiligo prevalence among 35 694 survey participants (Europe, n = 18 785; USA, n = 8517; Japan, n = 8392) was 1.3% (diagnosed, 0.6%; undiagnosed, 0.4%; vitiligo signs, 0.3%). Among 219 patients formally diagnosed with vitiligo (Europe, n = 150; USA, n = 48; Japan, n = 21), total VitiQoL scores were associated with age (P = 0.00017), disease extent (P < 0.0001), disease progression (P < 0.0001), disease management (P < 0.0001) and time since diagnosis (P = 0.0015). Behaviour scores varied based on skin phototype (P = 0.024) and ethnicity (P = 0.048). Higher total VitiQoL scores were reported in patients with head lesions (P = 0.027) and those with head and hand and/or wrist lesions (P = 0.018). Substantial high concern (rated 8–10 on an 11‐point Likert scale) for lesions was found across all body areas and varied with geographical region. Conclusions The vitiligo prevalence rate may be higher than previously reported, with a substantial proportion attributed to people who have not received a formal diagnosis. Among formally diagnosed patients with vitiligo, QoL was most severely impacted by more progressive and higher extent of disease.
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Affiliation(s)
- K Bibeau
- Incyte Corporation, Wilmington, DE, USA
| | - A G Pandya
- Palo Alto Foundation Medical Group, Sunnyvale, CA, USA.,University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - K Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, Paris, France
| | - H Jones
- Incyte Corporation, Wilmington, DE, USA
| | - J Gao
- Incyte Corporation, Wilmington, DE, USA
| | - A Lindley
- Incyte Corporation, Wilmington, DE, USA
| | - J E Harris
- University of Massachusetts Medical School, Worcester, MA, USA
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12
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Chavez-Alvarez S, Herz-Ruelas M, Raygoza-Cortez AK, Suro-Santos Y, Ocampo-Candiani J, Alvarez-Villalobos NA, Villarreal-Martinez A. Letter to the editor: "Oral mini-pulse therapy in vitiligo: A systematic review". Int J Dermatol 2022; 61:e246-e247. [PMID: 35239974 DOI: 10.1111/ijd.16135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sonia Chavez-Alvarez
- Dermatology Department, Hospital Universitario "Dr. José E. González", Facultad de Medicina, Universidad Autónoma de Nuevo León UANL, Monterrey, Nuevo León, Mexico
| | - Maira Herz-Ruelas
- Dermatology Department, Hospital Universitario "Dr. José E. González", Facultad de Medicina, Universidad Autónoma de Nuevo León UANL, Monterrey, Nuevo León, Mexico
| | - Ana Karina Raygoza-Cortez
- Plataforma INVEST Medicina UANL -KER Unit Mayo Clinic (KER Unit Mexico), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Yeudiel Suro-Santos
- Dermatology Department, Hospital Universitario "Dr. José E. González", Facultad de Medicina, Universidad Autónoma de Nuevo León UANL, Monterrey, Nuevo León, Mexico
| | - Jorge Ocampo-Candiani
- Dermatology Department, Hospital Universitario "Dr. José E. González", Facultad de Medicina, Universidad Autónoma de Nuevo León UANL, Monterrey, Nuevo León, Mexico
| | | | - Alejandra Villarreal-Martinez
- Dermatology Department, Hospital Universitario "Dr. José E. González", Facultad de Medicina, Universidad Autónoma de Nuevo León UANL, Monterrey, Nuevo León, Mexico
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13
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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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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: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disturbance (seven studies, 4.6–89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behavior (12.5–76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligo-associated burden of disease. Protocol Registration PROSPERO (CRD42020162223). Graphic Abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40257-021-00631-6.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology, Henri Mondor University Hospital and Université Paris-Est Créteil Val de Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil, 94010, Paris, France.
| | | | | | | | | | | | - Amit G Pandya
- Palo Alto Foundation Medical Group, Mountain View, CA, USA
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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15
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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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16
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Shah F, Patel S, Begum R, Dwivedi M. Emerging role of Tissue Resident Memory T cells in vitiligo: From pathogenesis to therapeutics. Autoimmun Rev 2021; 20:102868. [PMID: 34118458 DOI: 10.1016/j.autrev.2021.102868] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 03/20/2021] [Indexed: 02/07/2023]
Abstract
Vitiligo is an acquired depigmenting disorder which affects both skin and mucous membranes and autoimmunity has been strongly suggested to play a role in loss of melanocytes. The recurrence of skin macules at the same sites where they were observed prior to the treatment, suggests the existence of Tissue Resident Memory T cells (TRMs) that persist within the skin or peripheral tissues with a longer survivability. Emerging studies have shown that reactivation of these skin TRMs results into autoreactive TRM cells in various autoimmune diseases including vitiligo. This review focuses on different subsets (CD8+ TRMs and CD4+ TRMs) of TRM cells, their retention and survivability in the skin along with their pathomechanisms leading to melanocyte death and progression of vitiligo. In addition, the review describes the TRM cells as potential targets for developing effective therapeutics of vitiligo.
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Affiliation(s)
- Firdosh Shah
- C. G. Bhakta Institute of Biotechnology, Uka Tarsadia University, Tarsadi, Surat 394350, Gujarat, India
| | - Shivani Patel
- C. G. Bhakta Institute of Biotechnology, Uka Tarsadia University, Tarsadi, Surat 394350, Gujarat, India
| | - Rasheedunnisa Begum
- Department of Biochemistry, Faculty of Science, The Maharaja Sayajirao University of Baroda, Vadodara 390 002, Gujarat, India
| | - Mitesh Dwivedi
- C. G. Bhakta Institute of Biotechnology, Uka Tarsadia University, Tarsadi, Surat 394350, Gujarat, India.
