Real-World Experience of Vitiligo Patients: A Retrospective Chart Review

Abstract

Background:

Vitiligo is a common depigmenting skin disorder with an estimated prevalence of 0.5% to 2% worldwide.

Objective:

We conducted a study to characterize the presentation of vitiligo in community dermatology clinic setting in Ontario, Canada.

Methods:

A retrospective cross-sectional study was performed through an electronic chart review at a community dermatology clinic with 2 sites in Ontario, Canada.

Results:

We found a male to female ratio of 1:1.3. The average age at the time of assessment was 40.8 years (ranging from 7 to 75 years). Sixteen percent of the patients were children (less than 18 years of age). Hands were the most common location for vitiligo (55.8%).

Conclusions:

Our findings are in keeping with previously described epidemiologic data. To our knowledge, this is the first Canadian study looking at the population in a community setting.

Background

Vitiligo is a common depigmenting skin disorder with an estimated prevalence of 0.5% to 2% worldwide. ¹ In 2012 the clinical classification of vitiligo was revised by the Vitiligo Issues Consensus Conferences and divided in: non-segmental vitiligo (NSV), segmental vitiligo, and undetermined/unclassified. ² Vitiligo has been associated with different autoimmune conditions including thyroid disease, alopecia areata, diabetes mellitus, Addison disease, systemic lupus erythematosus, inflammatory bowel disease, among others. ³ We conducted a study to characterize the presentation of vitiligo in community dermatology clinic setting in Ontario, Canada.

Methods

A retrospective cross-sectional study was performed through an electronic chart review at a community dermatology clinic with 2 sites in Ontario, Canada. We used the electronic medical records [EMR] (Accuro EMR, QHR Technologies, Kelowna, BC, Canada) to locate patients with the diagnosis of vitiligo by using the term: “vitiligo, from January 2008 to April 2022,” and also searched our phototherapy records to make sure that no patients were missed during the EMR search. We then reviewed each case to determine sex, age, diagnosis, location, and previous treatments.

Results

We identified a total of 43 patients comprised of 19 males (44%) and 24 females (56%) with a male to female ratio of 1:1.3. The average age was 40.8 years (ranging from 7 to 75 years). Sixteen percent of the patients were children (less than 18 years of age).

The location of lesions was common on the hands (55.8%), head and neck (51%), abdomen (34.9%), legs (37.2%), arms (32.6%), feet (27.9%), back (18.6%), and inguinal/axillae (13.9%/11.6%) (Supplementary Figure S1). Concurrent conditions most frequently found were: thyroid disease (14%), hypertension (16.3%), irritable bowel syndrome (11.6%), arthritis (11.6%), anemia (4.6%), and alopecia (4.6%) (Supplementary Table S1).

Most patients had used some sort of topical therapy prior to being referred to dermatology with tacrolimus being the most commonly used by the referring doctor (15%). Among those who received phototherapy (narrow band ultraviolet B [UVB]), the average number of sessions was 400 sessions (average of 1.5 sessions per week). The description of treatments used at the dermatology clinic is presented in Supplementary Table S2.

Discussion

Vitiligo is characterized by the depletion of melanocytes resulting in the characteristic skin lesions, with chalky-white macules and patches with clear borders. ⁴ Although a worldwide estimated prevalence has been established, there seem to be large geographic differences. ⁵ Our results are in keeping with the reported observation that males and females are equally affected. NSV develops at all ages. In our study the average age was 40.8 years which represents the age at which they were seen in clinic and not necessarily the onset of the disease.

Inflammatory and autoimmune diseases have been found in association with vitiligo, such as thyroid disease, alopecia areata, rheumatoid arthritis, psoriasis, and atopic dermatitis.^3,6,7 A report from Sawicki et al ⁸ described the prevalence of autoimmune disease in a Canadian population at a tertiary centre, with thyroid disease (12%) and pernicious anaemia (1.3%) being the most common; which is similar to our results.

In regards to therapy, the majority of patients used some kind of topical therapy as presented in Supplementary Table S2. A previous meta-analysis concluded that phototherapy requires at least 1-year duration to achieve maximal treatment response. ⁹ Consistent with our population, patients on phototherapy had an average duration of 400 sessions.

The limitations of this study are several including: data from 1 dermatologic clinic with 2 locations; does not include many patients with vitiligo who may not seek medical treatment or a dermatologist assessment; no information on response to therapy, data collected for clinical purposes and not research, and the possibility of inaccurate/incomplete data.

Conclusions

The clinical presentation of vitiligo varies across different populations. Our findings are in keeping with previously described epidemiologic data. To our knowledge, this is the first Canadian study looking at the population in a community setting.

Supplemental Material

sj-docx-1-cms-10.1177_12034754231223699 – Supplemental material for Real-World Experience of Vitiligo Patients: A Retrospective Chart Review

Supplemental material, sj-docx-1-cms-10.1177_12034754231223699 for Real-World Experience of Vitiligo Patients: A Retrospective Chart Review by Fabian Rodriguez-Bolanos, Chelsea Obeng-Asumeng and Melinda Gooderham in Journal of Cutaneous Medicine and Surgery