Family vitiligo impact scale: A scale to measure the quality-of-life of family members of patients with vitiligo.

BACKGROUND: Vitiligo places a significant psycho-social burden on caregivers and family members. AIMS: The aim of the study was to develop and preliminarily validate a scale to measure the psychosocial impact of vitiligo on adult family members. METHODS: Themes that emerged from qualitative interviews and a focus group discussion with family members were used to generate items for a preliminary scale, followed by pre-testing and scale development. The new scale was then tested with two comparator scales and a global question. RESULTS: A preliminary scale with 32 items was pilot tested on 30 participants. Following this, the scale was condensed to 16 items in 12 domains that were administered to 159 participants. Scale scores ranged from 0 to 48 with a mean of 19.75 ± 12.41. The scale had excellent internal consistency with Cronbach's alpha coefficient of 0.92 (0.70-0.95) and also showed good test-retest reliability at two weeks (r = 0.946). The scale showed criterion, convergent and known group validity. LIMITATIONS: It was conducted in a large teaching hospital which may have resulted in selection of patients with persistent or progressive disease and more worried family members. Vitiligo is highly stigmatized in our country and the performance of the scale may need to be evaluated in other communities and cultures as well where stigma is less oppressive. CONCLUSION: Family Vitiligo Impact Scale appears to be an easy-to-complete, reliable and valid instrument to measure the psychosocial impact of vitiligo in family members of patients. It may be useful as an outcome measure in both clinical and research settings.

A cross-sectional study of spontaneous repigmentation in vitiligo.

BACKGROUND: Spontaneous regression is well documented in several chronic skin diseases such as psoriasis, alopecia areata, and atopic dermatitis. However, information on vitiligo is scarce. AIMS: We studied the frequency, extent, and factors affecting spontaneous repigmentation in vitiligo. METHODS: A cross-sectional descriptive study was undertaken in 167 patients with vitiligo with an emphasis on history of spontaneous repigmentation. Where available, photographs documenting spontaneous repigmentation were also obtained. Repigmentation was defined as spontaneous if it occurred when the patient was off treatment for at least 3 consecutive months. RESULTS: Spontaneous repigmentation occurred in 36 (21.5%) patients with complete repigmentation in 6 (3.6%) patients. The extent varied from 0.5% to 100% (mean, 35.4 ± 37.9%) of vitiliginous skin. It occurred after 3 months to 47 years (mean, 8.7 ± 9.5 years) of onset of vitiligo and persisted for 2 months to 27 years (mean, 4.4 ± 6.2 years). Diffuse repigmentation was the most common pattern observed in 20 (55.6%) patients and there was a good color match in 26 (72.2%) patients. Likelihood of spontaneous repigmentation was 3.5 times greater in patients with more than 3 years of stable disease (P = 0.001). LIMITATIONS: The chief limitation was the dependence on patient recall for the data, except when documented by images. CONCLUSION: Spontaneous repigmentation occurs in one-fifth of patients with vitiligo. In some patients, the repigmentation is clinically significant and long-lasting. Considering its frequency and extent, spontaneous repigmentation should be taken into account both when evaluating novel interventions and counselling patients about the course of the disease.

Prevalence of metabolic syndrome and cardiovascular changes in patients with chronic plaque psoriasis and their correlation with disease severity: A hospital-based cross-sectional study.

BACKGROUND: Previous epidemiological studies suggest an association between psoriasis and metabolic syndrome and risk of subclinical atherosclerosis. However, there is a paucity of data in the Indian population on these associations. OBJECTIVES: To evaluate the prevalence of metabolic syndrome and subclinical atherosclerosis in patients with chronic plaque psoriasis compared to healthy controls and to correlate the prevalence of metabolic syndrome with severity of psoriasis. METHODS: A hospital-based cross-sectional study was performed on 140 patients with chronic plaque psoriasis and 140 controls. Psoriasis was categorized as mild, moderate and severe based on psoriasis area and severity index (<10, 10-14 and ≥15, respectively) and as disease of short (<1 year), intermediate (1-3 years) and long duration (>3 years). In all patients and controls, body mass index was calculated, blood pressure and waist circumference were measured and fasting bloaod sugar and lipid profile were estimated. Metabolic syndrome was diagnosed by the presence of 3 or more of the modified National Cholesterol Education Program's Adult Treatment Panel III criteria. A subset of 30 psoriatic patients and 30 healthy controls were selected by the systematic sampling method for cardiac evaluation including electrocardiography, echocardiography and carotid intima-media thickness measurement. RESULTS: The prevalence of metabolic syndrome was significantly more in psoriatic patients than in controls (39.3% vs. 17.1%, odds ratio = 3.13). Psoriatic patients also had a significantly higher prevalence of hypertension, abdominal obesity and diabetes. There was a significant trend to increase in prevalence of metabolic syndrome, hypertension and type 2 diabetes with increased severity and longer duration of the psoriasis. Patients with psoriasis had significantly higher carotid intima-media thickness (mean 0.61 mm ± 0.01 mm vs. 0.37 mm ± 0.01 mm) than controls. LIMITATION: This was a hospital-based cross-sectional study with a relatively small sample size. A prospective study with a larger sample would have validated the results further. CONCLUSION: There is a significantly higher prevalence of metabolic syndrome in psoriasis patients as compared to controls; the prevalence of metabolic syndrome and its components increases with severity and duration of psoriasis. There is a higher prevalence of subclinical atherosclerosis in patients with psoriasis thus increasing the risk of cardiovascular disease. We suggest that patients with moderate to severe psoriasis be screened routinely for metabolic syndrome and cardiovascular disease and encouraged to correct modifiable cardiovascular risk factors.

