Vitiligo: Is Psychological Support Necessary?

The vitiligo, characterized by the progressive 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 stigmatization 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 midst of social construction and whose self-image is of great importance. It's not uncommon for vitiligo patients to be the victims of misunderstandings and even inappropriate comments, fuelled by unfounded fear and hasty judgments. To improve the quality of life of those affected by this disease, whose worldwide prevalence is estimated at between 0.5% and 2%, it is essential to raise public awareness.

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

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 focused on 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, urbanization, 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, researchers found that people with vitiligo had nearly 3 times the risk of suffering from a psychological problem. According to the study, obsessive-compulsive disorders were particularly prevalent, 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 care can notably include individual appointments with a psychotherapist. The latter can provide 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 organizations 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 compassionate 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 appropriate 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 tranquility, while for others, it represents a significant burden.

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• 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).