Patient-Reported Outcomes in Vitiligo: QoL Scales, Minimal Important Change, and Clinic Integration

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Key Takeaways

  • Why measure QoL? VASI captures extent, but not impact (stigma, avoidance, mood). PROMs close that gap.
  • Core tools: dermatology-generic DLQI plus a vitiligo-specific instrument for sensitivity (face/hands, social situations).
  • Actionable thresholds: use minimal important change (MIC) to judge whether a score shift is clinically meaningful.
  • Workflow: 2-minute intake on phone/tablet → auto-chart → flags for counseling, therapy escalation, or treatment change.

Why PROMs Matter in Vitiligo

Two patients with the same VASI can have radically different lives. PROMs surface visibility burden (face/hands), social withdrawal, and mood symptoms, guiding truly personalized care (e.g., prioritizing excimer for periorificial patches or counseling referrals).

Scales at a Glance (DLQI + Vitiligo-Specific)

Table 1. PROM options for vitiligo.
Instrument What it measures Strengths Limitations When to use
DLQI (10 items) Dermatology QoL (symptoms/feelings, daily activities, work/school, personal relationships) Widely validated; quick; cross-disease benchmarking Not pigment-specific; ceiling/floor effects possible Baseline + every 8–12 weeks
Vitiligo-specific PROM (e.g., visibility/stigma subscales) Appearance concerns, camouflage burden, social avoidance, site-specific distress Higher sensitivity to face/hands and seasonal changes Less standardized across clinics Baseline, before/after NB-UVB cycles, pre-/post-surgery
Screeners (PHQ-2/PHQ-9, GAD-2/GAD-7) Depression/anxiety symptoms Brief; referral triggers Not disease-specific When PROM flags mood impact

Minimal Important Change (MIC)

  • DLQI: a reduction of ~4 points (or a category drop, e.g., “very large” → “moderate” effect) is often considered a meaningful improvement.
  • Vitiligo-specific PROMs: use instrument guidance (e.g., 0.5 SD rule) or anchor to patient global rating (“a little better” or more).
  • Decision-making: if VASI improves but PROM unchanged/worse, re-focus targets (high-visibility sites, camouflage, counseling).

Clinic Workflow: 2-Minute PROMs

  1. Intake: patient completes DLQI + 4–6 vitiligo-specific items on phone/tablet while checking in (auto-score).
  2. Flagging: thresholds trigger banners: DLQI≥11 (very large effect), any severe item, or high anxiety/depression screener.
  3. Plan: align therapy with impact (e.g., intensify face/hand regimen, add excimer, offer camouflage tips, or mental health referral).
  4. Follow-up: repeat every 8–12 weeks or at major milestones (post-NB-UVB cycle, post-op, season change).

Integrating PROMs with VASI

  • Dual endpoints: track F-/T-VASI alongside DLQI and vitiligo-specific scores to present a balanced progress chart.
  • Goal setting: “Reach F-VASI50 and reduce DLQI by ≥4 within 12–24 weeks,” then move to maintenance (see Relapse & Maintenance).
  • Shared decisions: PROMs guide whether to prioritize combination therapy, surgery, or camouflage/psychosocial support.

Quick Tables

Table 2. DLQI categories for quick interpretation.
DLQI score Impact Clinic action
0–1 No effect Routine care
2–5 Small Address site priorities
6–10 Moderate Optimize therapy; consider excimer focus
11–20 Very large Escalate care; offer psychosocial support
21–30 Extremely large Urgent impact mitigation; consider rapid-access plan
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