Study Explores the Psychosocial Burdens of Vitiligo

Khaled Ezzedine, MD, PhD

A recent systematic review of vitiligo concluded that the disease had broad psychological implications in affected patients that required multidisciplinary approaches to treatment strategies.

Investigators led by Khaled Ezzedine, MD, PhD, Department of Dermatology, Henri Mondor University Hospital, added that continued education about vitiligo was warranted to address the burden of the disease.

The new data was supported by the recent influx of studies concerning the depression and anxiety in patients with vitiligo.

The global prevalence of the disease had been recorded as approximately 0.5%-2.0%, with noticeable lesions appearing at various ages, predominantly at 30 years or younger.

With their study, Ezzedine and colleagues sought to comprehensively describe the psychosocial burdens of vitiligo, the comorbidities associated with the disease, as well as potential coping strategies and perceptions from patients and caregivers.

Methods

Initially, Ezzedine and investigators conducted an extensive literature search that incorporated material from PubMed, EMBASE, Scopus, and the Cochrane database.

They searched through the earliest available entries on vitiligo through March 1, 2021. Peer-reviewed primary publications, clinical trials, and observational studies were all accepted.

The team would then extract the available data, which included study design, geographic region, sample size, patient demographics, comorbidities, psychosocial burdens, and coping strategies.

In total, the initial database searches resulted in 168 usable articles for the study.

Overall, 72.6% of the studies used were published in the past 10 years, though some were as early as 1979.

Defining Vitiligo

Ezzedine and investigators noted that a majority of the studies used standard quality of life (QoL) instruments to assess patients, though 8 studies utilized a Vitiligo-specific (VitiQoL) instrument.

The team would summarize the psychosocial comorbidities referenced in the available studies.

Overall, 9 studies noted the presence of any psychosocial comorbidity in 32.6%-90% of patients with vitiligo, with depression and anxiety being the most commonly reported.

A total of 41 studies reported depression or depressive orders in this patient group, with a prevalence range of 0.1%-62.3%.

Compared with controls, psychosocial comorbidities were also noted to be significantly (p ≤ 0.05) associated with vitiligo were depression in 11 studies, and the QoL and psychosocial burden of vitiligo was most frequently compared to psoriasis.

Factors associated with the burden included female sex (30 studies), visible lesions (17 studies), younger age (16 studies), progressive disease (7 studies) and more.

In terms of coping with vitiligo,8.3%-78.3% of patients in 6 studies used concealing clothing, while a similar percentage of patients from 5 studies altered their body movements.

Common misperceptions of the disease were that it was contagious and caused by a lack of hygiene or infection.Caregiver burdens were also associated with depression and anxiety, with 2 studies reported significant parental depression in the case of pediatric vitiligo.

Ezzedine and investigators believed they had gathered significant evidence that defined the burdens of vitiligo, and the broad effect on psychosocial well-being of those affected, be it patients or caregivers.

They offered potential solutions in defining and managing the disease through different treatments and research.

“The extent of the psychosocial comorbidities summarized in this systematic review indicates that multidisciplinary approaches to treatment strategies (including medical and psychological treatment) and education about vitiligo are needed to address the burden of this disease,” the team wrote.

The study, “Psychosocial Effects of Vitiligo: A Systematic Literature Review,” was published online in the American Journal of Clinical Dermatology.