Updates in the Treatment of Vitiligo - Episode 2
David Rosmarin, MD, illustrates the impacts of vitiligo on patient quality of life.
David Rosmarin, MD: I had a patient who didn’t appear to have anything different from 10 feet away, but 1 thing I noticed was that she had her hair covering her forehead. Even though it was a very hot day here in Boston, she wore [long] pants and long-sleeved shirts. She also had gloves on. That’s telling me that she’s trying to hide something. In this case, it was her vitiligo. Luckily, we were able to help her out significantly. If somebody is able to change their hairstyle and tell you, “This is the first time I’ve been able to change it in years. I can wear the clothes that I want to. I can go to the beach. I feel better about myself,” then we’ve helped their quality of life. Previously, she didn’t want to share a room with friends, and now she’s willing to do that.
The No. 1 comorbidity associated with vitiligo is autoimmune thyroid disease, such as Hashimoto disease or Graves disease. In some studies, up to 25% of patients who have vitiligo will also have autoimmune thyroid disease. There are other autoimmune comorbidities, which are much less common, such as type 1 diabetes and pernicious anemia, but those are the main ones that we associate [with vitiligo]. Vitiligo can itch for people, but it’s more commonly asymptomatic. There’s also some recent research that certain high-frequency sounds are harder for some patients with vitiligo to hear compared with the normal population, but that’s still ongoing research.
The cost of vitiligo comes in different ways. There’s an out-of-pocket burden for patients who are buying cosmetic products or different clothing to hide it. There’s also economic burden in terms of lost days of work if patients don’t feel comfortable. There’s also the economic burden of treatment. One of the most common treatments is phototherapy, and many patients don’t have access to a light booth or don’t have a home booth. But some of them can go into an office, usually 3 times per week. We usually say you need at least 70 treatments to tell if it’s working. If that patient has to travel to a light booth 3 times a week, they may be missing work or school, and there can be a burden in that direction as well. Plus, there’s the actual cost from the payers to the physician offices who are administering the phototherapy. There’s also cost in terms of our other treatments, our orals as well as topicals, but those tend to be not quite as high.
Some patients will be impacted in terms of their mental health and its effect on their quality of life. It usually isn’t a symptomatic disease for patients. The impact on them is how they view their vitiligo and the impact on their well-being. Some patients won’t go out because of their vitiligo spots. They don’t want others to see them. That can be a burden. And if they can’t go out, they can’t interact with others. Some have more depression or anxiety specifically because of their vitiligo, or their vitiligo can exacerbate existing anxiety and depression. That can also be an economic burden, and it can really affect those patients.
Transcript edited for clarity.