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17
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Yang M, Du M, Tang Z, Han G, Dong W, Chen Z, Song Y. Comparison of efficacy and safety of traditional Chinese patent medicine in the treatment of vitiligo in children or adults: A protocol for systematic review and network meta-analysis. Medicine (Baltimore) 2021; 100:e24878. [PMID: 33725959 PMCID: PMC7982174 DOI: 10.1097/md.0000000000024878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/02/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Vitiligo is a common depigmented skin disease in children or adults, which usually causes considerable psychological burden to life and work for the reason that it affects appearance. The conventional therapies, including external 308 nm excimer laser therapy along with oral administration of western medicine, are associated with distinct disadvantages. Notably, traditional Chinese patent medicine (TCPM) exerts a vital part in treating vitiligo. Currently, no existing research has examined the effectiveness and safety of different TCPMs in treating vitiligo among either child or adult patients. As a result, the present network meta-analysis was carried out for the systematic comparison of the effectiveness of different TCPMs in treating vitiligo. METHODS The electronic databases, like PubMed, Web of Science, EMBASE, The Cochrane Library, Chinese Scientific Journals Database, China National Knowledge Infrastructure, Wanfang database and China BioMedical Literature, were searched systemically by 2 reviewers independently from inception to August 2020 to identify relevant randomized controlled trial (RCTs) according to our study inclusion criteria. In data extraction, risk of bias among those enrolled articles was also detected. Besides, the Bayesian network meta-analysis method was utilized to evaluate the evidence and data collected. This adopted the STATA and Win BUGS software for analysis. RESULTS The present work assessed the safety and efficacy of different TCPMs in treating vitiligo among child or adult patients. CONCLUSION Our findings can shed precious lights on applying TCPMs in clinic and help the clinicians to formulate the efficient diagnostic and therapeutic strategies. ETHICS AND DISSEMINATION No ethical approval was needed in this study. INPLASY REGISTRATION NUMBER INPLASY2020120050.
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Affiliation(s)
- Meng Yang
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Mengmeng Du
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Zhikun Tang
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
| | - Guanqing Han
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Wenyao Dong
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Zhaoyu Chen
- First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine
| | - Yeqiang Song
- Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong Province, China
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18
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Zhang D, Wei X, Hong W, Fu L, Qian G, Xu AE. A retrospective study of long term follow-up of 2283 vitiligo patients treated by autologous, non-cultured melanocyte-keratinocyte transplantation. Aging (Albany NY) 2021; 13:5415-5425. [PMID: 33582653 PMCID: PMC7950304 DOI: 10.18632/aging.202472] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022]
Abstract
Background: Autologous non-cultured melanocyte-keratinocyte transplantation (MKTP) can be used to treat stable vitiligo cases, but there were insufficient clinical data to evaluate its safety and efficacy. Objective: To assess the influence of various factors on the therapeutic outcome of MKTP. Method: The single-center retrospective study included stable vitiligo patients who underwent MKTP between June 2009 and June 2018. Univariate and/or multivariable analysis were used to determine the factors affecting the outcome of repigmentation. Result: The study comprised 2283 patients who had long-term follow-up data (12-108months). Excellent repigmentation was achieved in 400/606 (66%),788/1341 (58.8%),437/684 (63.9%),18/24 (75%) patients with segmental vitiligo, pre-MKTP phototherapy, younger than 24 years, the lesion on the perineum and scrotum, respectively. However, the patients with a positive family history, Koebner phenomenon responded worse(χ2=29.417, P<0.001; χ2=107.397, P<0.001; respectively). Overall, a significant positive correlation between duration of stability and percentage of repigmentation was found (χ2=42.053, P<0. 001). Conclusion: MKTP is efficient and well tolerated for stable vitiligo treatment. Various factors such as duration of disease stability, vitiligo type, family history, site of lesion should be carefully assessed before using MKTP, as it would further improve the post-operative repigmentation.
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Affiliation(s)
- Dimin Zhang
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Xiaodong Wei
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Weisong Hong
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Lifang Fu
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Guopei Qian
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
| | - Ai-E Xu
- The Department of Dermatology, The Third People's Hospital of Hangzhou, Hangzhou Institute of Dermatology and Venereology, Hangzhou, China
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Yang B, Zhao H, Zhao N, Zhou B, Chen G, Wang Y, Zhang H, Lin Y, Liu H, Kundu R. Reliability and validity of the Chinese version of the vitiligo specific quality of life instrument (VitiQoL). DERMATOL SIN 2021. [DOI: 10.4103/ds.ds_48_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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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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Batchelor JM, Thomas KS, Akram P, Azad J, Bewley A, Chalmers JR, Cheung ST, Duley L, Eleftheriadou V, Ellis R, Ferguson A, Goulding JM, Haines RH, Hamad H, Ingram JR, Laguda B, Leighton P, Levell N, Makrygeorgou A, Meakin GD, Millington A, Ogboli M, Rajasekaran A, Ravenscroft JC, Rogers A, Sach TH, Santer M, Stainforth J, Tan W, Wahie S, White J, Whitton ME, Williams HC, Wright A, Montgomery AA. Home-based narrowband UVB, topical corticosteroid or combination for children and adults with vitiligo: HI-Light Vitiligo three-arm RCT. Health Technol Assess 2020; 24:1-128. [PMID: 33245043 PMCID: PMC7750863 DOI: 10.3310/hta24640] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Systematic reviews suggest that narrowband ultraviolet B light combined with treatments such as topical corticosteroids may be more effective than monotherapy for vitiligo. OBJECTIVE To explore the clinical effectiveness and cost-effectiveness of topical corticosteroid monotherapy compared with (1) hand-held