Investigators Develop New Vitiligo Impact Treatment Score

Julien Senechal, MD, PhD

Investigators in France developed and validated a dermatologic specific burden score called the Vitiligo Impact Treatment (VIT) score.

The score was tested in a large vitiligo population and patient acceptable symptom state (PASS) was calculated and defined to help identifying patients overwhelmed by the treatment.

Investigators led by Julien Senechal, MD, PhD, Service de Dermatologie, Centre de Référence des Maladies Rares de la Peau, Hôpital Saint André, CHU de Bordeaux, believed the questionnaire would be used to develop patient-centered approaches to vitiligo management involving the personalized adaptation of treatment regimens to find a balance between treatment benefit and burden.

They also noted the “devastating” impact on the quality of life and self-esteem and psychiatric comorbidities vitiligo can have on the 0.1% to 2% of the world’s population who are affected by the disease, and the challenges regarding appropriate treatment.

Their study occurred in the framework of an ongoing e-cohort project called ComPare. In it, the investigators aimed to develop and validate a patient reported measurement of the burden of treatment in vitiligo patients.

The Methods

Senechal and colleagues utilized a multistep method to develop a questionnaire to measure the burden of patients with vitiligo.

The investigators initially conducted a literature search on PebMEd to identify published questionnaires or scoring systems related both to the quality-of-life impact and burden of treatment of vitiligo.

Among vitiligo quality of life scales, several instruments such as the vitiligo impact scale, the vitiligo impact patient scale, and the vitiligo life quality index related to treatment burden.

As of December 2020, the ComPaRe cohort consisted of 42,000 patients with chronic conditions. A total of 343 adult patients with vitiligo from the cohort were included in the current study.

Each participant from the cohort was tasked with answering an online survey with open ended questions that explored the different aspects of vitiligo. Their responses would be analyzed and used to identify 24 themes related to the burden of the disease.

Each theme was transformed in a questionnaire and evaluated with a 4-point Likert scale: "Disagree" (1), “Slightly agree" (2), "Agree" (3), "Strongly Agree" (4) and "Not concerned" (0).

Construct validity of the instrument was assessed by comparing the instrument’s score to the Dermatology Life Quality Index (DLQI), Vitiligo Impact Patient score (VIPs) and Treatment Burden Questionnaire (TBQ) scores.

The Findings

By the end of the study, a 19-item questionnaire was developed that assessed the burden of treatment in patients with vitiligo through 4 pertinent dimensions: finding a doctor, topical treatments, light treatment, and impact on outdoor activities and photoprotection.

The team noted that their instrument complemented existing measures of dermatologic quality of life such as the DLQI and VIP, and that they believed their score fulfilled an unmet need in the clinical research of vitiligo by defining the burden of treatment as the core outcome.

Additionally, they believed it could be used in clinical practice as a validated global score that is easy to calculate to identify patients overwhelmed by their treatment and demonstrated that patients with a VITs score above 48.5 (PASS) were at risk of being overwhelmed.

Though the study was conducted based on the burdens of vitiligo, Senechal and investigators stated that “future studies could explore how our patient reported instrument could be generalized to other chronic inflammatory skin diseases.”

The study, “Vitiligo Treatment Impact score (VITs): development and validation of a vitiligo burden of treatment questionnaire using the ComPaRe Vitiligo e-cohort,” was published online in the Journal of The European Academy of Dermatology and Venereology.