Author's Reply.

Sir,

We agree with authors that there are several cultural-specific issues affecting psychological health of vitiligo patients. Comparison with questionnaires such as Vitiligo Impact Scale-22 (VIS-22)[1] would have identified a better scale for Indian patients. However, VIS-22 was published in 2014 when we were done with the study. Among our 96 patients, 78 (81.2%) had fear, 44 (45.8%) had stubbornness, 48 (50%) patients had issues in memory power, 73 (76%) had stress, 24 (25%) showed restlessness, 36 (36.5%) patients changed in their religious activities, and 32 (33.3%) patients had suicidal tendency.

Our institute is focused on integrative medicine delivery for chronic dermatoses, especially by combining Ayurveda, Homeopathy, and Yoga with dermatology.[2] A literature search of complementary and alternative systems of medicine revealed that psychological issues are part of homeopathic case taking.[3] We agree with authors that VIS-22 is more suitable to India, albeit, their questions are familiar to doctors from complementary and alternative medicine systems. Both VIS and VIS-22 deals with tension, fear, and suicidal tendency but stubbornness, restlessness, and memory power are not included in the study. Such Indian culture-specific questionnaire may also be suitable for intense hyperpigmented conditions such as lichen planus pigmentosus. We are grateful to authors for their opinion. We believe their comment will support evidence for using Indian culture-specific questionnaire, especially in vitiligo.

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Conflicts of interest

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