The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes

Abstract

Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.

Figure 1

PRISMA flow diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.

Figure 2

Categorization of mean total scores for (a) DLQI and CDLQI,* (b) Skindex‐29 and Skindex‐16,^† (c) VitiQoL,^‡ and (d) VIS‐22.^§ CDLQI, Children’s Dermatology Life Quality Index; DLQI, Dermatology Life Quality Index; VIS, Vitiligo Impact Scale; VitiQoL, Vitiligo‐specific Quality of Life. * DLQI/CDLQI total score interpretation: 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; 11–20, very large effect on patient’s life; 21–30, extremely large effect on patient’s life. ^† Skindex total score interpretation: ≤5, very little effect; 6–17, mild effect; 18–36, moderate effect; ≥37, severe effect. ^‡ VitiQoL total score interpretation: 0–5, no effect; 6–20, mild effect; 21–38, moderate effect; ≥39, severe effect. ^§ VIS‐22 total score interpretation: 0–5, no effect; 6–15, mild effect; 16–25, moderate effect; 26–40, large effect; and 41–66, very large effect.

Figure 3

Factors significantly associated with reduced QoL. BSA, body surface area; QoL, quality of life.