Camouflage for vitiligo

Cosmetic camouflage is indispensable for patients with vitiligo and can result in an improvement of their quality of life. Recent cosmetic advances enabled camouflage to obtain a suitable color match and keep it waterproof. However, camouflage needs some techniques. Therefore, patient education through a camouflage lesson is required to enjoy camouflage. Here the authors introduced a few tips for suitable camouflage, which were devised through camouflage lessons.     

Therapeutic interventions to lessen the psychosocial effect of vitiligo in children: A review

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.     

白癜风患者生活质量的调查分析

为了解白癜风对患者生活质量所带来的影响，采用问卷调查的方法，对2001年6月-2002年1月来我科门诊就诊的白癜风患者进行问卷调查。结果白癜风对患者日常生活、心理影响、休闲活动、工作上学、人际关系、私生活等方面都有一定的影响。本研究提示白癜风对患者生活质量可带来较大的影响。     

Impact of childhood vitiligo on adult life

Background The onset of vitiligo occurs before the age of 20 years in 50% of patients. Having a chronic disease in childhood can impede a child’s health‐related quality of life (HRQL). Objectives Firstly, to compare the social and psychosexual development and current HRQL of young adult patients with childhood vitiligo with those of a group of healthy controls. Secondly, to compare these outcomes in patients reporting negative childhood experiences with those of patients not reporting negative childhood experiences. Methods Eligible patients were mailed questionnaires on (i) sociodemographic and clinical characteristics, (ii) social and psychosexual development, (iii) generic and dermatology‐specific HRQL, (iv) presence of negative childhood experiences related to vitiligo, (v) specification of these negative experiences and (vi) patients’ recommendations for further care. Results A total of 232 patients with vitiligo completed the questionnaires. Social and psychosexual development and generic HRQL in young adult patients with childhood vitiligo were not different from those of healthy controls. However, patients reporting negative childhood experiences reported significantly more problems in social development than those not reporting negative experiences. Furthermore, negative childhood experiences were significantly associated with more HRQL impairment in early adulthood. Conclusions Reporting negative experiences from childhood vitiligo appears to be associated with HRQL impairment in young adults with vitiligo.     

Effect of vitiligo on self-reported health-related quality of life

BACKGROUND: Vitiligo is a pigmentary disorder affecting at least 1% of the total population. Although the disease does not produce direct physical impairment, it may considerably influence the psychological well-being of the patients. It has been suggested that patients suffer from low self-esteem, poor body image and a poor quality of life. The majority of the studies on the psychosocial impact of vitiligo were conducted in the U.S.A. and England. OBJECTIVES: This study aims to quantify the burden of vitiligo by estimating health-related quality of life in the Dutch-speaking Belgian population (Flanders). This is compared with the level of disability caused by psoriasis in a similarly recruited population. It is also our purpose to detect those at risk of experiencing a poor quality of life and to identify variables that might predict this impairment. PATIENTS AND METHODS: Patients with vitiligo (n = 119) and 162 patients with psoriasis were included in a postal survey. In order to obtain a patient-based measurement of quality of life we used the Dermatology Life Quality Index (DLQI), a widely validated questionnaire that is easy to use and allows comparison between several skin disorders. Other survey questions were related to demographic data and disease-related characteristics. RESULTS: We obtained excellent response rates in both patient groups. The overall mean DLQI score for vitiligo (4.95) was lower than that for psoriasis (6.26) (P = 0.01). Patients with vitiligo experienced significantly less impairment of life quality from the symptoms and treatment of the disease (P < 0.001). The highest individual mean scores in vitiligo were found for Q2 (feelings), Q4 (clothing), Q5 (social and leisure activities) and Q3 (daily routine). The interaction of disease and sex on the DLQI score was highly significant (P = 0.001). While men with vitiligo scored significantly lower than men with psoriasis (P < 0.001), we found a comparable overall DLQI score for women in these disease groups. The number of consultations (P = 0.005) and severity of the disease (P < 0.001) were independently related to the DLQI. CONCLUSIONS: Our study quantifies the burden on the quality of life caused by vitiligo and indicates specific areas of patients' lives which are most affected by the disease. Sex, number of consultations and subjective disease severity independently predict the quality of life. The quality of life impairment in women affected with vitiligo equals the impairment caused by psoriasis in our study population. These results should awake the interest of physicians in this 'cosmetic' disease, since appropriate treatment is likely to improve the quality of life of vitiligo patients.     

