Research Progress on Quality of Life Assessment Scale for Patients with Vitiligo

Although vitiligo does not endanger the patient’s life safety, the prolonged disease and repeated episodes cause huge psychological pressure on the patient, hinder the patient’s interpersonal communication, and significantly reduce the quality of life of the patient. Using the quality of life scale to assess the quality of life of patients is a common method to study the impact of disease on patients. This article reviews the application progress of the quality of life assessment scale for patients with vitiligo.

Vitiligo is a common depigmented skin disease that is mainly characterized by the loss of melanocytes in the skin, mucous membranes, and hair follicles. The worldwide incidence is about 1%, and the incidence has been increasing in recent years. The etiology and pathogenesis of this disease are still not clear. At present, there are theories of genetics, immune dysfunction, self-destruction of melanocytes, neurochemical and oxidative stress. People of all skin tones and people of any age can develop vitiligo. Skin lesions can be seen in various parts of the body surface. Although it does not endanger the life of the patient, the prolongation of the disease and repeated episodes cause tremendous psychological pressure on the patient and hinder the patient’s interpersonal communication. , Often brings significant damage to patients’ quality of life. Therefore, the assessment of quality of life is of vital importance. The progress of the application of the Vitiligo Quality of Life Assessment Scale is summarized below.

1. Definition of Life quality of vitiligo patients

Quality of life is also called quality of life or quality of life. The World Health Organization (WHO) Quality of Life Research Group in 1993 defined quality of life as: the experience of individuals in different cultures and value systems about their goals, expectations, standards, and concerns about their living conditions. The medical field introduced the concept of health-related quality of life in the 1970s, which mainly reflected the impact of diseases and treatment on quality of life from three aspects of physical, psychological and social functions. The quality of life questionnaire is widely used as an important tool to study the quality of life.

2. Impact of vitiligo on patients’ quality of life

Vitiligo is a chronic disease. The quality of life of patients is often affected by the appearance of the disease and its long course of disease. It can be seen that it is not enough to evaluate the severity of a patient’s condition only through indicators such as body surface area occupied by skin lesions. Studies show that more than 50% of respondents said that vitiligo has a serious impact on their quality of life, with “seeking cure or effective treatment options” and “long-term treatment” having the greatest impact on patients. However, there are still few studies on the quality of life of patients with vitiligo. Only 9% of the studies used the quality of life of patients with vitiligo as the primary or secondary evaluation index. This unstable mood is also common in minor patients.

Overall, the quality of life of adolescents (15-17 years) was significantly lower than that of children (7-14 years). In addition, studies have shown that parents of children with vitiligo can cause psychological problems or social stress due to their children’s illness, which makes their quality of life decline. Therefore, dermatologists are recommended to raise awareness of mental health problems caused by the disease, which can help improve the quality of life of parents of children.

3. Quality of life assessment method and its application in patients with vitiligo

In view of the increasing requirements of patients for quality of life at present, the evaluation of quality of life has become an important indicator for selecting treatment options and evaluating the effect of treatment. Accurate assessment of patients’ quality of life is very important in clinical practice. The assessment of quality of life is usually done in the form of a self-assessment of a scale. The measurement scale can be divided into three types: a universal scale, a skin scale-specific scale, and a vitiligo scale.

3.1 Universal scale

Commonly used universal scales include the medical outcomes study 36-term shortform healthservy SF-36 scale, the Nottingham Health Profile NHP and the World Health Organization Quality of Life Scale (WHOQOL-100). SF-36 is currently used in clinical trials. SF-36 includes 36 items to evaluate the quality of life from 8 aspects, namely physiological function, pain, vitality, social function, psychological function, general health status, physiological role function and emotional role function. The higher the score, the better the quality of life. The higher. Ghajarzadeh et al. Used SF-36 to conduct a quality of life control study of vitiligo, psoriasis, and alopecia areata. The results showed that the overall quality of life of patients with vitiligo (average score: 63.80) was better than that of psoriasis patients (average score: 59.80) However, the quality of life was worse than that of alopecia areata patients (mean score 68.01). However, SF-36 mainly emphasizes the physical disability caused by the disease, and does not pay enough attention to psychological issues such as shame and distress. For these influencing factors, clinical trials have found that SF-36 cannot distinguish the difference between the treatment group and the placebo group.

