A nationwide, multicentric case–Control study on vitiligo (MEDEC-V) to elicit the magnitude and correlates

Abstract

Background: Vitiligo is an acquired, idiopathic, and common depigmentation disorder. The values of various epidemiologic parameters are often doubtful due to the methodological weaknesses of the studies. Aims: To elicit the magnitude of various epidemiological parameters and important correlates of vitiligo. Materials and Methods: Every vitiligo patient attending the outpatient department of medical colleges spread over most of the Indian states were examined over a period of 1 year. Various epidemiological and clinical variables were examined and compared with age and sex-matched controls (registered in the Clinical Trial Registry of India CTRI/2017/06/008854). Results: A total of 4,43,275 patients were assessed in 30 medical colleges from 21 Indian states. Institutional prevalence of vitiligo was 0.89% (0.86% in males and 0.93% in females, P < 0.001). The mean age at presentation and mean age at onset were 30.12 ± 17.97 years and 25.14 ± 7.48 years, respectively. Head–neck was the most common primary site ( n = 1648, 41.6%) and most commonly affected site ( n = 2186, 55.17%). Most cases had nonsegmental vitiligo ( n = 2690, 67.89%). The disease started before 20 years of age in more than 46% of cases. About 77% of all cases had signs of instability during the last 1 year. The family history, consanguinity, hypothyroid disorders, and depressed mood were significantly ( P < 0.001) higher among the cases. First, second, and third-degree family members were affected in 269 (60.04%), 111 (24.78%), and 68 (15.18%) cases, respectively. Work-related exposure to chemicals was significantly higher among cases ( P < 0.008). Obesity was less common among vitiligo cases [ P < 0.001, odds ratio (OR) 0.78, 95% confidence interval (CI): 0.71–0.86]. Conclusion: This is one of the largest studies done on vitiligo in India. The prevalence of vitiligo was found to be 0.89% among hospital attendees. Prevalence of vitiligo was higher among females than in males and prevalence of family history, consanguinity, hypothyroid disorders were higher in vitiligo than among controls.

Psychosocial Effects of Vitiligo: A Systematic Literature Review

“…Depression and anxiety were the most commonly reported psychosocial comorbidities. Forty-one studies reported depression or depressive disorders (including major depressive disorder, bipolar disorder, and dysthymic disorder) in patients with vitiligo, with a prevalence range from 0.1–62.3% [ 15 , 17 , 22 , 23 , 28 , 30 , 32 , 34 , 35 , 39 , 40 , 43 , 44 , 46 , 48 , 50 , 57 , 68 , 69 , 71 , 92 , 100 , 104 , 113 – 115 , 131 , 137 , 138 , 142 , 143 , 145 , 146 , 150 , 154 , 155 , 158 – 160 , 163 , 177 ]. Twenty studies reported anxiety or anxiety-related disorders (including generalized anxiety disorder, agoraphobia, social phobia [not social avoidance], and panic disorder), with a prevalence of 1.9–67.9% [ 22 , 23 , 30 , 34 , 39 , 43 , 44 , 46 , 50 , 57 , 92 , 115 , 137 , 138 , 150 , 154 , 155 , 158 , 159 , 175 ].…”

“…Compared with controls, psychosocial comorbidities noted to be significantly ( p ≤ 0.05) associated with vitiligo were depression (11 studies) [ 23 , 28 , 33 , 34 , 55 , 63 , 128 , 140 , 143 , 145 , 155 ], anxiety (ten studies) [ 23 , 30 , 33 , 34 , 55 , 63 , 119 , 128 , 140 , 155 ], emotional or behavioral impairment (six studies) [ 9 , 23 , 34 , 128 , 140 , 161 ], adjustment disorder (four studies) [ 15 , 30 , 37 , 128 ], low self-esteem (three studies) [ 57 , 65 , 134 ], relationship and sexual dysfunction (three studies) [ 33 , 155 , 161 ], sleep disturbance (two studies) [ 55 , 117 ], suicidality (one study) [ 128 ], self-consciousness (one study) [ 119 ], embarrassment (one study) [ 145 ], alexithymia (one study) [ 108 ], and alcohol abuse or addiction (one study) [ 128 ]. Five studies reported that depression [ 30 , 84 , 85 , 102 , 164 ] and/or anxiety [ 84 , 164 ] scores measured by Beck Inventory scales were not significantly different in patients with vitiligo vs controls.…”

“…Factors that were significantly associated with higher psychosocial (Fig. 3 ) or overall QoL burden were female sex (30 studies) [ 15 , 21 , 25 , 28 , 30 , 45 , 46 , 49 , 51 , 57 , 62 , 66 – 68 , 70 , 88 , 90 , 99 , 104 , 107 , 109 , 112 , 113 , 120 , 123 , 132 , 143 , 146 , 154 , 158 ], lesion location in visible areas (e.g., face, hands [17 studies]) [ 4 , 25 , 35 , 37 , 49 , 62 , 70 , 80 , 89 , 90 , 92 , 101 , 122 , 123 , 138 , 143 , 151 ] or genitals (eight studies) [ 70 , 89 , 97 , 105 , 115 , 122 , 144 , 151 ], younger age (16 studies; particularly those aged <30 years and more so in adolescents) [ 17 , 25 , 30 , 48 , 49 , 62 , 67 , 68 , 70 ,…”

“…|| Includes one study with a population in Jordan and Germany (n = 167). The number of patients in each country was not available in the published study; thus, the full population is included in both countries on this map [92], Georgia [159], Germany [104], India [22,28,43,100,113,114,137,138,143,145,146,150,177], Italy [142], Iran [30], Japan [163], Jordan [104], South Korea [71], Mexico [115], Nepal [32], Nigeria [44], Saudi Arabia [17,46,48,50], Singapore [68,69], Taiwan [23], Thailand [35], Turkey [34,39,57,155,158], UK [40,160], USA [ [173] comorbidity in vitiligo compared with other skin diseases.…”

“…Factors that were significantly associated with higher psychosocial (Fig. 3) or overall QoL burden were female sex (30 studies) [15,21,25,28,30,45,46,49 [17,25,30,48,49,62,67,68,70,88,100,113,119,132,151,160], and extensive body area involvement (13 studies) [4,25,63,65,70,89,92,96,98,107,151,152,166]. Unmarried and/or single relationship status (nine studies) [17,22,48,49,62,70,93,113,138], longer disease duration (nine studies; particularly duration >5 years) [4,…”