Assessment and management of patients with vitiligo and psychological distress: clinician survey

Abstract Vitiligo is a common, pigmentary skin disorder, affecting 1% of people worldwide. People with vitiligo have a significantly higher prevalence of psychosocial comorbidities, including anxiety, depression and suicidal ideations, than nonaffected individuals (Ezzedine K, Eleftheriadou V, Jones H et al. Psychosocial effects of vitiligo: a systematic literature review. Am J Clin Dermatol 2021; 22:757–74). The British Association of Dermatologists’ (BAD) 2022 vitiligo guidelines recommend the assessment of psychosocial impact in all patients with vitiligo, with management tailored to severity (Eleftheriadou V, Atkar R, Batchelor J et al. BAD guidelines for the management of people with vitiligo 2021. Br J Dermatol 2022; 186:18–29). We conducted a UK-wide consultation exercise aimed at establishing the current assessment and management practices of patients with vitiligo who experience psychological distress due to their skin. This project was supported by the UK Dermatology Clinical Trials Network and was also distributed to BAD members. Seventy-eight responders completed the online questionnaire (83% doctors, 14% nurses and 3% psychologists). On average, responders reviewed eight patients with vitiligo in the clinic during the preceding 6 months; 37% of these patients were estimated to have moderate/severe psychological distress. Sixty-seven per cent reported routine screening for psychological impact using mainly the Dermatology Life Quality Index (56%) and Patient Health Questionnaire-9 (16%). Forty-eight per cent used no formal screening tool but asked general questions. Thirty-three per cent do not routinely screen for psychological impact. For the management of mild psychological distress, 83% of responders signpost to online resources or advise self-referral to local services; 16% wrote to the general practitioner only. For the management of moderate-to-severe psychological distress, 28% referred patients to psychiatric services, 29% to psychological services and 37% to community services. Four per cent stated they would not take any action. Interestingly, 18% were not aware of any available local, regional or national psychological services. Waiting times for urgent psychological input ranged from 2 months to 2 years. Eighty-seven per cent of responders felt that their patients with vitiligo would benefit from a tailor-made online psychological intervention targeting specific aspects of the condition and that patients with vitiligo would engage with it (80%). Digital accessibility was highlighted as the main concern by remaining responders. Sixty per cent of responders expressed interest in participating in a trial examining the effectiveness of an online-delivered psychological intervention for patients with vitiligo and moderate/severe psychological distress. In summary, significant variation exists in the assessment and management of patients with vitiligo and psychological distress. Our survey suggests an unmet need for such an online intervention and a need for educational resources to give to clinicians regarding pathways to mental health services.