Quality of life in children and adolescents with vitiligo
Authors: Morales-Sánchez Martha Alejandra , Díaz-Ortega Ana Karla , Peralta-Pedrero María Luisa 
Published: January 2023

Abstract
The assessment of the quality of life (QoL) in vitiligo patients is essential to quantify the psychological burden of the disease. The effect of vitiligo on the QoL has been reported extensively in adults; however, there is a lack of information in Mexican children. To assess the QoL in children and adolescents with vitiligo and their association with affected body surface area (BSA) and age. A cross-sectional study was conducted in vitiligo patients aged between 5 and 17 years. The study was approved by our institutional review board and informed consent was obtained from all participants and their parents. Participants with psychiatric and neurological disease were excluded. Vitiligo was clinically diagnosed by an experienced dermatologist, and the following variables were registered: sex, age, origin, education, treatment, time and response to treatment, age of onset, clinical type, affected body areas and skin phototype. All participants were requested to complete the CDLQI questionnaire, those aged from 5 to 10 years filled the cartoon format and those from 11 to 17 years filled the text version. The measure of the disease extent was done using the Vitiligo Extent Score (VES). A total of 223 participants were recruited, 102 males (46·2%) and 120 females (53·8%) with a mean age of 9·86 (SD 3·02) years. The mean age of onset of vitiligo was before the first decade of life, of 7·12 (SD 3·66) years. The most frequent type of vitiligo was nonsegmental 53·8% (n = 120), followed by segmental 46·2% (n = 103). The most affected area was head 63·7% (n = 142), followed by trunk 56·1% (n = 125). The median of body surface affected area was 0·7797 with a minimum of 0·0060 and a maximum of 22·285, of these 84·3% (n = 188) had lesions that covered &lt;1% of the BSA and 15·7% (n = 35) &gt;1% BSA. Phototype III was the most frequent in half of the population, followed by phototype IV. The mean duration of the treatment was 11·32 (SD 18) months; 62·3% (n = 139) of them showed good response to treatment. The mean value of the CDLQI questionnaire was 4·95 (SD 4·57) points, with a minimum of 0 and a maximum of 30 points. The participants were classified according to CDLQI results in the following groups: 22·9% (n = 51) showed no effect of vitiligo in their QoL, 50·7% (n = 113) had a small effect, 19·3% (n = 43) a moderate effect, 4·9% (n = 11) a very large effect and only 2·2% (n = 5) an extremely large effect. A total CDLQI score between 0 and 9 was obtained from 85·2% (n = 190) of the participants and 14·8% (n = 33) had a score &gt;10 points. Differences between subgroups were found; children older than 10 years had a lower CDLQI score (mean of 4·13 points), and children under this age had a higher CDLQI score (mean of 5·54 points), and this difference was significant, P = 0·026. Regarding the affected BSA, patients with CDLQI in ranges between 0 and 9 points had a median VES index of 0·1905, while children with CDLQI &gt;10 points had a median VES index of 0·4781, P = 0·024. No significant differences were found when we analysed the rest of the variables in relation to quality-of-life results. The effect of vitiligo on the QoL in Mexican children and adolescents with vitiligo was similar to that of previous studies. We found a higher prevalence of patients with moderate effect on the QoL. The lower the age and the BSA affected, the greater the impact on the QoL.