Quality of life in patients with vitiligo

INTRODUCTION

Vitiligo is an acquired disorder characterized by well circumscribed depigmented macules and patches that result from a progressive loss of functional melanocytes.¹ Few believed that the word ‘vitiligo’ is derived from the Latin word ‘vitelius’ meaning vale, i.e. pink pale flash of calf, since the clinical lesions resembled the white patches of spotted calf, while others think that it is derived from the word ‘vitium’ meaning blemish. Although Vitiligo affects all races worldwide, But the highest incidence of vitiligo is noted in India and Mexico.² Various factors play important role in pathogenesis of vitiligo like autoimmunity, dysregulated immunity, genetic factors and environmental factors.³ It is classified as mentioned in (Table 1).

In India, vitiligo is associated with higher stigma as depigmentation is much obvious in darker skin types. Vitiligo patients face many psychiatric morbidities like anxiety, depression, sleep disturbance etc. They have a lower self-esteem.⁴ They feel difficulty in participating in various social events. Vitiligo can affect patient’s quality of life.⁵ Vitiligo is a chronic disease with unpredictable course and there is no uniformly effective treatment is available for it. These factors also contribute to impair quality of life in patients with vitiligo. Quality of life is multidimensional index of different social, behavioural and cultural factors.⁶ There are many tools designed to measure quality of life including general tools, disease specific tools and dermatology specific tools. Dermatology specific tools are the dermatology life quality index (DLQI), skindex and the dermatology quality of life scales (DQoLS).⁷ DLQI is a simple tool for routine clinical use.⁸ It contains simple 10 questions which are asked to patients. Each question is answered either ‘Very much’ (score 3), ‘A lot’ (score 2), ‘A little’ (score 1) or ‘Not at all’ (score 0).

METHODS

In our study, we included 150 patients aged more than 16 years diagnosed as vitiligo visiting the outpatient department of dermatology, venereology and leprosy, PDU Govt. Medical College and Hospital, Rajkot during year 2018-19. Patients personal data like age, sex, marital status, education was collected. History and clinical examination including type of vitiligo, stability of vitiligo, presence of facial lesion was performed and the dermatology life quality index questionnaire were asked to each patient.

According to answers given by patient, dermatology life quality index was calculated. DLQI score is interpreted as following: 0-1 no effect at all on patient's life, 2-5 small effect on patient's life, 6-10 moderate effect on patient's life, 1-20 very large effect on patient's life, and 21-30 extremely large effect on patient's life. Mean DLQI scores for different groups were calculated and compared by using unpaired t test.

RESULTS

Out of 150 patients of vitiligo, 3 (2%) patients felt no effect of vitiligo on their quality of life, 66 (44%) patients felt small effect of vitiligo on their quality of life, 69 (46%) patients felt moderate effect of vitiligo on their quality of life while 12 (8%) patient felt very large effect of vitiligo on their quality of life. None of the patients felt extremely large effect of vitiligo on their quality of life (Figure 1).

The mean DLQI score

The mean DLQI of different groups are given in (Table 2). The mean DLQI in unmarried patients was 8.5 as compared to 3.29 of married ones with p value less than 0.0001 suggesting statistically significant difference in mean DLQI of unmarried as compared to married patients. Hence marital status had great effect on quality of life in patients with vitiligo.

The mean DLQI was higher in female patients, patients with unstable vitiligo and with facial involvement as compared to male patients, patients with stable vitiligo and patients without facial involvement respectively. But the p value for these groups found was greater than 0.001.

Hence this difference in mean DLQI of these groups was not statistically significant. Other groups showed almost similar mean DLQI.

DISCUSSION

Several interesting observations have been made in our study. In our study mean DQLI was 6.14 which is almost similar to previous study done by Mishra et al (6.86) and lower than study done by Krishna et al (7.02) (Table 3).^6,10 In our study, mean age of patients was 30.16 years, which is almost similar to other studies done by Mishra et al (29.36) and Aghaei et al (28.3).^6,9

Patients in age group of 16-30 years had highest mean DLQI (6.47) comparable to study done by Krishna et al (6.92) while patients in age group of >50 had lowest mean DLQI (4) (Figure 2).¹⁰

In our study there was a statistically significant difference in mean DLQI between married and unmarried while in previous study done by Mishra et al, there was no statistically significant difference between married and unmarried.⁶ This finding may be due to social stigma for vitiligo in society as unmarried patients with vitiligo face more difficulty for getting married.

There was no statistically significant difference in mean DLQI score between male and female vitiligo patients, literate and illiterate vitiligo patients, localized and generalized vitiligo patients, stable and unstable vitiligo patients and vitiligo patients with facial involvement and without facial involvement. These findings are similar to previous study done by Mishra et al.⁶

CONCLUSION

To conclude, vitiligo carries significant stigmata in our society with associated psychological morbidities. It is not only a cosmetic problem for the patients, but also affects the social, behavioural and cultural aspects of patient’s life. Data that acquired from our study suggests majority of patients with vitiligo have moderate effect of vitiligo on their quality of life. Unmarried patients are affected more. So, vitiligo despite of a cosmetic problem, more aggressive attitude is required while treating vitiligo. Along with treatment, proper counselling and psychological support is must.

ACKNOWLEDGEMENTS

It gives me immense pleasure to be a part of D.V.L department of prestigious P.D.U Govt. Medical College and Hospital, Rajkot where this study was conducted. I am indebted to each and every person who were involved to make this study a success.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the institutional ethics committee

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