Beyond Traditional Treatment: The Importance of Psychosocial Therapy in Vitiligo
June 2018 | Volume 17 | Issue 6 | Editorials | 688 | Copyright © 2018
Alexandra K. Rzepecki BS,a Beth N. McLellan MD,b and Nada Elbuluk MD MScc
aDepartment of Dermatology. University of Michigan Medical School, Ann Arbor, MI bDivision of Dermatology, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY cThe Ronald O. Perelman Department of Dermatology. New York University School of Medicine, New York, NY
Vitiligo is an acquired depigmentation disorder of the skin. Patients with vitiligo often face a challenging disease course, having to cope with a condition that is known to be physically disfiguring, psychologically devastating, and socially stigmatizing. Although an extensive amount of research has been directed towards the dermatologic treatment of vitiligo, an overall lack of data exists investigating treatment of the psychological and emotional burden of patients with vitiligo. This paper reviews the literature for treatment options in patients with vitiligo that specifically target the psychosocial domain. Despite being limited in quantity, several studies have proven the benefits of adjuvant care in the form of group therapy, cognitive behavioral therapy, and self-help programs. Although preliminary evidence is promising, larger prospective studies are needed to further define the role of these psychosocial interventions before integrating them in a more official capacity into the standard of care for patients with vitiligo. Because of the considerable impact of vitiligo beyond its physical symptoms, dermatologists ought to consider the utility of adjuvant therapies to adequately address impairments in self-esteem, body image, and quality of life in patients with vitiligo. J Drugs Dermatol. 2018;17(6):688-691.
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Vitiligo is an acquired autoimmune disorder characterized by the development of depigmented, non-scaly macules or patches on the skin, hair, or both.1 With an estimated prevalence of 0.5% to 2%, it is the most frequent cause of depigmentation worldwide.2 Because of the sporadic loss of color, vitiligo can be physically disfiguring, psychologically devastating, and socially stigmatizing, often profoundly affecting patients’ quality of life. Despite this, vitiligo is too often dismissed as a cosmetic condition with trivialization of the patients’ distress, which only further exacerbates the intensity of negative feelings that can be associated with the disease.3The psychological status of patients with vitiligo has often been investigated, showing that individuals can suffer from a multitude of feelings including anxiety, depression, suicidal attempts, phobias, and limited personal relationships.4 Because of the significant social and emotional burden patients with vitiligo encounter, a dire need for psychosocial interventions exists.5 However, there is a lack of data investigating how individuals can emotionally cope with vitiligo as a chronic skin disease.6We conducted a literature review for treatment options in patients with vitiligo that specifically target the psychosocial and emotional domain of the condition. We provide an overview of our findings, hoping to raise awareness about the utility of a holistic approach to treatment that includes acknowledgment and management of the psychologically distressing aspects of the disease in addition to its clinically apparent signs.7Psychosocial Vulnerability in VitiligoUnlike most internal illnesses, vitiligo is a condition visible to others, and those afflicted may suffer social and emotional consequences. Patients must not only learn to adapt to the bodily changes they are facing, but they must also be psychologically prepared for the possibility that their condition may spread or deteriorate at any time, causing a certain degree of uncertainty and helplessness.8 Because there is not one distinct etiology for the condition, patients with vitiligo often live in fear and anxiety of what may lead to the appearance of new lesions.9–11 The disease course, which can be progressive and episodic, is unpredictable, and to many, a source of psychological stress. Individuals can ultimately suffer from various psychiatric comorbidities such as depression, which was reported to be five times more likely among patients with vitiligo than controls (P less than 0.001).12 In fact, cyclic antidepressants are widely used to treat the depression of patients with vitiligo.13 Additionally, studies investigating the psychological status of patients with vitiligo reported that individuals suffer from feelings of disfigurement and psychological disturbance,14 anxiety,15 depression,12 impaired self-esteem,9 sleep disturbances,16 and sexual dysfunction.17Various factors may contribute to and potentially worsen the disease experience, such as extent of skin involvement, distribution