Psychosocial burden of lichen planus pigmentosus is similar to vitiligo, but greater than melasma: A cross-sectional study from a tertiary-care center in north India

Abstract

Background: Lichen planus pigmentosus can have a negative impact on the quality of life; however, this has not been studied in detail. Objectives: To study the quality of life in patients with lichen planus pigmentosus and compare it with patients with vitiligo and melasma. Methods: This was a cross-sectional study conducted in a tertiary-care center in north India from January 2018 to May 2019. Patients ≥ 18 years of age with lichen planus pigmentosus (n = 125), vitiligo (n = 113) and melasma (n = 121) completed the Dermatology Life Quality Index (DLQI) questionnaire and answered a global question on the effect of disease on their lives. In addition, patients with vitiligo completed the Vitiligo Impact Scale (VIS)-22 questionnaire, while those with lichen planus pigmentosus and melasma filled a modified version of VIS-22. Results: The mean DLQI scores in patients with lichen planus pigmentosus, vitiligo and melasma were 10.9 ± 5.95, 9.73 ± 6.51 and 8.39 ± 5.92, respectively, the difference being statistically significant only between lichen planus pigmentosus and melasma (P < 0.001). The corresponding mean modified VIS-22/VIS-22 scores were 26.82 ± 11.89, 25.82 ± 14.03 and 18.87 ± 11.84, respectively. This difference was statistically significant between lichen planus pigmentosus and melasma, and between vitiligo and melasma (P < 0.001 for both). As compared to vitiligo, patients with lichen planus pigmentosus had a significantly greater impact on “symptoms and feelings” domain (P < 0.001) on DLQI, and on “social interactions” (P = 0.02) and “depression” (P = 0.04) domains on VIS-22. As compared to melasma, patients with lichen planus pigmentosus had significantly higher scores for “symptoms and feelings,” “daily activities,” “leisure” and “work and school” domains of DLQI, and all domains of VIS-22. Female gender was more associated with impairment in quality of life in patients with lichen planus pigmentosus, while lower education, marriage, younger age and increasing disease duration showed a directional trend. Limitations: Use of DLQI and modified version of VIS-22 scales in the absence of a pigmentary disease-specific quality-of-life instrument. Conclusion: Patients with lichen planus pigmentosus have a significantly impaired quality of life. The psychosocial burden of lichen planus pigmentosus is quantitatively similar to that of vitiligo, but significantly greater than melasma.

Quality of life measurement in vitiligo. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes with external experts

“…Higher quimp in patients with darker skin types than in those with fair skin was also reported 42 . Mean DLQI scores of adult vitiligo patients from studies performed in 21 different countries are presented in Figure 2 44–83 . Most studies demonstrated a moderate or small effect on patient's lives score according to the DLQI banding descriptors.…”

“…Higher total Skindex‐16 scores were observed for patients with urticaria and acne than those with vitiligo 101 . One study reported greater quimp in vitiligo patients compared to those with melasma, 63 but no significant difference was found in other studies 64,65 . There was no significant difference between HRQoL of children with vitiligo and alopecia areata 102 …”

“…VIS-22 was used in four different studies including studies from China and Nepal. 44,65,92,125 The Vitiligo Life Quality Index (VLQI) 29 has a 1-week recall period and so may reflect HRQoL changes after short periods of time, such as following treatment. In contrast to other vitiligo-specific instruments, the VLQI contains an item on pain, irritation or itching due to vitiligo.…”

“…In several VIS‐22 items, vitiligo is not mentioned and (as in case of the VitiQoL) this may lead to a misunderstanding that the questions are not limited of vitiligo. VIS‐22 was used in four different studies including studies from China and Nepal 44,65,92,125 …”

Psychosocial impact of vitiligo in patients with skin of color

“…4,38,40 Table 1 summarizes the findings of studies reporting the effect of vitiligo on the quality of life and associated psychiatric comorbidities in patients with skin of color. [3][4][5]8,[13][14][15]17,18,26,[35][36][37][38][41][42][43][44][45]…”