3.2 Dermatological special Scale

3.2.1 Dermatology Life Quality Index (DLQI) and The Children’s Dermatology Life Quality Index (CDLQI)

There are 10 questions in DLQI, which are currently widely used for quality of life assessment of various skin diseases. Patients answered these 10 questions based on their past week, with a total score of 0 to 30. A higher score indicates a lower quality of life. A study using DLQI to compare the quality of life of chronic skin diseases showed that the quality of life of patients with vitiligo (average DLQI 7.0) was worse than that of patients with psoriasis (average DLQI 6.7) and rosacea (average DLQI 4.3). In patients with atopic dermatitis (DLQI average of 8.5).

3.1.2 Skindex

The skin index questionnaire was originally designed by Chren et al. It contains a total of 61 questions and was measured from both the psychosocial and physiological aspects. Subsequently, Chren et al. Simplified the original scale and improved it to 30 items, namely Skindex-29. The improved scale has a total of 29 questions, including three dimensions of symptoms, emotions, and functions. Compared with the original 61-item scale, it improves the discrimination and assessment ability, and shortens the completion time. The scale requires patients to answer the effects of skin diseases on themselves in the past 4 weeks. The score of each question is from 0 (never) to 5 (always), and the total score is 0 to 100 points. A study using Skindex-29 to assess the quality of life of patients with vitiligo showed that 74.6% of patients were worried that their skin condition would worsen, 62.9% of patients were worried that they had severe skin conditions, and 55.6% of patients were worried that the disease would bring loved ones Inconvenience, 53.5% of patients feel depressed due to their skin condition. In 2002, the Skindex-16 scale was formed. Skindex-16 was further simplified than Skindex-29. The simplified scale removed some questions with the same answers and focused more on measuring the distress rather than the frequency. There are 16 questions on the scale, including symptoms (1 to 4 questions), emotions (5 to 11 questions), and functions (12 to 16 questions). Each question is scored from 0 (never trouble)-6 (Always trouble). The scale is also widely used in quality of life surveys of various skin diseases.

3.3 Vitiligo specified scale

Although the dermatological universal scale can assess the overall impact of vitiligo patients on the quality of life, the general scale has limitations and often cannot accurately determine the degree and dimension of the impact of the disease on quality of life, that is, it does not have good specificity. Here are three types of vitiligo scales that have been developed and verified in recent years.

3.3.1 Vitiligo－specific quality－of－life instrument(VitiQoL)

In 2013 Lily and others developed and validated a vitiligo-specific quality-of-life instrument (VitiQoL: vitiligo-specific quality-of-life instrument). The VitiQoL questionnaire consists of 15 questions, with item scores ranging from 0 (never) to 6 (always) and total scores from 0 to 90 points. In addition, the questionnaire has a 16th question, which uses a scale from 0 (no skin disease) to 6 (worst case) to assess the severity of vitiligo, but does not count towards the total score. This questionnaire is initially in English and has been studied for reliability and validity in the American population. Its internal consistency reliability Cronbathe’s alpha is 0.935, which shows that it has good internal consistency. Aggregation validity was confirmed by the correlation between VitiQoL and other self-assessment scales (Skindex-16, r = 0.816; DLQI, r = 0.832). VItiQoL is a vitiligo-specific assessment scale based on the patient’s perspective. Compared with the universal scale, VItiQoL is more targeted and can be used to assess the patient’s disease status, disease burden, and therapeutic value. It can also be used in clinical Experimental research. At present, the scale has been translated into Portuguese and Persian, and has confirmed its reliability and validity in Brazil and Iran, respectively. Recently, Catucci and others used the Portuguese version of VitiQoL to evaluate the quality of life of patients with vitiligo, and the results confirmed the strong correlation between the scores of VitiQoL and DLQI (r = 0.81; P <0.001). More vulnerable.

