Mental Health and Psychosocial Burden Among Patients with Skin of Color Living with Vitiligo: Findings from the Global VALIANT Study

Factors associated with vitiligo burden in patients with darker skin (Fitzpatrick skin types IV–VI) are not fully understood. This analysis of patients in the global VALIANT study examined the quality of life (QoL) and psychosocial health among patients with vitiligo by skin type. Participants from 17 countries were surveyed regarding their clinical characteristics, everyday experiences with vitiligo, impact of vitiligo on daily activities, emotional well-being, and mental health. Of 3541 surveyed patients, 40.8% (n = 1445) had darker skin versus 59.2% (n = 2096) with fairer skin (types I–III). Patients with darker skin had greater median disease extent than those with fairer skin (6.6% vs 2.5%; P < 0.0001). Mean Vitiligo Impact Patient scale scores were higher among patients with darker skin (31.2 vs 24.5; P < 0.0001); daily activities and emotional well-being were significantly more impacted among patients with darker skin. Among individual skin types, patients with types V and VI expressed considerably higher rates of burden versus all other skin types in all assessments. Interestingly, among patients with fairer skin, those with skin type I reported higher rates of burden than those with skin types II and III. Patients with darker skin, particularly skin types V and VI, were more impacted in their daily lives, emotional well-being, and mental health than those with fairer skin, suggesting that a disproportionate need for strategies to improve QoL and mental health burden exists among patients with vitiligo who have skin of color. Vitiligo is a disease that causes white patches to appear on the skin. The study described here analyzed whether vitiligo is more difficult for people with darker skin. To answer this question, the authors used data from a large patient survey called the VALIANT study. Over 3000 people living with vitiligo from 17 countries responded to the survey, and close to half had darker skin. People with darker skin tended to report that larger areas of their body were covered in white patches, suggesting that people with fairer skin may underestimate the extent of their vitiligo. In addition, people with darker skin reported a worse effect on their daily life than those with fairer skin; were more likely to be discouraged and worried about their disease spreading; and were more likely to feel that their vitiligo affected what clothes they wore or what activities they participated in. People with darker skin reported more difficulty with their careers and were more likely to be anxious or depressed. Even among people with darker skin (three types), effects of vitiligo were worst among those with the darkest skin. These results show that vitiligo is a difficult disease for all people living with vitiligo, but the burden is most amplified among people with darker skin.