narrowband ultraviolet B light monotherapy and (2) hand-held narrowband ultraviolet B light/topical corticosteroid combination treatment for localised vitiligo. DESIGN Pragmatic, three-arm, randomised controlled trial with 9 months of treatment and a 12-month follow-up. SETTING Sixteen UK hospitals - participants were recruited from primary and secondary care and the community. PARTICIPANTS Adults and children (aged ≥ 5 years) with active non-segmental vitiligo affecting ≤ 10% of their body area. INTERVENTIONS Topical corticosteroids [mometasone furoate 0.1% (Elocon®, Merck Sharp & Dohme Corp., Merck & Co., Inc., Whitehouse Station, NJ, USA) plus dummy narrowband ultraviolet B light]; narrowband ultraviolet B light (narrowband ultraviolet B light plus placebo topical corticosteroids); or combination (topical corticosteroids plus narrowband ultraviolet B light). Topical corticosteroids were applied once daily on alternate weeks and narrowband ultraviolet B light was administered every other day in escalating doses, with a dose adjustment for erythema. All treatments were home based. MAIN OUTCOME MEASURES The primary outcome was self-assessed treatment success for a chosen target patch after 9 months of treatment ('a lot less noticeable' or 'no longer noticeable' on the Vitiligo Noticeability Scale). Secondary outcomes included blinded assessment of primary outcome and percentage repigmentation, onset and maintenance of treatment response, quality of life, side effects, treatment burden and cost-effectiveness (cost per additional successful treatment). RESULTS In total, 517 participants were randomised (adults, n = 398; and children, n = 119; 52% male; 57% paler skin types I-III, 43% darker skin types IV-VI). At the end of 9 months of treatment, 370 (72%) participants provided primary outcome data. The median percentage of narrowband ultraviolet B light treatment-days (actual/allocated) was 81% for topical corticosteroids, 77% for narrowband ultraviolet B light and 74% for combination groups; and for ointment was 79% for topical corticosteroids, 83% for narrowband ultraviolet B light and 77% for combination. Target patch location was head and neck (31%), hands and feet (32%), and rest of the body (37%). Target patch treatment 'success' was 20 out of 119 (17%) for topical corticosteroids, 27 out of 123 (22%) for narrowband ultraviolet B light and 34 out of 128 (27%) for combination. Combination treatment was superior to topical corticosteroids (adjusted risk difference 10.9%, 95% confidence interval 1.0% to 20.9%; p = 0.032; number needed to treat = 10). Narrowband ultraviolet B light was not superior to topical corticosteroids (adjusted risk difference 5.2%, 95% confidence interval -4.4% to 14.9%; p = 0.290; number needed to treat = 19). The secondary outcomes supported the primary analysis. Quality of life did not differ between the groups. Participants who adhered to the interventions for > 75% of the expected treatment protocol were more likely to achieve treatment success. Over 40% of participants had lost treatment response after 1 year with no treatment. Grade 3 or 4 erythema was experienced by 62 participants (12%) (three of whom were using the dummy) and transient skin thinning by 13 participants (2.5%) (two of whom were using the placebo). We observed no serious adverse treatment effects. For combination treatment compared with topical corticosteroids, the unadjusted incremental cost-effectiveness ratio was £2328.56 (adjusted £1932) per additional successful treatment (from an NHS perspective). LIMITATIONS Relatively high loss to follow-up limits the interpretation of the trial findings, especially during the post-intervention follow-up phase. CONCLUSION Hand-held narrowband ultraviolet B light plus topical corticosteroid combination treatment is superior to topical corticosteroids alone for treatment of localised vitiligo. Combination treatment was relatively safe and well tolerated, but was effective in around one-quarter of participants only. Whether or not combination treatment is cost-effective depends on how much decision-makers are willing to pay for the benefits observed. FUTURE WORK Development and testing of new vitiligo treatments with a greater treatment response and longer-lasting effects are needed. TRIAL REGISTRATION Current Controlled Trials ISRCTN17160087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 64. See the NIHR Journals Library website for further project information.
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22
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Narayan VS, Uitentuis SE, Luiten RM, Bekkenk MW, Wolkerstorfer A. Patients' perspective on current treatments and demand for novel treatments in vitiligo. J Eur Acad Dermatol Venereol 2020; 35:744-748. [PMID: 32893377 PMCID: PMC7983948 DOI: 10.1111/jdv.16927] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/11/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The treatment of non-segmental vitiligo (NSV) remains a challenge. Current treatments often achieve suboptimal clinical results. To improve these treatment results, several new therapies are being developed and investigated. There is, however, little evidence on the actual need for novel therapies. OBJECTIVE To assess patients' perspective on current and novel therapies for vitiligo. METHODS A prospective questionnaire study was conducted in a large cohort of vitiligo patients that consecutively visited the outpatient clinic of the Amsterdam University Medical Centre between April 2017 and January 2019. Patients were requested to fill in a digital questionnaire on patient characteristics, disease burden, quality of life, efficacy and satisfaction of current treatments and aspects regarding new treatments. RESULTS A total of 325 vitiligo patients completed the questionnaire (60% response rate). Of the respondents, 94% believed that new and improved treatments are needed and 86% would be willing to participate in clinical trials investigating a new therapy. Sixty-nine per cent would agree on taking weekly injections if it led to effective treatment results. Of the patients that had received therapy before, 49% reported that the current treatments were not effective and 50% was not satisfied with the current treatments. Sixty-seven per cent of the patients experienced facial lesions as an extreme burden, whereas this was, 25%, 12% and 10% for lesions on the hands, trunk and feet, respectively. The emotional burden score was significantly higher in dark skin types compared with light skin types (respectively, 8 vs 5, U P < 0.05). CONCLUSION There is a substantial need for new vitiligo therapies. A considerable number of patients in our study are dissatisfied with current treatments and are emotionally burdened by the disease. Moreover, the vast majority demands novel treatments and is willing to participate in clinical trials.