白癜风患者生活质量评估量表的研究进展

白癜风虽不危及患者生命安全，但疾病的迁延不愈、反复发作给患者造成巨大的心理压力，妨碍患者的人际交往，使患者生活质量明显下降。采用生活质量量表评估患者生活质量是研究疾病对患者影响的常用方法。本文将对白癜风患者生活质量评估量表的应用进展加以综述。     

Identification of categories at risk for high quality of life impairment in patients with vitiligo

Background  Quality of life (QoL) in patients with vitiligo is strongly impaired. Therefore, it seems inadequate to describe the severity of the disease using only physical indicators.
Objectives  To investigate the QoL of patients with vitiligo, identifying categories at risk for high impairment, also analysing single questions from a QoL instrument.
Methods  The Skindex-29 questionnaire, a QoL dermatology-specific instrument, was completed by 181 consecutive patients with vitiligo. Answers to the Skindex-29 items were given on a five-point scale, from 'never' to 'all the time'.
Results  The QoL problems more frequently experienced 'often' or 'all the time' were: worry of the disease getting worse (60%), anger (37%), embarrassment (34%), depression (31%), having social life affected (28%), and shame (28%). The prevalence of patients with probable depression or anxiety, evaluated using the 12-item General Health Questionnaire, was 39%, and the prevalence of patients with alexithymia, evaluated using the 20-item Toronto Alexithymia Scale, was 24%. The association of QoL impairment with psychological problems was very strong for all the items, and remained significant also when taking into account simultaneously gender, age, clinical severity, family history, and localization of vitiligo.
Conclusions  Detailed information on QoL in patients with vitiligo may lead dermatologists to pay particular attention to patient categories at risk for a high QoL impairment.     

Psychiatric morbidity in vitiligo: prevalence and correlates in India

BACKGROUND: Vitiligo, a common pigmentary disorder, is recognized to be associated with a high psychiatric morbidity, yet compared to other dermatological disorders like leprosy, psoriasis, etc., it has not been subjected to detailed evaluation of its psychological consequences. The data from the developing countries on this aspect in particular is meager. METHODS: One hundred and thirteen cases with vitiligo were evaluated along with 55 healthy controls comparable for sociodemographic profile and matched on attitude to appearance scale. Clinical details, impact of illness, associated dysfunction and psychological morbidity were additionally assessed. RESULTS: Twenty-eight patients with vitiligo were found to have psychiatric morbidity, a clinic prevalence rate of 25% (95% confidence interval 20.3-29.3%). The majority of the cases had a diagnosis of adjustment disorder. Psychiatric morbidity was significantly correlated with dysfunction arising out of illness. CONCLUSIONS: Vitiligo is associated with high psychiatric morbidity. There is a need to develop cross-cultural database on psychosocial aspects and psychiatric morbidity associated with vitiligo.     

Psychiatric morbidity in psoriasis and vitiligo: a comparative study

The psychiatric morbidity in psoriasis patients was compared with that in vitiligo patients using the standardised Hindi (vernacular language) version of the General Health Questionnaire (GHQ-H). Thirty new and untreated patients each with psoriasis or vitiligo and between the ages of 18-60 yrs, constituted the study group. The prevalences of psychiatric morbidity as assessed by the GHQ-H were found to be 53.3% and 16.22% in the psoriasis and vitiligo patients respectively; the difference was statistically significant (p=0.0028). The prevalences of depression were 23.3% and 10% in psoriasis and vitiligo respectively and anxiety was observed in 3.3% of each group. Sleep disturbance was the most common complaint and was present in 56.6% of psoriasis patients and 20% of the vitiligo patients. However, the parameter of sleep disturbance showed a statistically significant difference between the two dermatoses (p=0.0034).     

