Psychosocial Effects of Vitiligo: A Systematic Literature Review

Abstract

Background Patients with vitiligo experience reduced quality of life. Objective To comprehensively describe the available evidence for psychosocial burden in vitiligo. Methods A systematic review of observational studies and clinical trials identified using PubMed, EMBASE, Scopus, and the Cochrane databases was performed through 1 March, 2021, to assess psychosocial comorbidities in vitiligo. Two independent reviewers performed an assessment of articles and extracted data for qualitative synthesis. Results Included studies (N = 168) were published between 1979 and 1 March, 2021; 72.6% were published since 2010. Disorders including or related to depression (41 studies, 0.1-62.3%) and anxiety (20 studies, 1.9-67.9%) were the most commonly reported. The most prevalent psychosocial comorbidities were feelings of stigmatization (eight studies, 17.3-100%), adjustment disorders (12 studies, 4-93.9%), sleep disturbance (seven studies, 4.6-89.0%), relationship difficulties including sexual dysfunction (ten studies, 2.0-81.8%), and avoidance or restriction behavior (12.5-76%). The prevalence of most psychosocial comorbidities was significantly higher vs healthy individuals. Factors associated with a significantly higher burden included female sex, visible or genital lesions, age < 30 years (particularly adolescents), and greater body surface area involvement, among others. The most commonly reported patient coping strategy was lesion concealment. Limitations Available studies were heterogeneous and often had limited details; additionally, publication bias is possible. Conclusions The results of this systematic review show that vitiligo greatly affects psychosocial well-being. The extent of psychosocial comorbidities supports the use of multidisciplinary treatment strategies and education to address the vitiligoassociated burden of disease. Protocol Registration PROSPERO (CRD42020162223).

Evaluation of the Behavioral and Psychological Symptoms in Patients with Vitiligo in China

“… 18 Importantly, the quality of life of vitiligo may be largely affected by psychosocial comorbidity. 19 …”

“…18 Importantly, the quality of life of vitiligo may be largely affected by psychosocial comorbidity. 19 Skin plays an important role in our interaction with the world, and skin color is an important factor in perceiving someone's health. 20 The results of our study showed that the total score of SCL-90 was 136.44, which is significantly higher than the Chinese norm.…”

The association between social support and depression among patients with vitiligo in China

“…Although vitiligo will not bring serious health problems, it could cause significant cosmetic problems and serious psychological damage to patients ( Simons et al, 2020 ). The psychological burden of this skin disease is relatively high ( Ezzedine et al, 2021 ). Patients with vitiligo are more likely to suffer clinical depression or depressive symptoms ( Lai et al, 2017 ).…”

Gene polymorphisms and serum levels of BDNF and CRH in vitiligo patients

“…Clinically, the non-symptomatic whitish macules on skin in vitiligo patients are not as onerous as the signs of other chronic cutaneous diseases. Nevertheless, vitiligo may serve as a cause for the wide range of psychological impairments resulting in violation of mental well-being and quality of life [4][5][6]. To this end, the better understanding of pathophysiology of vitiligo might be achieved by investigation of the interplay between genetic, neurohumoral, and environmental factors in the onset and progression of the disease [7][8][9][10].…”