Impact of vitiligo on daily life and work productivity: new research findings
Investigators conclude non-specific measures do not account for the experiences of patients with severe or facial vitiligo (1,600 words, 8 minutes)
A new study suggests that generic health-related quality of life (HRQoL) measures may be insensitive when evaluating patients with vitiligo. The study authors write that more sensitive disease-specific measures may be needed.
In the study, published in Dermatology and Therapy (2024; 14:1633–1647), the authors note patients with vitiligo often experience stigmatization and psychological stress that impacts their daily lives, careers, and emotional well-being—adverse outcomes that may be worsened by the severity of their vitiligo or location of lesions. Because of this, the investigators assessed how various factors impact patient HRQoL and work productivity.
For this project, researchers examined retrospective data on 1,388 patients from the Adelphi Real World Vitiligo Disease Specific Programme, a cross-sectional survey of physicians and their patients with vitiligo that collected data between Dec. 2021 and July 2022.
Investigators assessed patient-reported outcomes using the Vitiligo-Specific Quality of Life Instrument (VitiQoL), the Hospital Anxiety and Depression Scale (HADS), and EQ-5D-5L. They also used the Work Productivity and Impairment Questionnaire (WPAI) questionnaire to assess disease-related impairment of daily activities. Finally, they stratified the data by physician-reported disease severity, the presence or absence of vitiligo on the face, and body surface area (BSA) percentage affected.
The authors found the mean VitiQoL, HADS depression, and anxiety scores were higher in individuals with severe disease compared to patients with mild or moderate disease. Patients with facial involvement also reported higher VitiQoL and HADS scores than those without.
BSA involvement of 5% or greater was also associated with higher VitiQoL, depression, and anxiety scores.
Also, the patients with severe vitiligo, facial lesions, or 5% or greater BSA reported higher activity impairment. The mean EQ-5D-5L-utility score was approximately 0.9 regardless of disease severity or total BSA affected.
“Interestingly, although the EQ-5D-5L utility scores do not demonstrate a statistically significant correlation between QoL and severity and BSA subgroups, the EQ-5D-5L utility score did demonstrate a modest correlation between lower QoL and the face being affected,” the authors write. “However, the magnitude of the difference in EQ-5D-5L utility scores between patients with facial involvement compared to those without was very small.”
Bottom line: For patients with vitiligo, more severe disease, facial lesions, and higher BSA involvement are more often associated with poorer outcomes and activity impairment. Commonly used HRQoL measures may not be sensitive enough to evaluate the impact of vitiligo on patients, so there is a need for more sensitive disease-specific measures.
From the literature on dermatology in skin of colour
Analyzing Fitzpatrick skin type distribution of vitiligo on Instagram
The authors of this paper write that previous studies exploring vitiligo-related content and trends on platforms such as YouTube and Instagram showed that most content reflects patient experiences. Noting social media platforms represent an accessible educational tool for reaching different patient populations and understanding gaps in demographic distribution is essential for patient education, investigators compared Fitzpatrick skin type (FST) representation on Instagram and actual reported demographic distribution for vitiligo.
Researchers pulled public Instagram posts from @vitiligosociety, @worldvitiligo, and #vitiligo hashtags on Nov. 25, 2022, excluding advertisements, group photos, black-and-white images, and photos with no visible skin. They chose the three search criteria based on search popularity. A medical student independently rated photos by FST, and a board-certified dermatologist validated the results. Investigators analyzed photos by year posted, gender, age, and body area photographed. The researchers compared each Instagram account to reported prevalence based on self-reporting, which revealed that FST I to III had a higher prevalence of 0.66 relative to types IV to VI at 0.34 in the U.S. They found that @vitiligosociety, @worldvitiligo, and #vitiligo had a significantly larger prevalence of FST IV to VI (≥ 0.64) compared to previously reported prevalence.
The authors conclude that their findings suggest that darker skin types were more represented on Instagram in vitiligo compared to the reported prevalence. They say this may be attributed to differential impacts on patients with darker skin colour, as they have reported lower QoL compared to vitiligo patients with FST I to III.
Expert recommendations on use of topical therapeutics for vitiligo in pediatric, adolescent, and young adult patients
This paper details the development of evidence-based- and consensus-based expert recommendations on diagnosing and treating vitiligo in young patients.
This study included articles published in English, containing primary and pediatric-specific data, and involved analysis of six or more patients. Through a video conference, investigators reviewed research questions on May 9, 2022. One month after the meeting, participants participated in an online survey documenting their level of agreement with the generated statements using a 5-point Likert scale.
A total of 50 articles on topical corticosteroids or topical calcineurin inhibitors, five on topical Janus kinase inhibitors, two on pseudocatalase, and two on microdermabrasion met inclusion criteria. The participants made 42 recommendations on diagnosing vitiligo and optimal topical therapeutics, with 33 recommendations obtaining a 70% or greater composite agreement and strong agreement. Among the recommendations are topical calcineurin inhibitors twice daily, topical corticosteroids with time limitation due to atrophy risk, and topical ruxolitinib, 1.5%, cream—used off-label for patients younger than 12 years and limited to nonsegmental vitiligo—were identified as evidence-based first-line therapies in the management of pediatric and adolescent patients. There was also specific guidance on age-based data, a minimum therapeutic trial of six months or greater, prolonged therapy to prevent recurrence, and the positive benefit of coordinated use of UV therapeutic sources.
