الفهرس 
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Abstract
Vitiligo is the most common pigmentary disorder affecting skin melanocytes. Vitiligo greatly affects patients ‟quality of life and psychological status leading to prevalence of multiple disorders like anxiety and depression among them. Vitiligo can be a barrier in patients‟ life in all aspects such as education, social life, marriage and even seeking jobs. Moreover, vitiligo could represent a financial burden for patients due to the need for long treatment courses. The goal was to improve vitiligo patients’ quality of life and in turn improve their health status. The objectives were (1) to assess quality of life of vitiligo patients. (2) To estimate direct cost of illness of vitiligo and whether it represents a financial burden on patients. Patients and methods: The current study was a cross sectional and was carried out at the outpatient clinic of the vitiligo unit at the Dermatology and Venerology Department in Tanta University Hospitals in Tanta City from October 2021 to March 2022. The study included 66 vitiligo patients aged 16 and older who attended the vitiligo clinic during the period of the study. Patients were approached by non-probability convenient sampling technique. Data was collected via a predesigned questionnaire which consisted of four parts (1) Sociodemographic Data. (2) Disease profile of patients. (3) Quality of life measurement using the Vitiligo Life Quality Index (VLQI). (4) Direct cost of illness. Results: The study included 66 vitiligo patients aged from 16 -70 years old with a mean of 35.9 ± 15.3 years. About three quarters (74.2%) of patients were females. Eighty percent (80.3%) of patients lived in rural areas. More than half (53.5%) were highly educated and 27.3% of them had no or just primary education. About forty percent (43.9 %) of patients were housewives and 24.2 % were students. Sixty percent (60.6 %) of patients were married while 30.3 % were single. About half (53.0%) of them reported not having enough income and 42.4% reported having sufficient income. Most vitiligo patients included in the study were nonsmokers (94%). Also, none of them were engaged in the habit of drug abuse or alcohol consumption. About forty percent (42.4%) of participants had chronic disease, mainly hypertension (17.8%), thyroid disorders (10.7%), diabetes (7.1%) and chronic lung disease (7.1%). Only 1.5% and 3% had other associated autoimmune namely systemic lupus erythematosus and history of chronic skin disease(acne) respectively. More than one quarter had (27.3%) had family history of vitiligo while 7.6 % have a family history of other autoimmune disease namely systemic lupus erythematosus (40%), rheumatoid arthritis (20%), psoriasis (20%) and rheumatic fever (20%). The current study revealed that 80.3%, 16.7% and 3% of the participants had skin type IV, III and V respectively. Almost all participants (98.5%) suffered from non-segmental vitiligo and 68.2 % were in an active state of vitiligo while 31.8 % were in stable condition. The mean age of onset for vitiligo among participants was 30.3 ± 15.5 year. The mean vitiligo duration among participants was 5.6 ± 7.5 years. About three quarters of participants (72.7%) had vitiligo lesions involving both exposed and non-exposed parts of the body and 19.7 % had exposed lesions only. Vitiligo lesions commonly affected patients‟ hands (69.7%), face (62.1%), arms (59.1%), feet (48.5%) and legs (42.4%). On the other hands lesion affecting the scalp and genitalia were the least (12.1% and 7.6%) respectively. The commonly used treatments among vitiligo patients were topical therapy (84.8%), systemic therapy (71.2 %) and phototherapy (narrow band UVB (95.5 %). Out of the included vitiligo patients 50%, 55.3% and 76.2% were committed to regular topical, systemic and phototherapy, respectively. Moreover, 80.3% of patients reported regimentation of vitiligo lesions in response to treatment. Most participants (78.9 %) suffered from a degree of impairment to their quality of life ranging from slight to extreme effect. Patients suffering from moderate effect represented 21.2%, followed by very large and extreme effect which represented 19.7% each and eventually patients suffering slight effect represented 18.2%. Meanwhile only 21.2% of all patients reported no affection for their quality of life. Regarding the relationship between socio demographic characteristics and quality of life impairment categories, it was found that there were statistically significant associations between patients‟ residence, occupation and income and the degree of life quality impairment (P=0.02, 0.033 and 0.007 respectively). More than one third of patients (38.5 %) lived in urban areas suffered extreme affection of their quality of life compared to 15.1 % lived in rural areas. More than one quarter of unemployed patients (29.7%) suffered a very large effect compared to 15.4 % among employed participants. One quarter of patients with not enough income (25.7%) suffered extreme effect compared to 14.3% among those with just enough income. Regarding the relationship between disease characteristics and quality of life impairment categories, it was found that 22.2% of patients with active vitiligo had extreme affection to their quality of life compared to 14.3 % who had stable vitiligo. More than one third of patients with exposed lesions (38.5%) suffered extremely compared to 16.7% who had lesions in both exposed and non-exposed areas. About one third of patients with no regimentation (30.8%) suffered extremely compared to 17 % among those with repigmented lesions with no statistically significant association in between.