OTHER MEASURES
7. OTHER LEGISLATIVE MEASURES Electoral integrity
reason for this is not known but may have been because patients felt that they were in a specialist clinic where their lesions would be cured. This study result is similar to that reported in Holland where a study of 119 vitiligo patients revealed no relationship between disease duration and QOL in vitiligo patients.110 A study in Korea of QOL of one hundred and thirty three vitiligo patients came to a contrary conclusion.88 They found that long duration of disease and frequent visits to the clinic negatively impacts on QOL.88 They thought that it was the chronicity of the disease which led to the poor QOL.
5.8.7.12 Age at onset of vitiligo: There was no significant association between age at onset and QOL impairment. It did not matter at what age vitiligo started; rather what was important to these patients was that they had vitiligo. There was no study to compare the influence of age at onset of vitiligo on QOL with.
CHAPTER SIX
CONCLUSION, LIMITATIONS AND RECOMMENDATIONS CONCLUSION.
Vitiligo is more common in adults compared to children. The commonest age at presentation to the dermatology clinic is age 6-10 years in children and age 18-29 years in adults. Age at onset is
<10 years in children while adults have two peaks, third and after the fifth decades of life.
Presentation to the dermatology clinic is within 1-2 years of onset of vitiligo in most patients. A family history of vitiligo is uncommon in Ibadan. PUVASOL is the main modality of treatment in Ibadan and children were not treated with systemic steroids.
Koebnerization and leukotrichia were not a common phenomenon in the current study group of children and adult vitiligo patients. Re-pigmentation of lesions following treatment is better in children. The area of body surface involvement by vitiligo was mostly <9. The head/ scalp is the commonest area of onset of vitiligo. Acrofacial vitiligo is the commonest class of vitiligo in adults and segmental vitiligo the commonest in children. Lesions appear in exposed body parts in
>80% of patients. Use of self-medication was low in these vitiligo patients.
There are some significant differences in clinical characteristics between adult and childhood vitiligo. Gender difference exists between adult and childhood vitiligo with children having a female preponderance and adults having a male preponderance. Re-pigmentation following treatment is better in childhood vitiligo. Segmental vitiligo is more of a feature of childhood vitiligo. Only children had the vulva as the area of onset of vitiligo.
Vitiligo significantly impairs QOL and this QOL impairment is irrespective of whether patients are newly diagnosed or not. Level of QOL impairment was mostly mild to moderate. All items on the DQLI were affected by vitiligo with differences in level of impairment between newly diagnosed and old patients. Embarrassment or self consciousness, choice of clothing, social interactions and problems with work were the main items that impaired QOL. Sexual relationship and friendship did not affect QOL significantly.
Marital status, age at presentation, severity of lesions, visibility of lesions, and history of spread of lesion were also significantly associated with QOL impairment. Significant association was not found between gender, level of education, history of re-pigmentation, class of vitiligo, age at onset, duration of disease, number of visits to clinic and QOL impairment.
LIMITATIONS TO THE STUDY.
1. Difficulty with retrieval of case notes.
2. Incomplete information from case notes.
3. Inability to clarify some information from patients because it was a retrospective study.
4. Frequent loss of patients to follow up clinic visits.
RECOMMENDATIONS.
1. Childhood vitiligo has some pecularities (segmental classification, re-pigmentation with treatment, female gender preponderance, the vulva as area of onset) which should be looked out for.
2. Quality of life assessment should be part of the examination of vitiligo patients at first presentation and during the course of treatment.
3. Multidisciplinary approach to vitiligo management to include clinical psychologists for patients with impaired QOL.
4. Health talk on radios, television and news print to enlighten the populace about vitiligo and reduce the stigmatization of patients.
5. Formation, recognition and encouragement of local non-governmental organizations like VITSAF (Vitiligo Support and Awareness Foundation) who organize meetings between people who have vitiligo.
6. Organization of regular meetings between doctors, pharmacists and vitiligo patients to help source for drugs and answer their specific questions.
7. Government funded research into re-pigmentation modalities of vitiligo in teaching hospitals.
8. Establishing a liaison with international foundations for vitiligo like the National Vitiligo Foundation Inc (NVFI) and the National Organization for Albinism and
Hypopigmentation (NOAH) and local vitiligo association.
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