Measuring Quality of Life in Indian Vitiligo Patients.

Sir,

We read with interest the recently published article titled, “Dermatology life quality index does not reflect quality of life status of Indian vitiligo patients” by Narahari et al.[1] The authors found that in 54% of their patients, there was no effect or a small effect on quality of life as assessed by dermatology life quality index (DLQI). This did not match their impression of how troubled their patients, as well as Indian patients in general, are due to vitiligo. They concluded that DLQI was not a good measure of the psychosocial impact of vitiligo in Indian patients. This inference would have been more robust if a formal comparison had been made between DLQI and patients’ self-report of disease burden, as has been done by some workers.[23] Alternatively, another validated questionnaire could have been used for comparison.[4] However, their broad point that a disease-specific instrument may be better than a generic one in assessing the impairment in quality of life is generally accepted.[5] Vitiligo impact scale (VIS) and VIS-22 are vitiligo-specific quality of life instruments developed and validated for Indian patients.[36] We conducted a study that compared DLQI and VIS-22 in measuring the quality of life of Indian vitiligo patients and found that while DLQI scores correlated moderately well with the patient-perceived distress, VIS-22 scores showed a strong correlation.[3] These results suggest that though DLQI may be an acceptable alternative, a vitiligo-specific instrument may estimate the psychosocial burden of disease more accurately. Narahari et al.[1] mention certain issues that troubled their patients and stress the need for a culture-specific questionnaire that addresses these and similar concerns. In fact, many of these issues are covered in VIS-22, which was based on a qualitative study using semi-structured interviews of Indian vitiligo patients,[7] supplemented by suggestions from experienced dermatologists and relevant items from other quality of life instruments. The concerns mentioned by Narahari et al.[1] and the corresponding item numbers in VIS-22 include fear of various objects and situations (items 12, 18), suicidal tendency (items 9, 14), marriage prospects (item 20), teasing students in odd names in schools (item 22), and questioning by others (items 3, 8). It would be interesting to learn how useful they find VIS-22 in measuring quality of life in their vitiligo patients.

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