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Research Letter |

Characteristics of Patients With Universal Vitiligo and Health-Related Quality of Life FREE

May W. Linthorst Homan, MD; Mirjam A. G. Sprangers, MS, PhD; John de Korte, MS, PhD; Jan D. Bos, MD, PhD; J. P. Wietze van der Veen, MD, PhD
Arch Dermatol. 2008;144(8):1062-1064. doi:10.1001/archderm.144.8.1062.
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Little is known about universal vitiligo, a rare type of vitiligo in which more than 80% of the skin is depigmented. We do not know whether patient characteristics differ from those in the more common types of vitiligo. Moreover, nothing is known about health-related quality of life (HRQOL) in these patients. The aims of this study were to describe characteristics and HRQOL of patients with universal vitiligo and to compare these with the characteristics and HRQOL of patients with general vitiligo.

All adult patients (>18 years) having universal vitiligo diagnosed at the Netherlands Institute for Pigment Disorders (NIPD), Amsterdam, were mailed a package containing information about the study, an informed consent form, a questionnaire booklet with a questionnaire on patient characteristics and 2 QOL questionnaires—the 36-item Dutch Short Form (SF-36)1 and the 29-item Dutch Skindex (Skindex-29)2—and a stamped return envelope. In case a patient did not respond, the patient was reminded by telephone with a maximum of 3 follow-up calls.

A cohort of 245 adult patients with general vitiligo, referred to the NIPD in 2006, served as a comparison group. Each patient with universal vitiligo was matched for sex and age with 2 patients of the comparison group.

To detect a priori differences between respondents and nonrespondents, age and sex were compared using a χ2 test and a t test, respectively. The characteristics of patients with universal vitiligo were compared with those of patients with general vitiligo, using a t test or a χ2 test. The means of the scale scores and the summary scores of the SF-36 and the Skindex-29 of patients with universal vitiligo were compared with those of patients with general vitiligo, using t tests. Effect sizes were calculated.3 An effect size of 0.3 can be considered as clinically important.4 The level of significance was set at P < .05.

A total of 65 patients were eligible for this study. Six patients did not want to participate in the study, and 4 patients did not respond. The 55 patients included in this study (response rate, 85%) ranged in age from 22 to 77 years (median age, 52 years). The respondents and nonrespondents did not differ significantly with respect to age and sex. Patient characteristics and P values are presented in Table 1.

Patients with universal vitiligo reported significantly more comorbidities than the patients with general vitiligo (P < .05). The most frequently mentioned comorbidities were thyroid dysfunction, rheumatoid arthritis, diabetes mellitus, and alopecia areata. Patients with universal vitiligo seemed to experience rheumatoid arthritis more often (15%) than patients with general vitiligo (3%; P < .05). Furthermore, alopecia areata was reported in 4 patients with universal vitiligo, whereas none of the patients with general vitiligo reported this comorbidity (P < .05). Patients with universal vitiligo reported having more family members (47%) with vitiligo than patients with general vitiligo (35%; P < .05). Of the family members of patients with universal vitiligo, 24% also had universal vitiligo. Table 2 shows the results of HRQOL outcomes. Statistically significant differences were seen in the Physical Functioning, Bodily Pain, and General Health domains and in the Physical Component Summary of the SF-36, with a poorer physical HRQOL in patients with universal vitiligo. Scores on the Functioning scale of the Skindex-29 were significantly higher in patients with universal vitiligo, indicating more functional impairment in these patients compared with patients with general vitiligo (P < .05). The effect sizes of these statistically significant results can be considered clinically important.

Table Graphic Jump LocationTable 2. Health-Related Quality of Life (HRQOL)

Our results suggest that universal vitiligo represents the high end of the spectrum in general vitiligo. This is represented by an extreme clinical presentation with (sub)total depigmentation, a strong familial expression of the disease, and high prevalence of comorbidity, such as thyroid dysfunction, rheumatoid arthritis, and alopecia areata. Health-related QOL is comparable to what is found in general vitiligo except for poorer functioning in daily life and physical HRQOL, which probably reflects comorbidity.

ARTICLE INFORMATION

Correspondence: Dr Linthorst Homan, Netherlands Institute for Pigment Disorders, Department of Dermatology of the Academic Medical Centre, Meibergdreef 35, 1105 AZ, Amsterdam, the Netherlands (m.w.linthorsthoman@amc.uva.nl).

Author Contributions:Study concept and design: Linthorst Homan, Sprangers, de Korte, and van der Veen. Acquisition of data: Linthorst Homan. Analysis and interpretation of data: Linthorst Homan, Sprangers, de Korte, Bos, and van der Veen. Drafting of the manuscript: Linthorst Homan, Sprangers, and van der Veen. Critical revision of the manuscript for important intellectual content: Linthorst Homan, Sprangers, de Korte, Bos, and van der Veen. Statistical analysis: Linthorst Homan and Sprangers. Administrative, technical, and material support: Linthorst Homan. Study supervision: Sprangers, de Korte, Bos, and van der Veen.

Financial Disclosure: None reported.

Aaronson  NKMuller  MCohen  PD  et al.  Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998;51 (11) 1055- 1068
PubMed Link to Article
Chren  MMLasek  RJFlocke  SAZyzanski  SJ Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases. Arch Dermatol 1997;133 (11) 1433- 1440
PubMed Link to Article
Cohen  J Statistical Power Analysis for the Behavioral Sciences.  Hillsdale, NJ Lawrence Erlbaum Associates1988;
Revicki  DACella  DHays  RDSloan  JALenderking  WRAaronson  NK Responsiveness and minimal important differences for patient reported outcomes. Health Qual Life Outcomes 2006;41- 5
PubMed Link to Article

Figures

Tables

Table Graphic Jump LocationTable 2. Health-Related Quality of Life (HRQOL)

References

Aaronson  NKMuller  MCohen  PD  et al.  Translation, validation, and norming of the Dutch language version of the SF-36 Health Survey in community and chronic disease populations. J Clin Epidemiol 1998;51 (11) 1055- 1068
PubMed Link to Article
Chren  MMLasek  RJFlocke  SAZyzanski  SJ Improved discriminative and evaluative capability of a refined version of Skindex, a quality-of-life instrument for patients with skin diseases. Arch Dermatol 1997;133 (11) 1433- 1440
PubMed Link to Article
Cohen  J Statistical Power Analysis for the Behavioral Sciences.  Hillsdale, NJ Lawrence Erlbaum Associates1988;
Revicki  DACella  DHays  RDSloan  JALenderking  WRAaronson  NK Responsiveness and minimal important differences for patient reported outcomes. Health Qual Life Outcomes 2006;41- 5
PubMed Link to Article

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