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Affiliation(s)
- V S Narayan
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - S E Uitentuis
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - R M Luiten
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - M W Bekkenk
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - A Wolkerstorfer
- Department of Dermatology, Netherlands Institute for Pigment Disorders, Amsterdam Infection and Immunity Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
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Vocetkova K, Sovkova V, Buzgo M, Lukasova V, Divin R, Rampichova M, Blazek P, Zikmund T, Kaiser J, Karpisek Z, Amler E, Filova E. A Simple Drug Delivery System for Platelet-Derived Bioactive Molecules, to Improve Melanocyte Stimulation in Vitiligo Treatment. NANOMATERIALS 2020; 10:nano10091801. [PMID: 32927642 PMCID: PMC7559479 DOI: 10.3390/nano10091801] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/02/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022]
Abstract
Vitiligo is the most common depigmentation disorder of the skin. Currently, its therapy focuses on the halting of the immune response and stimulation of the regenerative processes, leading to the restoration of normal melanocyte function. Platelet-rich plasma (PRP) represents a safe and cheap regenerative therapy option, as it delivers a wide spectrum of native growth factors, cytokines and other bioactive molecules. The aim of this study was to develop a simple delivery system to prolong the effects of the bioactive molecules released from platelets. The surface of electrospun and centrifugally spun poly-ε-caprolactone (PCL) fibrous scaffolds was functionalized with various concentrations of platelets; the influence of the morphology of the scaffolds and the concentration of the released platelet-derived bioactive molecules on melanocytes, was then assessed. An almost two-fold increase in the amount of the released bioactive molecules was detected on the centrifugally spun vs. electrospun scaffolds, and a sustained 14-day release of the bioactive molecules was demonstrated. A strong concentration-dependent response of melanocyte to the bioactive molecules was observed; higher concentrations of bioactive molecules resulted in improved metabolic activity and proliferation of melanocytes. This simple system improves melanocyte viability, offers on-site preparation and is suitable for prolonged topical PRP administration.
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Affiliation(s)
- Karolina Vocetkova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
- Correspondence:
| | - Vera Sovkova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Matej Buzgo
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Vera Lukasova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Radek Divin
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Michala Rampichova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
| | - Pavel Blazek
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Tomas Zikmund
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Jozef Kaiser
- Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, 616 00 Brno, Czech Republic; (P.B.); (T.Z.); (J.K.)
| | - Zdenek Karpisek
- Institute of Mathematics, Faculty of Mechanical Engineering, Brno University of Technology, Technicka 2, 616 69 Brno, Czech Republic;
| | - Evzen Amler
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
- University Centre for Energy Efficient Buildings, Czech Technical University in Prague, Trinecka 1024, 273 43 Bustehrad, Czech Republic
| | - Eva Filova
- Institute of Experimental Medicine of the Czech Academy of Sciences, Videnska 1083, 142 20 Prague, Czech Republic; (V.S.); (M.B.); (V.L.); (R.D.); (M.R.); (E.F.)
- Department of Biophysics, 2nd Faculty of Medicine, Charles University, V Uvalu 84, 150 06 Prague, Czech Republic;
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Tanacan E, Atakan N. Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study. An Bras Dermatol 2020; 95:165-172. [PMID: 32113676 PMCID: PMC7175042 DOI: 10.1016/j.abd.2019.07.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/22/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the association between vitiligo and metabolic syndrome. METHODS A prospective cross-sectional study was conducted between 2014 and 2016. Study (n=155) and control groups (n=155) were evaluated for metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation criteria. Study group was divided into three groups according to their vitiligo area severity index and vitiligo disease activity score values (Group 1: 6.89 for VASI score, Group A: -1-0, Group B: 1-2 and Group C: 3-4 for vitiligo disease activity score respectively). MetS rates according to both criteria were compared between the vitiligo disease activity score and vitiligo area severity index groups. RESULTS Metabolic syndrome rates were 37.4% and 40% in the study group and 19.4% and 26.5% in the control group according to National CholesterolEducation Program Adult Treatment Panel III and International Diabetes Federation criteria, respectively (p<001 and p=0.011). Metabolic syndrome was more frequent in vitiligo area severity index Groups 2 and 3 compared to vitiligo area severity index Group 1, and in vitiligo disease activity score Group C compared to vitiligo disease activity score Groups A and B. STUDY LIMITATIONS Single center experience, absence of more specific oxidative-stress markers and lack of long-term follow-up of the patients. CONCLUSIONS Frequency of metabolic syndrome was higher in patients with non-segmental vitiligo and the rate was higher in active/severe form of the disease.
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Affiliation(s)
- Efsun Tanacan
- Department of Dermatology and Veneorology, Ufuk University School of Medicine, Ankara, Turkey.
| | - Nilgun Atakan
- Department of Dermatology and Veneorology, Hacettepe University Hospital, Ankara, Turkey
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25
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Howell MD, Kuo FI, Smith PA. Targeting the Janus Kinase Family in Autoimmune Skin Diseases. Front Immunol 2019; 10:2342. [PMID: 31649667 PMCID: PMC6794457 DOI: 10.3389/fimmu.2019.02342] [Citation(s) in RCA: 130] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/17/2019] [Indexed: 12/12/2022] Open
Abstract
Autoimmune skin diseases are characterized by significant local and systemic inflammation that is largely mediated by the Janus kinase (JAK)-signal transducer and activator of transcription (STAT) pathway. Advanced understanding of this pathway has led to the development of targeted inhibitors of Janus kinases (JAKinibs). As a class, JAK inhibitors effectively treat a multitude of hematologic and inflammatory diseases. Growing evidence suggests that JAK inhibitors are efficacious in atopic dermatitis, alopecia areata, psoriasis, and vitiligo. Additional evidence suggests that JAK inhibition might be broadly useful in dermatology, with early reports of efficacy in several other conditions. JAK inhibitors can be administered orally or used topically and represent a promising new class of medications. Here we review the evolving data on the role of the JAK-STAT pathway in inflammatory dermatoses and the potential therapeutic benefit of JAK-STAT antagonism.
