Limits at infinity

stigmatized by their condition⁸³. The chronic nature of the disease, need for long term treatment and unpredictable course of disease are usually very demoralizing for people living with the disease⁸³. It is thus pertinent to recognize and deal with the psychological components of this disease and ultimately improve the QOL of affected patients.

In our environment, patients with vitiligo face various challenges which could impair their QOL. Some people think that it is an infectious disease such as leprosy and refuse to associate with people with the disorder. In a study by Olasode et al⁶², most of the patients living with vitiligo were embarrassed by their own lesions and also by the rude remarks made by friends and acquaintances about their skin lesions. People also refused sitting next to them, avoided shaking hands and eating around them. Relationships with fellow workers and casual acquaintances were significantly negatively affected but family and sexual relationships were preserved. The coping mechanisms employed by the patients included use of cosmetic camouflage, wearing clothing to cover the lesions and avoiding social functions.

In this study, the Dermatology Life Quality Index (DLQI) questionnaire was the instrument used to evaluate QOL. All the patients had impaired QOL in varying degrees while all the controls had no impairment in their QOL. The total mean DLQI score for the patients was 6.12 ± 2.90 and for the controls was 0.32 ± 0.47 which was statistically significant. In a study by Silverberg et al⁸⁴, the total mean DLQI score for patients with vitiligo was 5.9 ± 5.5 which is similar to the score obtained in this study. In another study by Wong et al⁸⁵the total mean

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DLQI score for the patients was 6.40 ± 5.17 which is also similar to the value obtained in this study. This suggests that Quality of Life should be assessed in patients with vitiligo and psychotherapy offered to them to achieve optimum treatment outcomes.

The mean scores obtained in each domain of the DLQI for the patients and controls revealed that the effect of vitiligo on the patients’ symptoms and feelings, daily activities and leisure was significant. However, there was no significant effect on work and schooling, personal relationships and treatment. This finding tends to portend that in our environment, patients with vitiligo are embarrassed by their lesions and would limit their social outings. However, the disorder did not affect their occupation, career pursuits and relationships. Most of the patients who had very large impairment in their QOL were between the ages of 18 to 40 years which is likely due to fact that they are younger and are more concerned about their appearance. The proportion of females (13.5%) who had very large impairment in their QOL (DLQI scores between 11 to 20) was more than their male counterparts (10%). This is also because females are more concerned about their appearance than males.

This study also found that the percentage of BSA affected had different effects on each domain of the patients DLQI. Patients with extensive disease (BSA affected > 20%) had impairment of their daily activities. However, other domains of the DLQI were not significantly affected by the extent of disease.

Silverberg et al⁸⁴ had contrasting results in his study. He found that extensive disease affected daily activities as well as symptoms and feelings, leisure and relationships.

For incentives, all the patients had visual acuity done at the eye clinic at no cost and those who had refractive errors were given the recommended glasses at a reduced cost. The patients who had hypoacusis were also offered hearing aids at a reduced cost.

LIMITATIONS

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(1) PUVAsol was used to treat the patients rather than PUVA due to the unavailability of a phototherapy unit in the study location and nearby environment.

(2) The treatment option was limited to PUVAsol because other treatment options such as Narrow Band Ultra-Violet B radiation and Topical Calcineurin Inhibitors were more expensive and not readily available.

(3) The slit-lamp used for the eye examination had no camera and photographs of the ocular abnormalities detected could not be taken

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CHAPTER EIGHT

CONCLUSIONS AND RECOMMENDATIONS 8.1 CONCLUSIONS

Vitiligo is a depigmentary cutaneous disorder in which the skin of the face, trunk, extremities and genitals could be affected. The face is the part of the body mostly affected and the forehead and cheek are the sites of the face where the lesions mostly occur. The lesions on the face, in comparison with the other parts of the body affected, are most bothersome to the patients because they are easily noticed by the patients, their family members and friends.

Patients with vitiligo could also have ocular and auditory disorders due to the loss of pigmentary cells in the eyes and ears. The ocular and auditory disorders could be asymptomatic as was the case in this study and routine screening of the eyes and ears are recommended in patients with vititligo for detection of the occurrence of these disorders or worsening of pre-existing disorder(s). The simulataneous loss of pigmentary cells at both the skin and extracutaneous sites is likely from a pathogenic process affecting these cells which have a common origin from the embryonic ectoderm.

Photochemotherapy of vitiligo with PUVAsol could lead to partial or complete repigmentation of depigmented lesions in affected patients and this modality of treatment should be applied for at least six months to achieve its effect.

Vitiligo reduces the Quality of Life (QOL) of affected persons. The study highlights that patients living with vitiligo who have impaired QOL could have low self esteem with impairment of their daily activities and leisure. It is thus pertinent to identify and manage the psychological challenges that vitiligo patients are faced with.