Dermatology Life Quality Index does not Reflect Quality of Life Status of Indian Vitiligo Patients.

Sir,

There are many tools to measure quality of life (QoL) changes in vitiligo patients. Dermatology-specific tools include Dermatology Life Quality Index (DLQI) and three others.[1] DLQI is frequently used to measure changes in QoL of vitiligo patients in darker skinned races.[2] Finlay and his department reviewed the international use of DLQI. We explored its usefulness in Indian vitiligo patients. Hundred and eighty-seven patients were recruited for the study during 2012–2014. Institutional Ethics Committee gave ethical approval and informed consent taken from all patients. Ninety-six patients were allocated based on random numbers for DLQI based QoL assessment. A power point slides presentation was prepared to assist counseling of these patients. Counseling framework included details about the disease/associated diseases, treatment options available in biomedicine and other Indian systems of medicine, diet/investigations and the importance of medication adherence, and prognostic factors of the disease. No promise is made on nonrecurrence when re-pigmented. Nurse administered the DLQI before doctor's consultation. Three languages were used such as Malayalam, Kannada, and English.

Raw data from DLQI score sheets are tabulated on excel sheet. SPSS 16 (SPSS Inc., Chicago, IL) was used for analyses. Analysis of variance test was used for comparing the effect of gender, age, religion, education, and duration of the disease. Correlation analysis was done for body area involvement and psychological issues. DLQI scores revealed that in 5.2% of patients vitiligo had no effect at all on patient's life, 49% of patients had small effect on QoL, moderate effect on patient's life (29.2%), very large effect on patient's life (16.7%), and extremely large effect (0%). There was no significant effect of disease based on DLQI scoring. There was no influence of gender, age, education, religion, body area involvement, psychological factors (as narrated in DLQI), and other parameters [Table 1]. However, self-esteem, body image, stigma, and anxiety influenced health-related QoL in many other studies.[1]

Table 1

Mean DLQI scores of patient characteristics

Our patients had other complaints: Restlessness, fears of various objects and situations, suicidal tendency, etc. Other worries of patients included marriage prospects, teasing students in odd names in schools, questioning by others, etc.

However, DLQI showed small or no effect on QoL of 54% of patients. Indian dermatologists notice that patients are dreaded by the disease. There were multiple disease-specific QoL scales, Vitiligo Impact Scale (VIS),[3] VIS-22,[4] and vitiligo-specific QoL instrument.[5] VIS and VIS-22 developed in India, but its reproducibility on culture specific psychosocial changes in Indian population is unknown. VitiQoL is found reliable in the USA and Brazilian patients, but no studies were done in Indian patients. We need a culture-specific questionnaire reflecting Indian situations.

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Conflicts of interest

There are no conflicts of interest.