Vitiligo impact scale: an instrument to assess the psychosocial burden of vitiligo.

BACKGROUND: Vitiligo is a disease that significantly impairs quality of life. Previous studies have shown that vitiligo has an impact that may not correlate with the size and extent of depigmentation, indicating a need for an independent measure of the psychosocial burden. AIMS: To develop a rating scale to assess the psychosocial impact of vitiligo. METHODS: The study was undertaken in three broad phases: item generation, pre- and pilot testing, and test administration. Items were generated largely from a qualitative study using semi-structured interviews of patients. Face and content validity were assessed through pre- and pilot testing in 80 patients and the final version was administered to 100 patients who also received the Dermatology Life Quality Index (DLQI) and the Skindex-16. Each patient also underwent a physician global assessment (PGA) of the impact of vitiligo. Test-retest reliability was assessed in 20 patients. RESULTS: Of 72 items initially generated for the scale, 27 were retained in the final version. Subjects were able to comprehend the items and took about 5-7 min to complete the instrument. The scale was internally consistent (Cronbach's α = 0.85). Scores on the scale correlated moderately well with the DLQI and the Skindex (Spearman rank correlation: 0.51 and 0.65, respectively). The scale was able to discriminate between patients having mild and those having moderate and severe impact as assessed by PGA. The test-retest reliability coefficient (Spearman rank correlation) was 0.80. CONCLUSION: The Vitiligo Impact Scale appears to be a valid measure of the psychosocial impact of vitiligo and this instrument may be useful both in the clinic and in clinical trials.

Some indices pertaining to the leprosy control programme in Tamil Nadu, based on data from a random sample of fourteen government control units.

From a random sample of 14 Government Leprosy Control Units in Tamil Nadu, information on the profile of the newly-diagnosed leprosy patients and some important aspects of the control programme in 1978-81 was collected when monotherapy with dapsone was the practice. Among the new patients, 55 per cent were males, 24 per cent were children, 6 per cent had lepromatous leprosy and 9 per cent had a deformity. About 65 per cent were detected by active case-finding methods and 25 per cent were voluntary referrals. Of the total diagnosed patients, only 68 per cent started treatment; further, of these, about 40 per cent collected drugs for at least 6 months in the first year of treatment. The average attendance at the clinic was 34 per cent of the due attendance. Coverage in the annual examination of family contacts was 57 per cent. During the 4 yr period, about 70 per cent of the villages had population surveys with a coverage of 75 per cent or more. The introduction of multi-drug therapy has provided a new impetus to the programme and therefore a similar study is called for to provide valuable information about the extent of improvement in completion rates and overall impact.

PIP: Researchers used 1978-1981 data from a random sample of 100 rural subcenters of 14 government leprosy control unites (LCUs) in Tamil Nadu, India to learn the status of indices of the National Leprosy Control Programme. The lepromatous rate stood at 6% (4-10% range) with males having a much higher percentage (8.6% vs. 3.9%) and children having a much lower percentage (.6% vs. 8.3%). It was highest for those who voluntarily reported their condition (10.4%) and lowest for those detected during a routine contact examination (2.5%). Active case finding techniques detected most new cases [65%; population survey (59%) and routine contact examination (6%)] followed by voluntary referrals (25%; 8-44% range) and miscellaneous sources. Only 68% (38-82%) of newly diagnosed cases started treatment in the same calendar year or the next. Indeed 46% of those detected by population survey and 37% of contact examination did not even register. Therefore the active case finding program does not bring full benefits to patients. It should undertake intense efforts to motivate all diagnosed patients to take treatment. Moreover, as many as 60% of patients did not collect the drugs needed for the multidrug therapy for =or + 6 months. Some of these did not even do so in the 1st year of treatment. As time passed, the levels of irregularity rose (65% in 2nd year and 71% in 3rd year). Perhaps LCU staff should use a group approach to motivate patients to collect the needed drugs rather than an individualizes approach. In addition, 18-89% of patients at time of registration had a bacteriological examination in 12 LCUs. The median stood at 69%. The percentage of patients who have a bacteriological examination must improve since the multidrug therapy regimen is dependent on the type of leprosy the patient has (multi or pauci bacillary leprosy).