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Affiliation(s)
| | - Fiona I Kuo
- Incyte Corporation, Wilmington, DE, United States
| | - Paul A Smith
- Incyte Corporation, Wilmington, DE, United States
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26
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Gender Differences in Depression, Coping, Stigma, and Quality of Life in Patients of Vitiligo. Dermatol Res Pract 2019; 2019:6879412. [PMID: 31065260 PMCID: PMC6466925 DOI: 10.1155/2019/6879412] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 02/10/2019] [Accepted: 02/24/2019] [Indexed: 12/19/2022] Open
Abstract
Though vitiligo is one of the psychodermatological disorders which do not cause direct physical impairment, it is cosmetically disfiguring leading to serious psychological problems in daily life. We undertook this research to study patients of vitiligo the prevalence of depression, coping, stigma, and quality of life and comparison of the same in both genders. Patients diagnosed clinically as having vitiligo by consultant dermatologist were enrolled after informed consent and ethics approval. 156 patients were screened, of which 100 satisfying criteria were taken up for the study. A semistructured proforma was designed to collect the necessary information with administration of Beck's depression inventory, participation scale, dermatology life quality index, and adjustment to chronic skin diseases questionnaire. Depression prevalence was 63.64% in females and 42.86% in males (p<0.0457); the total mean BDI scores were significant with females having higher scores than males (p<0.0083). No significant differences were seen on participation scale though 52% females felt stigmatized as compared to 45% males (p <0.5779). While almost 97% of our patients had impaired quality of life there was no significant difference in both genders on the total score (p<0.3547). Females had significantly higher faulty coping style than males with significant differences on all domains and total scores (p< 0.0094). There was a strong association of depression with faulty coping and stigma (p< 0.0001) in both genders. Also association of stigma with quality of life showed highly significant findings in both genders (p< 0.0001) on all the domains of DLQI. This study helps in early identification of psychological problems in vitiligo patients and planning their future course of management, hence improving the prognosis and quality of life.
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Nørgaard K, Kielgast U. Quality of Life is Markedly Impaired by Rheumatological and Skin Manifestations in Patients with Type 1 Diabetes: A Questionnaire Survey. Diabetes Ther 2019; 10:635-647. [PMID: 30778903 PMCID: PMC6437232 DOI: 10.1007/s13300-019-0587-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION To estimate lifetime prevalence of diabetes-related upper limb and non-acquired skin manifestations in a representative type 1 diabetes (T1D) population and to identify associations between these conditions and quality of life. METHODS A questionnaire on these complications and measures of quality of life (World Health Organization-Five Well-Being Index [WHO-5]), depression, and diabetes-specific burden (Problem Areas in Diabetes [PAID] scale) was sent to all T1D patients in a Danish clinic (N = 583). RESULTS The response rate was 68.6%. Lifetime prevalence of any upper limb soft tissue lesion was 72%; prevalence of any skin lesion was 10.5%. Frozen shoulder and vitiligo were most common upper limb and skin manifestation, at a prevalence of 53 and 9.1%, respectively. Compared to patients with no skin lesion, those with at least one skin lesion had more depression (19 vs. 33%; P < 0.01) and lower WHO-5 scores. Frozen shoulder was associated with lower WHO-5 scores (P < 0.001), more depression (29 vs. 14%; P < 0.001), and a higher PAID score (P < 0.01). A diagnosis of carpal tunnel syndrome was associated with lower WHO-5 scores (P < 0.001), a higher risk of depression (29 vs. 16%; P < 0.01), and a higher PAID score (P < 0.001). CONCLUSION Upper limb soft tissue lesions and diabetes-specific non-acquired skin lesions are very common in patients with T1D and strongly associated with impaired life quality and increased risk of depression.
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Affiliation(s)
- Kirsten Nørgaard
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.
| | - Urd Kielgast
- Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Zealand University Hospital, Køge, Denmark
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28
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Ahmed A, Steed L, Burden-Teh E, Shah R, Sanyal S, Tour S, Dowey S, Whitton M, Batchelor J, Bewley A. Identifying key components for a psychological intervention for people with vitiligo - a quantitative and qualitative study in the United Kingdom using web-based questionnaires of people with vitiligo and healthcare professionals. J Eur Acad Dermatol Venereol 2018; 32:2275-2283. [PMID: 29972710 DOI: 10.1111/jdv.15168] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/21/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A. Ahmed
- Department of Dermatology; King Edward VII Hospital; Windsor UK
| | - L. Steed
- Centre for Public Health and Primary Care; Queen Mary University of London; London UK
| | - E. Burden-Teh
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - R. Shah
- Barts Health NHS Trust; London UK
| | - S. Sanyal
- Sandwell and West Birmingham NHS Trust; West Midlands UK
| | - S. Tour
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - S. Dowey
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
| | - M. Whitton
- Cochrane Skin Group; University of Nottingham; Nottingham UK
| | - J.M. Batchelor
- Centre of Evidence Based Dermatology; University of Nottingham; Nottingham UK
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Cadmus SD, Lundgren AD, Ahmed AM. Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: A review. Pediatr Dermatol 2018; 35:441-447. [PMID: 29766546 DOI: 10.1111/pde.13517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vitiligo commonly affects children, with half of affected individuals experiencing disease onset before the age of 20. Because childhood is a time of advancement in social and psychological development, understanding the extent of the effect of the disease and means of alleviation is crucial. Vitiligo has been shown to decrease children's quality of life, with greater distress in children with highly visible lesions and darker skin tones. This article reviews the literature regarding interventions that have been analyzed in children. Studies evaluating the effect of camouflage, cognitive behavioral therapy, psychological self-help tools, and support groups on the psychosocial aspects of vitiligo were included. The review highlights the ongoing need for studies to better understand the modalities described in this article, as well as others, such as skin dyes, bleaching creams, medical tattooing; week-long camps that cater to children with chronic skin disease; and biofeedback, that might have a role in preventing the psychosocial sequelae of childhood vitiligo.