3.3.2 Vitiligo Impact Scale－22，VIS－22

In 2014, Gupta and others developed and verified the Vitiligo Impact Scale-22 (VIS-22). The scale has 23 questions, of which the first 19 questions are public questions, and the last four questions are selected based on whether the patient is currently married and working or studying. There are four scores for each question, namely 0—no problem, 1—somewhat related, 2—somewhat related, and 3—very much related. The total score is 0 to 66 points. The reliability and validity of this scale was studied in 161 patients, and its internal consistency reliability was 0.9053. The validity of the correlation criterion showed that the scale was very similar to the Visual Analogue Scale (VAS). Strong correlation (r = 0.7076). Aggregation validity shows that the scale has moderate correlation with DLQI and Skindex-16 (DLQI, r = 0.71; Skindex-16, r = 0.72).

Recently, a team in India applied clinical criteria to the VIS-22 scale using a standard method. The study used the Global Question (GQ) scale as a reference to compare the degree of correlation between the quality of life of VIS-22 and DLQI vitiligo patients. The results show that the degree of correlation between VIS-22 and GQ (VIS-22, r = 0.77; DLQI, r = 0.69) and consistency (VIS-22, 51.6%; DLQI, 36.1%; p <0.001) are higher than DLQI . That is, VIS-22 can more accurately evaluate the impact of the quality of life of patients with vitiligo.

3.3.3 Vitiligo Impact PatientScale(VIPs)

The scale was developed and validated by Salzes et al in 2016, focusing on the effects of different skin sun typing on patients with vitiligo. The table has 29 items, of which 19 items are common to all skin types, and another 3 items are dedicated to type I-III skin (VIP-FS) and 7 items are dedicated to type IV-VI skin (VIP-DS). The scores are 0 to 110 points (I-III skin) and 0 to 130 points (IV-VI skin), and the scores are finally converted into a percentage system. The internal consistency reliability of the scale is 0.94. In terms of aggregation validity, the scale is divided into VIP-FS and VIP-DS according to skin type for correlation analysis at DLQI and SF12, respectively. VIP-FS and VIP-DS are related to The total score of DLQI is highly correlated (VIP-FS, r = 0.84; VIP-DS, r = 0.82), and VIP-FS and VIP-DS have moderate negative correlations with the total score of SF-12 (VIP-FS, r = －0.54; VIP-DS, r = －0.55). At present, the scale has not been developed and verified in other countries and languages, and no relevant clinical application of the scale has been found.

4. Use of measuring tools during vitiligo research

The universal scale is suitable for the preliminary screening of quality of life, and is conducive to a comprehensive understanding of the general health of the general population. But compared to disease-specific measurement tools, they are less sensitive to changes after treatment. The special measuring tools for skin diseases can reflect the difference between skin diseases and other system diseases, and can compare the impact of different skin diseases on the quality of life of patients. It can also be used to observe the changes in the quality of life of patients before and after the same disease treatment. But compared with the disease-specific scale, its specificity is not strong. The special scale for vitiligo is more suitable for the special problems faced by patients with vitiligo, such as the skin scale, itching of the skin, and the susceptibility of the skin to irritation, which are not applicable to patients with vitiligo, and focus more on the psychological problems of patients The burden of disease on patients. Therefore, the disease-specific scale is more suitable for observing the quality of life of a specific disease, and it is more convenient for doctors to compare the changes in quality of life of patients before and after treatment.

5. Current shortcomings and prospects of vitiligo

Dermatological diseases are more intuitive and easier to observe than diseases in other disciplines, so we cannot simply use the survival rate and other indicators to evaluate the efficacy; and dermatological diseases often have a longer course, and various skin diseases and psycho-nerve diseases Factors are highly related, so when treating patients with diseases, we must pay more attention to the impact of the disease on patients’ psychology, in order to achieve the effect of improving the quality of life of patients. At present, there are fewer types of vitiligo-specific evaluation scales, and research in China is rare. Patients’ different educational background and background affect their understanding of the questionnaire, so the development and verification of the Vitiligo Specific Evaluation Scale in the Chinese population may become a future research direction.

6. Conclusion of vitiligo

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