Quality of life and psychological adaptation of Korean adolescents with vitiligo

Aim The aim of the study was to evaluate the impact of vitiligo on the quality of life and psychological adaptation in a Korean adolescent population. Methods Fifty‐seven adolescents aged 12 to 18 years with vitiligo were evaluated using self‐report scales, namely the Skindex‐29, Piers‐Harris self‐concept, Center for Epidemiologic Studies Depression Scale (CES‐D), and Revised Children’s Manifest Anxiety Scale (RCMAS). Results Mean Skindex‐29 subscales were as follow; 21.8 (global), 16.3 (symptom), 18.6 (function) and 29.5 (emotion). Several clinical variables, such as duration of vitiligo, facial involvement, history of previous treatment, and patient‐assessed severity, affected the Skindex‐29 subscales in various ways. However, differences in Skindex‐29 scores according to the type of vitiligo, extent of involvement, and family history were not observed. The Piers‐Harris self‐concept scores showed a negative correlation with Skindex‐29 scores, while other psychological measures (CES‐D and RCMAS) were positively correlated. Conclusion The quality of life of adolescents with vitiligo is closely related to the patients’ apprehensions about their disease, psychosocial adjustment, and psychiatric morbidity, rather than the clinical severity of the condition itself. Clinicians should recognize and deal with psychological adaptation along with medical intervention when treating adolescent patients with vitiligo.     

Objective vs. subjective factors in the psychological impact of vitiligo: the experience from a French referral centre

Background  Vitiligo affects around 0·5% of the population. The burden of disease perceived by patients seems to be underestimated by the medical community.
Objectives  To analyse the impact of objective and psychological factors on the quality of life (QoL) and self-body image of patients with vitiligo.
Methods  Demographic data, medical information and psychological factors (perceived severity, trait anxiety, trait depression, trait self-esteem, body image and QoL) were prospectively collected for all patients.
Results  Forty-eight patients with a mean age of 43·9 years were included in the study. Vitiligo caused overall a moderate effect on patients' QoL with a 7·17 Dermatology Life Quality Index (DLQI) mean score (out of 30) without correlation with gender. According to distribution, no or minimal (DLQI 0–1), mild (2–5), moderate (6–11) and severe (12–20) impairment of QoL was found in five (10%), 14 (29%), 18 (38%) and 11 (23%) patients, respectively. The mean perceived severity evaluated by the patients was 4·91 based on visual analogue scale from 0 to 10. The self-body image was influenced by gender, perceived severity and disease characteristics. Perceived severity and patient personality were predictors of QoL impairment. Perceived severity of vitiligo was explained mainly by the patients' personality and less significantly by objective criteria.
Conclusions  Subjective as well as objective factors should be included in the assessment of disease severity and follow-up of patients with vitiligo. A simple perceived severity scale is useful in clinical practice.     

Willingness-to-pay and quality of life in patients with vitiligo

Background Vitiligo is a chronic pigmentary disorder of the skin, affecting 1–2% of the general population. Although not life threatening, vitiligo may considerably influence patients’ health‐related quality of life (QoL) and psychological well‐being. Willingness‐to‐pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. Objectives To assess the WTP and the QoL of patients with vitiligo. Methods Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ‐5D) questionnaire. QoL data were compared with n = 1511 patients from a national survey on psoriasis. Results The questionnaire was completed by 1023 patients (71·5% women, mean age 44·4 years, mean disease duration 20·3 years) with vitiligo. The mean DLQI was 7·0 (7·5 in women, 5·5 in men) compared with 8·6 in psoriasis. Of the patients with vitiligo, 24·6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34·1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20–29 years. EQ‐5D mean score was 83·6 compared with 75·3 in psoriasis. Of the patients with vitiligo, 32·9% would pay more than 5000 Euro in order to achieve complete disease remission. WTP was highest among middle‐aged patients (30–60 years). There was a significant correlation between DLQI scores and WTP (χ² = 65·43, P < 0·001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0·001). Conclusions Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients’ compliance and empowerment.     

