Vitiligo is the most common depigmentation disorder, according to current estimates. The disease can cause disfiguration and have a profound psychological burden, resulting in significantly impaired QOL. The precise etiology of vitiligo is unknown, but several factors are thought to play a role in the development of this disorder, including genetic, autoimmune, psychological, and environmental factors. Although the onset of vitiligo can happen at any age, the condition manifests itself before the age of 20 in about 50% of patients. Prior research shows that psychological stressors play a role in vitiligo.

Evaluating Post-Traumatic Stress Factors in Vitiligo

Vitiligo has been associated with disease-related discrimination, social isolation, lower self-esteem, embarrassment, anxiety, and depression. “The social stigma resulting from vitiligo can persist for decades and throughout a patient’s
lifetime,” says Dong-Lai Ma, MD, PhD. In addition, suicidal ideation has been reported in some studies of patients with vitiligo who are experiencing chronic stress, Dr. Ma notes, adding that these experiences can lead to the development of post-traumatic stress (PTS) or post-traumatic stress disorder (PTSD).

Therefore, Dr. Ma points out, it is important to evaluate psychological distress in patients with vitiligo in the early stages of the disease. However, research is lacking on the relationship between PTSD and vitiligo. To address this research gap, Dr. Ma and colleagues published a study in Clinical, Cosmetic and Investigational Dermatology that described the prevalence, severity, and risk factors for PTS in patients with vitiligo.

Investigators sought to determine whether PTSD was associated with vitiligo-related experiences and, if so, how PTSD affected patients with vitiligo. A questionnaire was completed by 337 patients with vitiligo to gather baseline
information and evaluate PTS symptoms and QOL. Based on symptom severity, patients were grouped and compared to analyze risk factors for PTSD.

PTS Affects Nearly One-Third of Patients With Vitiligo

Results from the study demonstrated that 30.3% of patients with vitiligo had PTS and 12.5% were confirmed for PTS developing into PTSD. The researchers observed that only 5.9% of patients with a clinical diagnosis of PTS and 11.9% of those with PTSD had ever sought any type of treatment, such as psychotherapy or medication.

A multiple logistic regression analysis identified risk factors for PTSD among patients with vitiligo. When compared with patients without PTS or PTSD, those with either condition had:

› A lower level of education,

› A higher incidence of vitiligo on the face and neck, feet and hands, and limbs, and

› Received significantly different surgical treatments for vitiligo.

The study team also found that the most common symptom of PTS in patients with vitiligo was sleep disturbance, followed by emotionally triggered thoughts, intrusive thoughts, avoidance of certain situations, and irritability (Figure). “Moderate” or “greater” sleep disturbances were observed in as many as 45% of patients with vitiligo, demonstrating significantly diminished QOL. These symptoms may lead patients with vitiligo to become more neurotic and emotionally vulnerable.

“Our data illustrate the critical need to assess PTS more comprehensively and provide care for patients with vitiligo who are affected by PTS and PTSD,” Dr. Ma says.

Efforts Needed to Increase Awareness of Vitiligo-Related PTS & PTSD

PTSD is believed to occur after traumatic events, but non-trauma events can also occur in patients with vitiligo. The psychological distress resulting from social stigma, financial burden, relapses, aggravation of the disease, and treatment side effects may also contribute to the onset of PTSD.

These findings may help spread awareness among dermatologists about the possibility of vitiligo-related PTS and PTSD. “Our data can also help inform proactive interventions to improve the efficacy of treatments,” adds Dr. Ma.

To decrease the burden, Dr. Ma recommends that healthcare professionals offer proactive early interventions when managing patients with vitiligo, such as physical activity, support groups, counseling, cognitive behavioral interventions, and pharmacological treatments.