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. 2023 Oct 1;159(10):1124-1128.
doi: 10.1001/jamadermatol.2023.2787.

Mental Health and Psychosocial Quality-of-Life Burden Among Patients With Vitiligo: Findings From the Global VALIANT Study

Kristen Bibeau  1 , Khaled Ezzedine  2   3 , John E Harris  4 , Nanja van Geel  5 , Pearl Grimes  6 , Davinder Parsad  7 , Mukta Tulpule  8 , Jackie Gardner  9 , Yan Valle  10 , Gaone Tlhong Matewa  11 , Christine LaFiura  12 , Anouk Lindley  1 , Haobo Ren  1 , Iltefat H Hamzavi  13
Affiliations

Mental Health and Psychosocial Quality-of-Life Burden Among Patients With Vitiligo: Findings From the Global VALIANT Study

Kristen Bibeau et al. JAMA Dermatol. .

Erratum in

  • Error in Supplement 1.
    [No authors listed] [No authors listed] JAMA Dermatol. 2024 Jan 1;160(1):118. doi: 10.1001/jamadermatol.2023.4958. JAMA Dermatol. 2024. PMID: 37991742 Free PMC article. No abstract available.

Abstract

Importance: Patients with vitiligo often have impaired quality of life (QOL) and experience substantial psychosocial burden.

Objective: To explore the global association of vitiligo with QOL and mental health from the patient perspective.

Design, setting, and participants: This qualitative study of the cross-sectional population-based Vitiligo and Life Impact Among International Communities (VALIANT) study was conducted from May 6, 2021, to June 21, 2021. Potential participants for this qualitative study were recruited from an online panel in 17 countries. Of 5859 surveyed adults (aged ≥18 years) who reported a vitiligo diagnosis, 3919 (66.9%) completed the survey, and 3541 (60.4%) were included in the analysis.

Exposures: Patients were asked questions regarding their emotional well-being, including QOL and mental health.

Main outcomes and measures: Reported analyses are descriptive and hypothesis generating. Vitiligo Impact Patient scale (VIPs) scores ranged from 0 to 60, with higher scores indicating more psychosocial burden.

Results: The median age of the 3541 patients was 38 years (range, 18-95 years), and 1933 (54.6%) were male; 1602 patients (45.2%) had more than 5% affected body surface area (BSA; Self-Assessment Vitiligo Extent Score assessed), and 1445 patients (40.8%) had Fitzpatrick skin types IV to VI (ie, darker skin). The mean (SD) global short-form VIPs score was 27.3 (15.6) overall; patients from India (mean [SD], 40.2 [14.1]) reported the highest scores (ie, most burden). The QOL burden according to the scale was profound for patients with more than 5% affected BSA (mean [SD] score, 32.6 [14.2]), darker skin (mean [SD] score, 31.2 [15.6]), and lesions on the face (mean [SD] score, 30.0 [14.9]) or hands (mean [SD], 29.2 [15.2]). At least 40% of patients globally reported that vitiligo frequently affected aspects of their daily lives, including choosing clothes to wear (1956 of 3541 [55.2%]). Most patients (2103 of 3541 [59.4%]) reported concealing their vitiligo frequently. More than half of patients (2078 of 3541 [58.7%]) reported diagnosed mental health conditions, including anxiety (1019 of 3541 [28.8%]) and depression (866 of 3541 [24.5%]). The Patient Health Questionnaire-9 depression screener showed that 55.0% of patients (1948 of 3541) had moderate to severe depressive symptoms; the highest rates were in India (271 of 303 [89.4%]) and among patients with more than 5% affected BSA (1154 of 1602 [72.0%]) and darker skin (987 of 1445 [68.3%]).