Quality of life for Korean patients with vitiligo: Skindex-29 and its correlation with clinical profiles

Vitiligo considerably influences the psychological well-being of patients. Disease-induced disfigurement can cause patients to experience a high level of stigmatization, which can lead to psychosocial stresses and negative impacts on quality of life (QOL). This study aims to ascertain the QOL of vitiligo patients compared to patients with other mild skin disorders. We also attempt to study which clinical features of vitiligo are closely related to the patient's QOL. One hundred and thirty-three vitiligo patients and 112 patients with mild skin disorders were analyzed. All participants were asked to fill out questionnaires covering comprehensive clinical profiles and the Korean version of Skindex-29. Statistical correlation between Skindex-29 and each clinical profile were analyzed. The symptom scale of Skindex-29 was significantly lower in vitiligo patients than in controls, but the function scale and the emotion scale were significantly higher in the vitiligo group than in controls. However, the difference in function scales between groups was significant in female patients, but not in male patients. Several clinical profiles, such as duration of disease, severity scores and previous history of treatments, showed close correlations with the function scale. Family history of vitiligo, Köebner phenomenon, patients' perspectives on disease prognosis, and discordance of the severity scores between physicians and patients also influenced the Skindex-29 subscales differently. In conclusion, the present study suggests that patients with vitiligo were highly affected in the functional and emotional aspects of QOL, with some sex differences. Various clinical features may play an important role in the QOL of vitiligo patients.     

Camouflage for patients with vitiligo vulgaris improved their quality of life

Background  Cosmetic camouflage is important for patients with vitiligo vulgaris. However, few studies have investigated its benefit for vitiligo patients.
Objectives  To analyze the psychological effects on patients with vitiligo vulgaris by camouflage lessons performed in vitiligo clinics in Kyoto University Hospital and Fukui Red Cross Hospital, Dermatological Life Quality Index (DLQI) questionnaires were collected before and 1 month after camouflage lessons.
Patients  Patients with vitiligo vulgaris, who visited our clinics in 2008 and had never experienced camouflage, were enrolled in this study. They took camouflage lessons and continued subsequent self-camouflage for 1 month. Control patients took no lessons and no camouflage.
Results  Camouflage improved the scores of DLQI when compared with those without camouflage ( P  = 0.005). Camouflage improved DLQI scores from 5.90 to 4.48. In DLQI subcategories, camouflage lessons improved a subcategory of symptoms and feelings ( P  = 0.0037).
Conclusions  These data supported the idea that camouflage for patients with vitiligo not only covers the white patches but also improves their quality of life.     

Cockade-like vitiligo and linear vitiligo

Summary The authors report 2 cases of atypical vitiligo in which they observed 1) cockade-like lesions resembling those of trichrome vitiligo (from the centre to the periphery, achromic area, hypochromic ring, normal or hyperchromic border), 2) numerous linear achromic lesions corresponding to former excoriations (Koebner's phenomenon, isomorphic phenomenon). Related affections are discussed with reference to these cases: the trichrome vitiligo described by Lerner and Fitzpatrick, and the primary leukomelanodermas described in black patients by Basset and by Sarrat and Nouhouayi.     