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Affiliation(s)
- Simi D Cadmus
- School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Ashley D Lundgren
- Division of Dermatology, Dell Medical School, University of Texas, Austin, TX, USA
| | - Ammar M Ahmed
- Division of Dermatology, Dell Medical School, University of Texas, Austin, TX, USA
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30
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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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31
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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: 11] [Impact Index Per Article: 1.8] [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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Elbuluk N, Ezzedine K. Quality of Life, Burden of Disease, Co-morbidities, and Systemic Effects in Vitiligo Patients. Dermatol Clin 2017; 35:117-128. [PMID: 28317521 DOI: 10.1016/j.det.2016.11.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Vitiligo is a complex, systemic disease associated with many autoimmune and autoinflammatory conditions. Additionally, the cutaneous changes of vitiligo have significant effects on quality of life and self-esteem. Further efforts are needed to increase our understanding of vitiligo comorbidities as well as to increase awareness of the psychological effects of vitiligo.
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Affiliation(s)
- Nada Elbuluk
- Ronald O. Perelman Department of Dermatology, NYU Ambulatory Care Center, NYU Langone Medical Center, 240 East 38th Street, 12th Floor, New York, NY 10016, USA.
| | - Khaled Ezzedine
- Department of Dermatology, EpiDermE, Henri Mondor Hospital, Université Paris-Est Créteil Val-de-Marne, 51 Avenue du Maréchal de Lattre de Tassigny, Créteil 94010, France
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Affiliation(s)
- V.K. Sharma
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
| | - R. Bhatia
- Department of Dermatology and Venereology All India Institute of Medical Sciences New Delhi India
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Long-term follow-up of patients undergoing autologous noncultured melanocyte-keratinocyte transplantation for vitiligo and other leukodermas. J Am Acad Dermatol 2017; 77:318-327. [DOI: 10.1016/j.jaad.2017.01.056] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 11/20/2022]
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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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Nguyen CM, Beroukhim K, Danesh MJ, Babikian A, Koo J, Leon A. The psychosocial impact of acne, vitiligo, and psoriasis: a review. Clin Cosmet Investig Dermatol 2016; 9:383-392. [PMID: 27799808 PMCID: PMC5076546 DOI: 10.2147/ccid.s76088] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Introduction Chronic skin conditions have been well reported to affect a patient’s quality of life on multiple dimensions, including the psychosocial domain. Psychosocial is defined as the interrelation of social factors with an individual’s thoughts and behavior. The assessment of the psychosocial impact of skin disease on a patient can help direct the dermatologists’ treatment goals. To evaluate the psychosocial impact of skin disease, we conducted a review of the literature on three skin conditions with onsets at various stages of life: acne, vitiligo, and psoriasis. Methods A PubMed search was conducted in March 2015 using the terms “psychosocial” AND “acne”, “psychosocial” AND “vitiligo”, and “psychosocial” AND “psoriasis”. The results were limited to articles published in English in the past 5 years studying patients of all ages. Results and their references were evaluated for relevance according to their discussion of psychosocial qualities in their patients and the validity of psychosocial assessments. The search for acne yielded 51 results, and eleven were found to be relevant; vitiligo yielded 30 results with ten found to be relevant; and psoriasis yielded 70 results with seven found to be relevant. Results According to the articles evaluated, 19.2% of adolescent patients with acne were affected in their personal and social lives. Social phobia was present in 45% of patients with acne compared to 18% of control subjects. Race and sex played a role in self-consciousness and social perceptions of the disease. Vitiligo negatively affected marriage potential and caused relationship problems in >50% of patients. Psoriasis negatively affected multiple domains of life, including work, relationships, and social activities. Anxiety and depression affected not only psoriasis patients but also their cohabitants; up to 88% of cohabitants had an impaired quality of life. Conclusion Though all three skin conditions resulted in an increase in anxiety and depression among their patient populations, the psychosocial focus varied slightly for each disease. Overall, acne, vitiligo, and psoriasis can have negative psychosocial impact in different stages of life development.
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Affiliation(s)
| | | | - Melissa J Danesh
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco
| | - Aline Babikian
- Touro University College of Osteopathic Medicine, Vallejo, CA, USA
| | - John Koo
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco
| | - Argentina Leon
- Department of Dermatology, University of California San Francisco School of Medicine, San Francisco
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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: 43] [Impact Index Per Article: 5.4] [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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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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Lotti T, Hercogova J, Fabrizi G. Advances in the treatment options for vitiligo: activated low-dose cytokines-based therapy. Expert Opin Pharmacother 2015; 16:2485-96. [DOI: 10.1517/14656566.2015.1087508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
Vitiligo, an acquired pigmentary disorder of unknown origin, is the most frequent cause of depigmentation worldwide, with an estimated prevalence of 1%. The disorder can be psychologically devastating and stigmatising, especially in dark skinned individuals. Vitiligo is clinically characterised by the development of white macules due to the loss of functioning melanocytes in the skin or hair, or both. Two forms of the disease are well recognised: segmental and non-segmental vitiligo (the commonest form). To distinguish between these two forms is of prime importance because therapeutic options and prognosis are quite different. The importance of early treatment and understanding of the profound psychosocial effect of vitiligo will be emphasised throughout this Seminar.
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Affiliation(s)
- Khaled Ezzedine
- Department of Dermatology and Paediatric Dermatology, National Centre for Rare Skin disorders, Hôpital Pellegrin, Bordeaux, France; Institut National de la Santé et de la Recherche Médicale. U1035, University of Bordeaux, Bordeaux, France.
