Association between vitiligo extent and distribution and quality-of-life impairment

Objective: To determine whether the extent, distribution, and duration of vitiligo are associated with impairment of specific aspects of quality of life. Design: A prospective questionnaire-based study of 1541 adults with vitiligo. Setting: Online questionnaire. Main Outcome Measures: Affected body surface area (BSA), distribution and duration of vitiligo, associated symptoms, and quality of life using the Dermatology Life Quality Index (DLQI). Results: Vitiligo had a negative effect on numerous aspects and the total score of the DLQI (mean [SD], 5.9 [5.5]). The DLQI scores in vitiligo were associated with an affected BSA of more than 25% (ordinal logistic regression; adjusted odds ratio, 2.17 [95% CI, 1.71-2.75; P<.001]) and number of body parts affected with vitiligo (P≤.009) but not laterality (P=.06) or duration of disease (P≥.54). Itching and/or burning skin occurred in a sizable percentage of vitiligo patients (35.1%) and were predicted by an affected BSA of more than 25% (adjusted odds ratio, 1.59 [95% CI, 1.26-2.01; P<.001]). Sexual dysfunction occurred in 18% of patients and was predicted by an affected BSA of more than 25% (adjusted odds ratio, 1.94 [95% CI, 1.44-2.61; P<.001]) and vitiligo lesions in the genital area (1.82 [1.30-2.53; P<.001]). Conclusions: Vitiligo extent is associated with increased quality-of-life impairment, including itching and sexual dysfunction. Moreover, different distributions of vitiligo lesions are associated with impairment of different aspects of quality of life.