Managing Both Physical, Mental Health Key for QOL in Vitiligo

Patients with non-segmental vitiligo (NSV) often experience a significant negative impact on their quality of life (QOL), but a new report suggests treatment can quickly lead to improvement. The study was published in the International Journal of Dermatology.1 

From a clinical standpoint, vitiligo is marked by the progressive destruction of melanocytes leading to patches of depigmented skin, the authors noted. Yet, the disease also brings with it a significant psychosocial burden. Those psychosocial impacts of vitiligo remain under-recognized, they added.

Four weeks of therapy with ruxolitinib led to a significant benefit on numerous assessments. | Image Credit: Peakstock - stock.adobe.com

In the new study, the investigators aimed to determine how NSV affects patients’ quality of life and whether treatment for vitiligo might reverse those impacts. In particular, they focused on topical ruxolitinib (Opzelura; Incyte). Ruxolitinib—a Janus kinase 1/2 inhibitor—was of particular interest because study data suggest it can have promising benefits for patients. In clinical trials, the therapy led to significant improvement in both Facial Vitiligo Area Scoring Index (F-VASI) and Total Vitiligo Area Scoring Index (T-VASI) scores.2 However, the data also suggest the therapy is more effective in controlling the disease on the face, and somewhat less effective on other parts of the body.

To see whether those improvements in pigmentation might also affect QOL, Coronella and colleagues enrolled 158 Italian patients with NSV.1 The patients were all at least 12 years old upon enrollment. They were assessed for QOL, disease severity, and emotional wellbeing at baseline. Ninety-one patients were reassessed following 4 weeks of twice-daily treatment with ruxolitinib.

At baseline, the patients had a high mean score of 22.4 (SD, ± 7.2) on the Dermatology Life Quality Index (DLQI). On the Hospital Anxiety and Depression Scale (HADS), patients had mean anxiety scores of 15.3 (± 4.9) and mean depression scores of 16.8 (± 4.2). Patient Global Impression of Severity (PGI-S) mean scores were 2.8 (± 0.5), and Vitiligo Impact Treatment Scores (VITs) were 37.3 (± 12.5). The VITs is a measure of patients’ perceptions and satisfaction with treatment, Coronella and colleagues said.

“These results collectively indicate that vitiligo significantly interferes with patients’ psychological and emotional well-being, as well as with their daily functioning,” the authors noted.

However, 4 weeks of therapy with ruxolitinib led to a significant benefit on numerous assessments. DLQI scores dropped to 10.1 (± 8.7); PGI-S fell to 1.5 (± 0.7), and the HADS scores fell to 7.3 (± 6.2) for anxiety and 8.1 (± 6.8) for depression, the authors said. VITs score decreased to 21.5 (± 16.6).

“All these improvements were statistically significant (P < .05), underscoring the positive psychological impact of ruxolitinib cream even after a relatively short period,” the investigators noted.

Coronella and colleagues said those improvements were particularly notable because they did not match the trend for clinical improvement. F-VASI and T-VASI scores improved in their study cohort, but only by minimal, non-significant amounts. The F-VASI went from 7.5 (± 2) to 7.1 (± 1.9), and the T-VASI fell from 23.2 (± 5.6) to 22.3 (± 5.4) at 4 weeks (P > .05).

“These findings imply that although visible repigmentation might not be substantial after just 4 weeks, patients still perceive considerable improvement in their overall well-being,” they said.

They added that this might represent the “expectation effect,” in which patient optimism and belief in their new therapy leads to enhanced perceptions of outcomes and enhanced emotional benefits. The investigators also said their findings showed important differences between newly diagnosed patients and those who had been diagnosed at least a year prior. Newly diagnosed patients tended to have higher DLQI scores, indicating a higher social and emotional burden in the months after diagnosis. Yet, those same recently diagnosed patients tended to have lower VITs scores, suggesting they were more motivated to adhere to their therapy, they said.

"In summary, this study demonstrates that NSV significantly impairs QoL, particularly in the early stages, and that ruxolitinib cream can offer meaningful psychological benefits within just 4 weeks of use, even before visible skin improvement occurs," the authors concluded. "This emphasizes the importance of a holistic treatment approach that prioritizes not just physical symptoms but also mental health and emotional resilience in managing vitiligo.

References

1. Picone V, Coronella L, Turco M, et al. The impact of vitiligo on patients' quality of life: retrospective observational study. Int J Dermatol. Published online July 31, 2025. doi:10.1111/ijd.17998

2. Tavoletti G, Avallone G, Conforti C, et al. Topical ruxolitinib: A new treatment for vitiligo. J EurAcad Dermatol Venereol. 2023;37(11):2222-2230. doi:10.1111/jdv.19162