Conclusions and relevance: This qualitative study found that, globally, patients with vitiligo reported being substantially affected in their emotional well-being, daily lives, and psychosocial health; the burden was typically greatest among patients with more than 5% affected BSA, darker skin types, and lesions on the face or hands. Survey findings suggest that patients reported having altered their behavior, expressed clear discontent, and have symptoms consistent with depression, which may be underdiagnosed.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Bibeau reported being an employee and shareholder of Incyte during the conduct of the study and outside the submitted work. Dr Ezzedine reported being a consultant for AbbVie, Incyte, La Roche-Posay, Pfizer, Pierre Fabre, Sanofi, ande Viela Bio. Dr Harris reported receiving grants from Aclaris Therapeutics, Celgene, Dermavant, Dermira, EMD Serono, Genzyme/Sanofi, Incyte, LEO Pharma, Pfizer, Rheos Medicines, Stiefel/GSK, Sun Pharmaceuticals, TeVido BioDevices, and Villaris Therapeutics Inc; receiving personal fees from 3rd Rock Ventures, AbbVie, Inc, Aclaris Therapeutics, Admirx, Aldena, Almirall, AnaptysBio, Avita, BiologicsMD, Boston Pharma, BridgeBio, Cogen Therapeutics, Dermavant, EMD Serono, Frazier Management, Genzyme/Sanofi, Granular Therapeutics, Inc, Incyte, Janssen, LEO Pharma, NIRA Biosciences, Methuselah Health, Pandion, Pfizer, Rheos Medicines, Sonoma Biotherapeutics, Sun Pharmaceuticals, Temprian Therapeutics, TeVido BioDevices, The Expert Institute, Twi Biotech, Villaris Therapeutics Inc, Vimela, Matchpoint Therapeutics, Merck, and Klirna during the conduct of the study; being a scientific founder for Aldena, Granular Therapeutics, Inc, NIRA Biosciences, Villaris Therapeutics Inc, Vimela, and Klirna; having equity in Aldena, Incyte, NIRA Biosciences, Rheos Medicines, TeVido BioDevices, Villaris Therapeutics Inc, Vimela, and Klirna; holding pending patents for US patent application No. PCT/US2017/067988 (2016), US patent application No. PCT/US2018/029531 (2017), US provisional patent application No. 62/835 861 (2019), and US provisional patent application No. 63/331 563 (2021); and holding a patent for US patent No. 11 278 505 (2018). Dr Harris also reported that Villaris was acquired by Incyte. Dr van Geel reported receiving grants from Incyte and consulting for AbbVie, Merck, Sun Pharma, and Pfizer outside the submitted work. Dr Grimes reported receiving grants from Incyte, Skin Better Science, L’Oréal, Pfizer, Johnson & Johnson, Mother Science, and LaserOptek; and consulting for Incyte, Skin Better Science, L’Oréal, AbbVie/Allegran, and Proctor & Gamble outside the submitted work. Dr Gardner reported receiving fees from Incyte for serving on the Vitiligo Advisory Board and Patient Council during the conduct of the study and fees from Avita for recruitment assistance outside the submitted work. Ms LaFiura reported receiving fees from Incyte as co-owner of the research agency commissioned to collect the data during the conduct of the study. Dr Ren reported receiving salary from Incyte and owning stocks in Incyte outside the submitted work. Dr Hamzavi reported receiving grants from AbbVie; receiving grants from Pfizer, Bayer, Lenicura, Incyte, Estee Lauder, Ferndale Laboratories, Loreal/Laroche Posay, Unigen Inc, Arcutis, Avita, ChemoCentryx, Clinuvel, and ITN paid to his institution; receiving consulting fees from Incyte and Pfizer paid to his institution; receiving consulting fees from UCB, Boehringer Ingelheim, Galderma Laboratories, Novartis, MyDerm Portal, Union Therapeutics, Sonoma, Jansen, and Vimela; being a shareholder in MyDerm Portal; serving on the board of the HS Foundation; and serving as cochair for the Global Vitiligo Foundation. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Global Vitiligo Impact Patient Scale (VIPs) Scores
aFitzpatrick skin types I to III were characterized as fairer skin types, and types IV to VI as darker skin types. bPatients with 0% affected body surface area (BSA) (n = 87) were excluded from analysis. The mean (SD) VIPs score for Africa and the Middle East was 30.2 (16.0) (P < .001 vs Europe and Canada); for Asia, 28.3 (16.1) (P < .01 vs Europe and Canada); for Brazil, 29.7 (17.1) (P < .001 vs Europe and Canada); and for the US, 29.4 (12.8) (P < .001 vs Europe and Canada). The mean (SD) VIPs score for affected BSA was 24.1 (13.9) for 1% to 5% (P < .001 vs <1% BSA) and 32.6 (14.2) for more than 5% (P < .001 vs 1%-5% BSA and <1% BSA). The mean (SD) VIPs score for Fitzpatrick skin type IV to VI was 31.2 (15.6) (P < .001 vs Fitzpatrick skin types I to III). The mean (SD) VIPs score for facial lesions (yes) was 30.0 (14.9) (P < .001 vs no facial lesions); for hand lesions (yes), 29.2 (15.2) (P < .001 vs no hand lesions); and for facial or hand lesions (yes), 28.2 (15.3) (P < .001 vs no facial or hand lesions).
Figure 2.
Figure 2.. Repercussions of Vitiligo on Patients’ Daily Lives
Patients were asked how frequently vitiligo affected their decision to participate in daily activities before the COVID-19 pandemic.
See this image and copyright information in PMC

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