Vitiligo: Is psychological support necessary?

The vitiligo, characterised by the gradual disappearance of skin pigmentation, is often mistakenly perceived as a mere aesthetic concern. However, for those affected, it is a condition with a much broader impact. Its white patches, with clear edges and often visible on the face, hands or feet, inevitably draw attention, particularly in individuals with dark skin. In some cultures, the macules of vitiligo are sometimes associated with erroneous beliefs, such as a lack of hygiene or a contagious disease, like leprosy. This stigmatisation stems from a lack of understanding of the disease and contributes to a feeling of social exclusion among patients.

Even if vitiligo does not cause physical pain, it can profoundly alter self-esteem, particularly in younger people, who are in the process of building their social status and whose self-image is very important. It is not uncommon for vitiligo patients to be the victims of misunderstandings and even inappropriate comments, fuelled by unfounded fear and hasty judgements. To improve the quality of life of people affected by this disease, whose worldwide prevalence is estimated at between 0.5% and 2%, it is essential to raise awareness among the general public.

The stigmatisation experienced by patients suffering from vitiligo usually stems from the misunderstanding of their condition and can be a source of stress, anxiety, and depressive or social avoidance behaviours.

Associated with certain comorbidities, vitiligo also has a significant impact on the psychology of patients, due to the aesthetic discomfort it causes. Some studies have indeed shown that people affected by vitiligo generally have a poorer body image, a lower self-esteem and higher levels of social and psychological distress. A retrospective study conducted between 2000 and 2013 looked into this subject and the potential link between psychological disorders and vitiligo. It involved 1432 patients with vitiligo and 5728 controls.

After accounting for individuals' psychological disorders and adjusting for sex, age, comorbidity, urbanisation, and the level of care in the facility, the adjusted risk ratio for all psychiatric disorders in patients with vitiligo was 2.926. This means that, for the population studied, the researchers measured that people with vitiligo had nearly 3 times the risk of suffering from a mental health issue. According to the study, it is primarily obsessive-compulsive disorders that are affected, with an adjusted risk ratio of 10.790.

In light of these findings, it appears crucial to offer psychological support to patients suffering from vitiligo.

This support can notably be provided through individual appointments with a psychotherapist. The latter can offer professional support and stress management strategies to help individuals cope with the emotional aspects of vitiligo, better manage their thoughts and emotions related to the disease and develop effective coping strategies. Joining a patient association or a support group can also provide relief. These organisations offer patients the opportunity to feel less isolated and more understood by meeting others living with the same condition, allowing them to share their experiences and practical advice for living better with the disease. Furthermore, patient associations can also provide educational support and medical accompaniment.

Finally, the importance of receiving a sympathetic dermatological follow-up should not be overlooked. Educating patients, reassuring them, and encouraging them to express their concerns and needs are all valuable interventions that are often forgotten. Moreover, consulting a dermatologist provides individuals suffering from vitiligo the opportunity to receive suitable treatment, either topical or oral, which allows them to keep their symptoms under control.

The need for psychological support varies from one patient to another. Some people living with vitiligo handle their condition with tranquillity, while for others, it represents a significant burden.

• NAEYAERT J. M. & al. Psychosocial effects of vitiligo. Journal of the European Academy of Dermatology and Venereology (2005).

• MIYACHI Y. & al. Camouflage for patients with vitiligo vulgaris improved their quality of life. Journal of Cosmetic Dermatology (2010).

• BORRADORI L. & al. Dermatologie et infections sexuellement transmissibles. Elsevier Masson (2017).

• EZZEDINE K. & al. Vitiligo: A Review. Dermatology (2020).

• HUNG C. & al. Increased risk of psychiatric disorders in adult patients with vitiligo: A nationwide, population-based cohort study in Taiwan. The Journal of Dermatology (2020).