Differential access to psoriasis biologic information in English and Spanish
The authors of this letter write that education is crucial in providing psoriasis patients with a comprehensive understanding of their disease and improving long-term management outcomes. However, language barriers can prevent patients from understanding information on medications provided online, particularly for non-English speakers in the United States. They note that U.S. Department of Health and Human Services data shows roughly 28.4% of the 62.1 million LatinX individuals residing in the United States are not fluent in English.
In the letter, the authors detail their examination of the English and Spanish versions of websites for psoriasis biologic medications and measure their quality as educational resources.
They created a quantitative metric to analyze the English and Spanish websites of the 12 biologic drugs approved by the United States Food and Drug Administration to treat psoriasis or psoriatic arthritis. With this metric, the researchers examined the websites’ language-specific educational materials, resources, and supplemental materials.
Of the biologics with Spanish websites, 58.3% had additional links in Spanish on their homepage; 25% of these links led to the prescribing information translated into Spanish, and 33.3% to Spanish-specific webpages with further information. Compared with English psoriasis biologic websites (100%), only 25% of Spanish psoriasis biologic websites described psoriasis and payment resources. Descriptions of psoriasis subtypes (83%) and safety information, visual aids, contraindications or special populations, and links to the U.S. Food and Drug Administration adverse event reporting were found on 75% of Spanish psoriasis biologic websites versus 100% of English psoriasis biologic websites. English psoriasis biologic websites featured testimonials 92% of the time, compared with only 17% of Spanish psoriasis biologic websites.
The PhenX Toolkit: Recommended measurement protocols for social determinants of health research
In this open-access paper, the authors describe the PhenX (consensus measures for Phenotypes and eXposures) toolkit and a Basic Protocol for selecting and implementing social determinants of health (SDoH) protocols for research studies.
The authors note that health disparities are driven by unequal conditions in the environments where people are born, live, learn, work, play, worship, and age. They write that the availability of recommended measurement protocols for SDoH will enable investigators to collect data consistently for SDoH constructs.
PhenX is a web-based catalogue of recommended measurement protocols for research studies with human participants. The authors say that using standard protocols from the PhenX Toolkit makes it easier to compare and combine studies, potentially increasing the impact of individual studies and aiding in comparability across the literature.
VIDEO: IDEF Educational Series: A targeted approach to vitiligo treatment
In this webinar from the International Dermatology Education Foundation, pediatric dermatologist Dr. Brittany Craiglow, Adjunct Associate Professor of Dermatology at the Yale School of Medicine, reviews the pathophysiology of vitiligo, its prevalence, treatment considerations, and the patient experience.
At the intersection of skin and society
While sales of chemical hair relaxers are declining in Canada, the U.S., and Europe, the companies that sell them are turning their focus to Africa, reports Black Enterprise.
The news article references a 2023 report published by the U.S. National Institutes of Health that showed women who use chemical relaxers at least four times a year are twice as likely to develop uterine cancer than those who don’t. Brazil and Canada have placed restrictions on formaldehyde in relaxers, and the U.S. Food and Drug Administration proposed banning the chemical last year.
Also, in an earlier article, the news outlet reported several Black women have filed lawsuits against hair product manufacturers, claiming that the products have caused cancer.
In contrast to these concerns, market research firm Euromonitor has published a report showing that sales of chemical relaxers in Tunisia and Kenya increased by 10% from 2017 to 2023.
This week
June 25 is World Vitiligo Day
June 27 is Canadian Multiculturalism Day
June 29 is International Day of the Tropics
Something to think about in the week ahead . . .
—Henry James, U.S./U.K. author (1843-1916)
In two weeks
Skin Spectrum Weekly will not publish on July 1, in recognition of Canada Day.
The newsletter will return on July 8 with coverage of a talk at the 2024 Atopic Dermatitis Summit by Dr. Marissa Joseph, medical director of the Ricky Kanee Schachter Dermatology Centre at Women's College Hospital. Dr. Joseph discussed the differences in eczema presentation between skin types. She provided an example from her clinic where a lack of awareness of these differences resulted in very different referrals for two patients with similar disease severity.
If you like Skin Spectrum Weekly, why not check out Chronicle’s other publications, podcasts, and portal?
Established in 1995, The Chronicle of Skin & Allergy is a scientific newspaper providing news and information on practical therapeutics and clinical progress in dermatologic medicine. The latest issue features:
Dr. Jerry Tan (Windsor, Ont.) shares his thoughts on recent findings showing that benzoyl peroxide in acne products can break down into benzene when stored in high-temperature conditions.
Drs. Andrei Metelitsa (Calgary), Geeta Yadav (Toronto), and Rahul Shukla (Hamilton) review several current innovations in cosmetic dermatology.
Drs. Jason Rivers (Vancouver), Cheryl Rosen (Toronto), Peter Hull (Halifax) and Jennifer Beecker (Ottawa) provide an overview of essential news in melanoma, including the use of artificial intelligence to support screening.
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The Women in Dermatology e-newsletter updates readers with new findings concerning dermatologic issues affecting women and the female dermatologists who care for them. Read the current issue here.
Season three of the Vender on Psoriasis podcast with Dr. Ron Vender has begun. Listen to the new season here. In episode five, Dr. Vender discusses whether vitamin D influences psoriasis severity, sex differences in psoriatic inflammation itch, and the risk of psychiatric disorders associated with acitretin.
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