| | | | - Maxine Whitton
- Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
| | - Nanja van Geel
- Department of Dermatology, Ghent University Hospital, Ghent, Belgium
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Whitton ME, Pinart M, Batchelor J, Leonardi-Bee J, González U, Jiyad Z, Eleftheriadou V, Ezzedine K. Interventions for vitiligo. Cochrane Database Syst Rev 2015; 2015:CD003263. [PMID: 25710794 PMCID: PMC10887429 DOI: 10.1002/14651858.cd003263.pub5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Vitiligo is a chronic skin disorder characterised by patchy loss of skin colour. Some people experience itching before the appearance of a new patch. It affects people of any age or ethnicity, more than half of whom develop it before the age of 20 years. There are two main types: generalised vitiligo, the common symmetrical form, and segmental, affecting only one side of the body. Around 1% of the world's population has vitiligo, a disease causing white patches on the skin. Several treatments are available. Some can restore pigment but none can cure the disease. OBJECTIVES To assess the effects of all therapeutic interventions used in the management of vitiligo. SEARCH METHODS We updated our searches of the following databases to October 2013: the Cochrane Skin Group Specialised Register, CENTRAL in The Cochrane Library (2013, Issue 10), MEDLINE, Embase, AMED, PsycINFO, CINAHL and LILACS. We also searched five trials databases, and checked the reference lists of included studies for further references to relevant randomised controlled trials (RCTs). SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the effects of treatments for vitiligo. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed study eligibility and methodological quality, and extracted data. MAIN RESULTS This update of the 2010 review includes 96 studies, 57 from the previous update and 39 new studies, totalling 4512 participants. Most of the studies, covering a wide range of interventions, had fewer than 50 participants. All of the studies assessed repigmentation, however only five reported on all of our three primary outcomes which were quality of life, > 75% repigmentation and adverse effects. Of our secondary outcomes, six studies measured cessation of spread but none assessed long-term permanence of repigmentation resulting from treatment at two years follow-up.Most of the studies assessed combination therapies which generally reported better results. New interventions include seven new surgical interventions.We analysed the data from 25 studies which assessed our primary outcomes. We used the effect measures risk ratio (RR), and odds ratio (OR) with their 95% confidence intervals (CI) and where N is the number of participants in the study.We were only able to analyse one of nine studies assessing quality of life and this showed no statistically significant improvement between the comparators.Nine analyses from eight studies reported >75% repigmentation. In the following studies the repigmentation was better in the combination therapy group: calcipotriol plus PUVA (psoralen with UVA light) versus PUVA (paired OR 4.25, 95% CI 1.43 to 12.64, one study, N = 27); hydrocortisone-17-butyrate plus excimer laser versus excimer laser alone (RR 2.57, 95% CI 1.20 to 5.50, one study, N = 84); oral minipulse of prednisolone (OMP) plus NB-UVB (narrowband UVB) versus OMP alone (RR 7.41, 95% CI 1.03 to 53.26, one study, N = 47); azathioprine with PUVA versus PUVA alone (RR 17.77, 95% CI 1.08 to 291.82, one study, N = 58) and 8-Methoxypsoralen (8-MOP ) plus sunlight versus psoralen (RR 2.50, 95% CI 1.06 to 5.91, one study, N = 168). In these three studies ginkgo biloba was better than placebo (RR 4.40, 95% CI 1.08 to 17.95, one study, N = 47); clobetasol propionate was better than PUVAsol (PUVA with sunlight) (RR 4.70, 95% CI 1.14 to 19.39, one study, N = 45); split skin grafts with PUVAsol was better than minipunch grafts with PUVAsol (RR 1.89, 95% CI 1.25 to 2.85, one study, N = 64).We performed one meta-analysis of three studies, in which we found a non-significant 60% increase in the proportion of participants achieving >75% repigmentation in favour of NB-UVB compared to PUVA (RR 1.60, 95% CI 0.74 to 3.45; I² = 0%).Studies assessing topical preparations, in particular topical corticosteroids, reported most adverse effects. However, in combination studies it was difficult to ascertain which treatment caused these effects. We performed two analyses from a pooled analysis of three studies on adverse effects. Where NB-UVB was compared to PUVA, the NB-UVB group reported less observations of nausea in three studies (RR 0.13, 95% CI 0.02 to 0.69; I² = 0% three studies, N = 156) and erythema in two studies (RR 0.73, 95% CI 0.55 to 0.98; I² = 0%, two studies, N = 106), but not itching in two studies (RR 0.57, 95% CI 0.20 to 1.60; I² = 0%, two studies, N = 106).Very few studies only assessed children or included segmental vitiligo. We found one study of psychological interventions but we could not include the outcomes in our statistical analyses. We found no studies evaluating micropigmentation, depigmentation, or cosmetic camouflage. AUTHORS' CONCLUSIONS This review has found some evidence from individual studies to support existing therapies for vitiligo, but the usefulness of the findings is limited by the different designs and outcome measurements and lack of quality of life measures. There is a need for follow-up studies to assess permanence of repigmentation as well as high- quality randomised trials using standardised measures and which also address quality of life.
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Affiliation(s)
- Maxine E Whitton
- c/o Cochrane Skin Group, The University of Nottingham, Room A103, King's Meadow Campus, Lenton Lane, Nottingham, UK, NG7 2NR. .
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Gupta V, Sreenivas V, Mehta M, Khaitan B, Ramam M. Measurement properties of the Vitiligo Impact Scale‐22 (
VIS
‐22), a vitiligo‐specific quality‐of‐life instrument. Br J Dermatol 2014; 171:1084-90. [DOI: 10.1111/bjd.13093] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 11/29/2022]
Affiliation(s)
- V. Gupta
- Department of Dermatology and Venereology All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India
| | - V. Sreenivas
- Department of Biostatistics All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India
| | - M. Mehta
- Department of Psychiatry All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India
| | - B.K. Khaitan
- Department of Dermatology and Venereology All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India
| | - M. Ramam
- Department of Dermatology and Venereology All India Institute of Medical Sciences Ansari Nagar New Delhi 110029 India
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Allam M, Riad H. Concise review of recent studies in vitiligo. Qatar Med J 2013; 2013:1-19. [PMID: 25003059 PMCID: PMC4080492 DOI: 10.5339/qmj.2013.10] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 10/20/2013] [Indexed: 12/12/2022] Open
Abstract
Vitiligo is an acquired pigmentry disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. Etiological hypotheses of vitiligo include genetic, immunological, neurohormonal, cytotoxic, biochemical, oxidative stress and newer theories of melanocytorrhagy and decreased melanocytes survival. There are several types of vitiligo which are usually diagnosed clinically and by using a Wood's lamp; also vitiligo may be associated with autoimmune diseases, audiological and ophthalmological findings or it can be a part of polyendocrinopathy syndromes. Several interventions are available for the treatment for vitiligo to stop disease progression and/or to attain repigmentation or even depigmentation. In this article, we will present an overall view of current standing of vitiligo research work especially in the etiological factors most notably the genetic components, also, types and associations and various and newer treatment modalities.
