Cessation of spread as a treatment objective in vitiligo: perception from the patients' point of view

DEAR EDITOR, Vitiligo is an acquired condition resulting from the progressive loss of melanocytes. It is known that the unpredictable nature of vitiligo and its tendency to progress can be psychologically overwhelming. In our previous clinical observational trials and during clinical practice we noticed frequently that disease stability is relevant for many patients. Therefore, we wanted to evaluate the perception of disease impact, the general treatment motivation and the treatment motivation if disease stabilization would be the outcome. The second aim was to evaluate whether clinical variables might influence the impact of the disease and motivation for treatment. This was a monocentre observational trial conducted at the Department of Dermatology of Ghent University Hospital. Between August 2009 and March 2015, we recruited in a consecutive manner 864 patients with nonsegmental vitiligo. The study was approved by the local ethics committee. Data were taken by history using a standardized questionnaire. Special attention was given to the questions with respect to the general treatment motivation (motivation A) and motivation for treatment if this could induce cessation of spread/ disease stability (motivation B). Patients were asked to score for both questions their motivation on a scale from 0 to 10. Statistical analyses were performed using SPSS 22.0 (IBM, Armonk, NY, U.S.A.). All values are expressed as median (interquartile range, IQR). For all tests, P-values of less than 0 05 were considered to indicate statistical significance. Adjustment for possible confounding factors was performed using a multivariate regression model. In total, 864 patients with nonsegmental vitiligo were enrolled in this study, including 400 men and 464 women (Table 1). The general motivation score for treatment (motivation A) was collected for 814 patients. Motivation to treat if stabilization could be achieved (motivation B) was available for 365 patients. The impact score was measured in 849 patients with vitiligo. The majority of included patients under treatment (68 4%) were using topical treatments (82 2%), followed by ultraviolet B (UVB) treatment (17 8%). A high number (87 6%) of patients with vitiligo reported a strong general motivation (motivation A) for treatment (score ≥ 7) (Fig. 1a). Only 3 5% mentioned a poor motivation (score < 4). Patients receiving UVB treatment and having dark skin phototypes displayed a significantly higher motivation for treatment (P = 0 019 and P = 0 008, respectively). The general motivation to treat was the highest during the first 2 years of the disease (P = 0 001). There was a drop in general treatment motivation in the age group of 11– 20 years (P = 0 036). The motivation to treat decreased slightly if disease stabilization was proposed as the treatment goal (motivation B). Still, 84 1% of patients mentioned a motivation score ≥ 7 if stable disease could be attained. Only 5 7% of patients seemed not to be willing to treat in this setting (motivation score < 4). The motivation for treatment to achieve disease stabilization was also the highest in the first 2 years of the disease (P = 0 013) and remained stable afterwards. There was a negative correlation between a higher body surface area (BSA) and motivation to treat if stabilization would be the outcome (P < 0 001) (Fig. 1b). In patients with a BSA of more than 10%, cessation of disease progression was a less important motivation for treatment (mean motivation B score BSA < 10% vs. BSA > 10%: 8 49 vs. 7 22; P = 0 001). There was a wide difference in reported impact scores of the patients (Fig. 1c–h). An impact score from 0 to 3 was found in 30 6% of patients, a score of 4–7 in 40 0% of patients and a score from 8 to 10 in 29 4% of patients. As