San Gallicano Dermatological Institute IRCCS, Rome, Italy.
Henry Ford Health System, Detroit, MI, USA.
J Eur Acad Dermatol Venereol. 2022 Sep;36(9):1507-1523. doi: 10.1111/jdv.18129. Epub 2022 May 11.
Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.
尽管历史上曾将其误诊为美容问题，但患有自身免疫性疾病白癜风的患者确实会承受相当大的生活质量（QoL）负担。本系统文献综述对同行评议的观察性和干预性研究进行了综述，描述了白癜风患者的人文负担的综合证据。通过 2021 年 2 月 10 日在 PubMed、EMBASE、Scopus 和 Cochrane 数据库中进行了检索，定性评估了白癜风患者的 QoL。两位独立审查员评估了纳入研究的文章，并提取数据进行定性综合分析。共纳入 130 项研究，发表于 1996 年至 2021 年期间。研究最多的地理区域是欧洲（32.3%）和中东（26.9%）。皮肤科专用工具，包括皮肤病生活质量指数（DLQI；80 项研究）及其针对儿童的变体（CDLQI；10 项研究）和针对家庭的变体（FDLQI；4 项研究），以及 Skindex 工具（Skindex-29，15 项研究；Skindex-16，4 项研究），最常用于衡量人文负担。使用较少的研究评估了白癜风专用工具，包括白癜风特定生活质量（VitiQoL；11 项研究）和 22 项白癜风影响量表（VIS-22；4 项研究）。在报告总体人群总评分的研究中，大多数研究显示白癜风对患者 QoL 有中度或更严重的影响（DLQI，35/54 项研究；Skindex，8/8 项研究；VitiQoL，6/6 项研究；VIS-22，3/3 项研究）。白癜风也对家庭和照顾者的生活质量产生了重大影响；4/4 项报告 FDLQI 评分的研究表明，对生活质量有中度或更严重的影响。一般来说，治疗（P<0.05）显著改善了 QoL，但治疗类型或持续时间没有趋势。在报告与 QoL 降低显著相关（P≤0.05）的因素的研究中，女性性别和可见病变和/或敏感部位的病变最为常见。总之，白癜风对患者的生活质量有明显的临床影响，这突显了应更加关注白癜风患者的生活质量下降意识和改善。