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Affiliation(s)
- Mohamed Allam
- Dermatology Department, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Riad
- Dermatology Department, Rumailah Hospital, Hamad Medical Corporation, Doha, Qatar
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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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Alghamdi KM, Moussa NA, Mandil A, Alkofidi M, Madani A, Aldaham N, Alkamel AA. Public perceptions and attitudes toward vitiligo. J Cutan Med Surg 2012; 16:334-40. [PMID: 22971308 DOI: 10.1177/120347541201600510] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies have discussed attitudes of vitiligo patients toward their disease. However, no studies have addressed this issue from the public's point of view. OBJECTIVE To explore the perceptions, attitudes, and misconceptions of the public toward vitiligo. METHODS A self-administered questionnaire was distributed to attendees of primary health care centers in Riyadh, Saudi Arabia, between January and August 2010. RESULTS Overall, 924 of the 1,000 distributed questionnaires were returned, and 429 were males (46.8%). Moreover, 33.1% (303 of 916) believed that vitiligo is contagious or did not know that it is not. The cause of vitiligo was thought to be infectious by 20.4% of respondents (182 of 894), inherited by 40.5% (365 of 902), autoimmune by 41.2% (370 of 899), and due to a lack of hygiene by 22.5% (199 of 883). Unmarried individuals and those with less education were more likely to state that vitiligo is caused by an infection (. = .02, . = .03, respectively). Younger individuals and those with less education were more likely to think that vitiligo is caused by a lack of hygiene (. = .01, . = .001, respectively). More than half of the participants (56.1%, 504 of 898) would be unwilling to marry a vitiligo patient. Younger individuals and males were less likely to marry a vitiligo patient (. = .01, . = .05, respectively), whereas those of lower income were more likely to accept it (. = .002). CONCLUSIONS Various misconceptions and negative attitudes about vitiligo among the public are prevalent. Educating the public about vitiligo could ultimately lead to better psychosocial well-being of vitiligo patients.
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Teovska Mitrevska N, Eleftheriadou V, Guarneri F. Quality of life in vitiligo patients. Dermatol Ther 2012; 25 Suppl 1:S28-31. [DOI: 10.1111/dth.12007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Fabrizio Guarneri
- Department of Territorial Social Medicine, Section of Dermatology; University of Messina; Messina; Italy
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Taieb A, Alomar A, Böhm M, Dell'anna ML, De Pase A, Eleftheriadou V, Ezzedine K, Gauthier Y, Gawkrodger DJ, Jouary T, Leone G, Moretti S, Nieuweboer-Krobotova L, Olsson MJ, Parsad D, Passeron T, Tanew A, van der Veen W, van Geel N, Whitton M, Wolkerstorfer A, Picardo M. Guidelines for the management of vitiligo: the European Dermatology Forum consensus. Br J Dermatol 2012; 168:5-19. [PMID: 22860621 DOI: 10.1111/j.1365-2133.2012.11197.x] [Citation(s) in RCA: 246] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The aetiopathogenic mechanisms of vitiligo are still poorly understood, and this has held back progress in diagnosis and treatment. Up until now, treatment guidelines have existed at national levels, but no common European viewpoint has emerged. This guideline for the treatment of segmental and nonsegmental vitiligo has been developed by the members of the Vitiligo European Task Force and other colleagues. It summarizes evidence-based and expert-based recommendations (S1 level).
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Affiliation(s)
- A Taieb
- Service de Dermatologie, CHU de Bordeaux, Bordeaux Cedex, France
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Moreira CG, Horinouchi CDS, Souza-Filho CS, Campos FR, Barison A, Cabrini DA, Otuki MF. Hyperpigmentant activity of leaves and flowers extracts of Pyrostegia venusta on murine B16F10 melanoma. JOURNAL OF ETHNOPHARMACOLOGY 2012; 141:1005-1011. [PMID: 22504061 DOI: 10.1016/j.jep.2012.03.047] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 03/26/2012] [Accepted: 03/28/2012] [Indexed: 05/31/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Pyrostegia venusta is a native Brazilian plant which has a variety of uses in traditional folk medicine including the treatment of vitiligo. However, its effectiveness on melanogenesis is not yet elucidated. AIM OF THE STUDY This study aimed to investigate the melanogenic activity of hydroalcoholic extracts from the leaves and flowers of P. venusta on murine B16F10 melanoma cells. MATERIALS AND METHODS Different concentrations of the hydroalcoholic extracts of flowers and leaves of P. venusta were evaluated in trials of spontaneous melanin content (4 days), and cell viability by the MTT assay in murine B16F10 cells, and in the mushroom tyrosinase activity in vitro. RESULTS Both extracts, leaves (0.1; 0.3; 1 and 3 μg/mL) and flowers (0.03 and 0.1 μg/mL) increased the melanin content in a concentration dependent manner after 4 days of incubation on melanoma cells. Leaves extract promoted enhancement of melanogenesis with maximum effect of 33.3±3% (3 μg/mL), and the flower extract increased in 23.4±3% (0.1 μg/mL). The cell viability test using MTT showed that in the same tested concentrations of both extracts no cell death was detected. Actually, either extract was not able to cause any change in the tyrosinase activity. HPLC analysis of P. venusta extracts found 0.09% and 1.08% of allantoin on leaves and flowers extracts, respectively. CONCLUSIONS The leaves and flowers extracts of P. venusta stimulates B16F10 melanogenesis at very low concentrations. These findings support the folk medicinal use of P. venusta on the treatment of hypopigmentation diseases, such as vitiligo.
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Affiliation(s)
- Camila G Moreira
- Department of Pharmacology, Universidade Federal do Paraná, Curitiba, PR, Brazil
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