Vitiligo Treatment Impact Score Developed in France

Khaled Ezzedine, MD, PhD

Investigators from France developed a patient reported measurement of the burden of treatment in adults with vitiligo that they believed had promising psychometric properties.

In their study, led by Khaled Ezzedine, MD, PhD, Hôpital Henri Mondor, Department of Dermatology, Créteil, the investigative team addressed several burden of vitiligo including psychiatric comorbidities such as depression and anxiety.

Additionally, Ezzedine and colleagues noted that vitiligo treatment has often required combination therapies including oral or topical immunosuppressants alongside light treatment.

The treatments traditionally used have often been both long and costly, resulting in only partial re-pigmentation.

Proper vitiligo management has also included finding a doctor, applying topical treatments and at times changing one’s lifestyle.

Drawing inspiration from an ongoing e-cohort dedicated to chronic diseases called ComPare, investigators set out to develop and validate a patient reported measurement of the burden of treatment in adult patients with vitiligo.

The Methods

Ezzedine and colleagues initiated the study by developing a questionnaire aimed to measure the burden of treatment in patients with vitiligo.

Questions were developed by a group of researchers, methodologists, dermatologists, and patients. A literature search was conducted prior to the development of the questionnaire, but investigators found no prior questionnaires devoted to measuring the burden of treatment in dermatology, including vitiligo.

However, several instruments such as the vitiligo impact scale, the vitiligo impact patient scale, and the vitiligo life quality index were reported in their literature search.

Ezzedine and investigators established 24 themes for their questionnaire that they believed related to the burden of treatment for vitiligo, each of which was evaluated with a 4-point Likert scale: “Disagree”, “Slightly agree”, “Agree”, “Strongly Agree”, and “Not Concerned”.

The total number of themes (or “items”) was reduced to 19 to avoid redundancies.

In total, 343 adults participated in the study, 204 of whom were patients taken from the ComPaRe vitiligo cohort.

The Findings

From October 2019 to February 2020, 343 patients participated in the validation of the Vitiligo Treatment Impact score (VITs).

The 19-item questionnaire included 4 main domains: “Finding a doctor”, “Phototherapy”, “Topical treatment”, and “Impact on outdoor activities and photoprotection”.

Upon completion, the instrument’s score was compared to the Dermatology Life Quality Index (DLQI), Vitiligo Impact Patient score (VIPs) and Treatment Burden Questionnaire (TBQ) scores.

The 19-item questionnaire correlated moderately with the DLQI 0.593 [0.511, 0.665], and the VIPs 0.587 [0.495, 0.666] but poorly the TBQ 0.242 [0.14, 0.34].

Ezzedine and investigators noted that their instrument complimented the existing measure of dermatologic quality of life such as the DLQI and VIPs, believing it addressed the gap in evaluating the burden of dermatological care.

Total scores were significantly different between patients currently receiving treatment versus those not receiving any treatment (51.9±19.5 vs 38.6±26, p<0.001), currently receiving light therapy versus those not receiving light treatment (61.4±15.9 vs 39.3±25.1, p<0.001); having versus not having friction area involvement(36.2±26sd vs 3.8±25, p=0.013); and having re-pigmented versus not having re-pigmented following treatment (39.5±26.2 vs 49.9±19.1 p<0.001).

A test-retest analysis was conducted on 151 patients and confirmed that reliability was good. The tool also showed good psychometric and face validity.

Despite some limitations, including the study being conducted exclusively in France, investigators believed future studies could incorporate the tool in studies involving other chronic inflammatory skin diseases.

“This questionnaire will be of use to develop a patient-centered approach of vitiligo management involving the personalized adaptation of treatment regimens to find the best balance between treatment benefit and burden,” the team wrote.

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.