Stigma in Vitiligo: associated factors and severity strata of the PUSH-D score.

Abstract

Vitiligo is the most common cause of skin depigmentation worldwide. Patients with vitiligo may experience stigma and this needs to be addressed. To evaluate stigma in patients with vitiligo, search for associated factors and establish severity strata for PUSH-D for patients with vitiligo. We conducted a cross-sectional study in ComPaRe vitiligo, an e-cohort of adult vitiligo patients. Stigmatization was assessed using the PUSH-D, a recently validated dermatology-specific stigmatization assessment tool. We conducted univariate and multivariable linear regression to identify patient and disease factors associated with the stigmatization. We used an anchor-based approach to define severity strata of the PUSH-D score. In total, 318 patients participated in this study. The mean age was 49.7 years and 73.9 % of the patients were women. Dark Skin phototype (IV-VI), severe face involvement (high SA-VES of the face) and depression (high PHQ-9 score) were positively associated with a higher score of stigmatization, although this association was weak (r=0.24, p value <0.001 and r=0.30, p value <0.001 respectively). Cut-off values of the PUSH-D that best discriminated patients with high and low stigma, as defined by the anchor question, were 13 and 23, (K=0.622, 95% IC [0.53; 0.71]). Our study is the first using a skin specific stigmatization tool to assess the stigma in patients with vitiligo. Creating strata helps to better interpret the PUSH-D in daily practice and may facilitate its use in clinical trials.