Cosmetic camouflage of visible skin lesions enhances life quality indices in leprosy as in vitiligo patients: an effective stigma reduction strategy

Abstract

The use of cosmetic camouflage for blemishes on skin of affected people is known to improve their Dermatology Life Quality Index (DLQI). Although the use and benefits of cosmetic camouflage is known and reported in vitiligo, its value in leprosy, where visible skin lesions are a reason for stigma and discrimination, is yet to be explored. A key resolution of the WHO Global Leprosy Strategy 2016-2020 is to stop discrimination and promote inclusion of persons affected by leprosy into society. Improving the DLQI of leprosy patients with the use of cosmetic camouflage is an effort in that direction.Objectives: We undertook this study to examine the change brought about by cosmetic camouflage in the DLQI of leprosy patients with visible skin lesions and, to compare the results with its use in vitiligo, as both are disorders associated with pigment dilution in the skin. Methods: The DLQI score was calculated for 9 consenting leprosy and 14 vitiligo patients at the time of enrolment. All patients were taught the simple technique of cosmetic camouflage of their skin patches on exposed parts of the body, such as face and arms/forearms. The DLQI scoring was calculated again after one month of use of cosmetic camouflage and compared with the baseline value.Results: The mean DLQI improved significantly (p < 0.0001) after the use of cosmetic camouflage in both vitiligo and leprosy groups, indicating the efficacy of camouflage in improving the quality of life. In addition, it was observed that the mean improvement in DLQI was higher in the leprosy group (14.67 ± 3.87) than in the vitiligo group (8.64 ± 2.96), the difference being statistically significant (p < 0.05), suggesting that camouflage has a very high impact on the quality of life in leprosy. Conclusions: Leprosy-related stigma and discrimination are pervasive in almost all cultures of the world. Such stigma affects many aspects of social participation. The WHO global strategy document 2016-2020 advocates inclusion of at least one stigma reduction strategy in all leprosy programme plans. Use of cosmetic camouflage for

Psychosocial Effects of Vitiligo: A Systematic Literature Review

“…Among QoL instruments assessing general health, total and/or component scores were most frequently reported for the adult and child versions of the Dermatology Life Quality Index (DLQI, 53 studies) [ 4 , 13 , 14 , 18 , 19 , 22 , 25 , 33 , 35 – 38 , 45 , 64 , 65 , 67 – 70 , 74 , 77 , 81 – 83 , 87 , 89 , 90 , 92 , 93 , 96 , 99 , 100 , 102 , 104 , 112 , 115 , 119 , 120 , 122 , 123 , 140 , 143 , 144 , 146 , 148 , 151 , 156 , 161 , 162 , 164 – 166 , 168 ], Children’s DLQI (seven studies) [ 24 , 67 , 73 , 101 , 103 , 110 , 152 ], 36-Item Short Form Health Survey (SF-36, eight studies) [ 9 , 82 , 83 , 105 – 107 , 161 , 162 ], General Health Questionnaire (eight studies) [ 14 , 30 , 65 , 93 ...…”

“…Fifty studies that reported DLQI mean scores for patients with vitiligo were further examined. Mean scores did not differ vastly by region, but there were trends for higher mean scores (i.e., increased burden of disease) in the Middle East (4.7–14.7) [ 14 , 45 , 64 , 74 , 82 , 83 , 87 , 104 , 112 , 140 , 144 , 164 , 166 ], Southern Asia (4.1–12.4) [ 18 , 22 , 38 , 100 , 120 , 143 , 146 , 168 ], and Eastern Asia (4.0–8.4) [ 35 , 68 – 70 , 119 , 156 , 161 , 162 ] compared with Europe (1.8–8.7) [ 4 , 77 , 89 , 90 , 92 , 93 , 96 , 99 , 102 , 104 , 122 , 123 , 148 ] and North America (5.2–6.6) [ 115 , 151 , 165 ]. The lowest DLQI mean scores were reported in Italy (1.8 [ 89 ] and 4.3 [ 90 ]), Singapore (4.0 [ 69 ] and 4.4 [ 68 ]), and Nepal (4.1 [ 38 ]), whereas the highest DLQI mean scores were reported in Saudi Arabia (14.7 [ 45 ] and 9.0 [ 64 ]) and Egypt (13.0 [ 144 ], 12.4 [ 87 ], 12.2 [ 25 ], and 11.2–11.9 [ 19 ]).…”

“…Four studies reported that comorbid depression significantly reduced overall QoL [ 35 , 92 , 100 , 115 ]. Management strategies [ 107 ] including camouflage [ 18 , 25 , 102 , 122 , 156 ], cognitive behavioral therapy [ 26 , 125 , 127 , 148 , 168 ], phototherapy [ 51 , 52 , 157 ], and depigmentation cream (in patients with extensive vitiligo) [ 19 ] were associated with decreased vitiligo-associated burden.

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

“…Tables 3 and summarize findings from interventional studies (in dermatology‐ and vitiligo‐specific and generic instruments respectively), including the effects of pharmaceutical treatment, phototherapy, photochemotherapy, surgical treatment, climatotherapy, homeopathic/natural treatment, camouflage and counselling on QoL. In general, most interventions significantly improved QoL at end of follow‐up compared with baseline 25,43,45,47,50,54,57,70–73,86,89,90,93,104,105,108,112,134,136,144 ; however, differences between treatment comparators within studies were rarely reported as significant. DLQI was used in the majority (23/33) of interventional studies 25,43,45,47,50,54,56,57,63,70–73,86,89–91,93,98,101,104,105,108 ; meaningful score changes (4‐point score reduction) 150 were achieved with ≥1 treatment arm in 10 studies 25,45,47,50,54,57,73,93,104,108 .…”

“…In general, most interventions significantly improved QoL at end of follow-up compared with baseline 25,43,45,47,50,54,57,[70][71][72][73]86,89,90,93,104,105,108,112,134,136,144 ; however, Systematic review of vitiligo quality-of-life outcomes Systematic review of vitiligo quality-of-life outcomes differences between treatment comparators within studies were rarely reported as significant. DLQI was used in the majority (23/33) of interventional studies 25,43,45,47,50,54,56,57,63,[70][71][72][73]86,[89][90][91]93,98,101,104,105,108 ; meaningful score changes (4-point score reduction) 150 were achieved with ≥1 treatment arm in 10 studies. 25,…”