Stigmatization experience, coping and sense of coherence in vitiligo patients

OBJECTIVE: This study examines the extent of stigmatization experienced by vitiligo patients considering the visibility of the lesions. METHODS: 363 vitiligo patients were assessed using the Experience with Skin Complaints (QES), Adjustment to Chronic Skin Disorders (ASC), and Sense of Coherence (SOC) questionnaires. Out of the total patients group two representative samples with 52 patients each were identified comparable for age, gender, and the duration of the skin disease, the first with visible and the second with invisible lesions. RESULTS: Data indicate a significant negative correlation between the QES dimensions, except for 'Composure', and between coping scales with sense of coherence withstanding. The 'visible lesions' group scored higher compared to the 'invisible lesions' group on the two QES scales 'Self-Esteem' and 'Refusal', i.e., patients with visible lesions experienced a higher level of stigmatization. CONCLUSION: This study provides new information which supports the notion that the stigmatization experience of vitiligo patients is psychologically relevant.     

Quality of life in vitiligo patients after treatment with long-term narrowband ultraviolet B phototherapy

Long-term treatments for chronic diseases such as vitiligo need to be evaluated for their clinical efficacy. Assessment of the quality of life (QOL), however, may provide the most relevant information on the actual benefit for these patients. In this study we evaluated QOL after long-term narrowband ultraviolet (UV) B for the treatment of vitiligo. All patients, with long-term stable vitiligo vulgaris, who were treated at our clinic during the last 4 years received specifically for this study a designed QOL questionnaire, which included questions about general well-being, camouflage and psychosocial aspects; 71.4% of the patients responded. Most patients indicated an improvement on a psychological level, but an increase in camouflaging. The present study shows that, after long-term narrowband UVB phototherapy, skin appearance does not play a major role in the life of vitiligo patients, while well being only improved in a minority of patients.     

Health‐related quality of life and marital quality of vitiligo patients in China

Background  Vitiligo can adversely affect the quality of life and sexual relationships of patients. Combination of the DLQI with the generic SF‐36 and ENRICH may give further insight in the evaluation of the burden in vitiligo patients. Objective  We sought to assess the health‐related quality of life (HRQoL) and marital quality of Chinese vitiligo patients and to identify the relevant clinical and socio‐demographic determinants. Methods  A total of 101 vitiligo patients and 126 healthy controls completed the questionnaires. HRQoL was measured using DLQI and SF‐36, and marital quality was measured using the ENRICH marital inventory. Results  Patients with vitiligo experienced significantly impaired health‐related quality of life and unstable marital relationships. Gender, distribution pattern of vitiligo and disease severity were independent predictors of DLQI, SF‐36 and ENRICH in this cohort. Conclusions  Vitiligo is associated with impairment of HRQoL and marital quality among Chinese patients. Alongside the medical interventions, the psychological and sociocultural assessment and intervention should be an essential part of the management of these cases.     

Psychosocial well-being of patients with skin diseases in general practice

BACKGROUND: Skin diseases are a substantial part of the problems dealt with by general practitioners. Although the psychosocial consequences of skin diseases in secondary care has been extensively studied, little is known about the psychosocial well-being of patients with skin diseases in primary care. OBJECTIVE: To investigate the psychosocial well-being of patients with skin diseases in primary care. PATIENTS/METHODS: Questionnaires about the psychosocial consequences of skin diseases were sent to patients with a skin disease who were registered within a research network (continuous morbidity registration) of general practices that continuously have recorded morbidity data since 1971. Questionnaires completed by 532 patients were eventually suitable for analyses. RESULTS: Compared with the general population, patients with skin diseases reported significantly lower scores for psychosocial well-being. Furthermore, a lower psychosocial wellbeing was significantly related with higher levels of disease-severity, lower disease-related quality of life, longer disease duration, more comorbidity and more physical symptoms of itch, pain and fatigue. After demographic variables and comorbidity were controlled for, sequential regression analyses showed that disease duration, disease severity and physical symptoms (itch, pain and fatigue) were significant predictors of psychosocial well-being. CONCLUSION: The psychosocial well-being of patients with skin diseases in primary care is lower than that of the general population. Special attention has to be directed to those patients with lowered psychosocial well-being who might be at risk of developing severe psychosocial impairments such as clinical depression.