Patient-Reported Outcomes in Vitiligo: DLQI, Vitiligo-Specific Scales, and What Counts as Clinically Meaningful

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Key Takeaways

  • Why PROMs? Pigment changes affect visibility, stigma, and function. PROMs help prioritize sites (e.g., face/hands) and set goals beyond % repigmentation.
  • Core tools: generic dermatology (DLQI, Skindex) + vitiligo-specific (VitiQoL, VitiPRO) ± FACE-Q for facial domains.
  • Clinically meaningful change: use MCID thresholds to judge benefit and to decide on escalation/maintenance.
  • Pair with objective scores: track PROMs alongside F-/T-VASI and standardized photography.

PROMs Used in Vitiligo

  • DLQI (Dermatology Life Quality Index): 10 items; broad impact on daily life/work; fast to administer.
  • Skindex (16/29): symptoms, emotions, functioning—useful when psychosocial burden is prominent.
  • VitiQoL: vitiligo-specific domains (stigma, coping, functioning); sensitive to facial and hand involvement.
  • VitiPRO / Vitiligo Impact Patient scale: brief disease-specific screening; good for busy clinics.
  • FACE-Q (selected modules): appearance-related QoL for facial vitiligo where cosmetic visibility is key.

Minimal Clinically Important Difference (MCID)

MCID contextualizes score changes that patients actually notice. Use published anchors when available; otherwise adopt pragmatic thresholds and keep them consistent across the clinic.

Table 1. Pragmatic MCID anchors (to adapt per local validation).
Instrument Scale Pragmatic MCID (example) Notes
DLQI 0–30 (↓ is better) ≥4-point decrease Suggests meaningful QoL gain
Skindex-16 total 0–100 (↓ better) ≥10-point decrease Domain-specific MCIDs vary
VitiQoL 0–90 (↓ better) ≥6–10-point decrease Adjust to local validation data
VitiPRO Tool-specific Improvement category shift Use categorical anchors

Clinic Workflow: Baseline → Follow-up

  1. Baseline: DLQI + VitiQoL; standardized photos; Wood’s lamp; record F-/T-VASI.
  2. Interim (8–12 weeks): short PROM (VitiPRO) + targeted domains; check early response on excimer/NB-UVB pathways.
  3. Milestone (24–36 weeks): repeat DLQI + VitiQoL; compare against MCID and VASI change to judge success.
  4. Maintenance: yearly PROMs or when relapse suspected.

Linking PROMs to Treatment Decisions

Table 2. PROM-driven decision support.
Scenario PROM signal Action
Facial vitiligo, social impact high DLQI ≥ 6 or VitiQoL high Prioritize face; consider tacrolimus + NB-UVB or label-eligible topical JAK
Acral disease with functional burden Persistent high PROM scores Escalate to excimer + steroid pulses; protect from friction
Good VASI but poor QoL PROMs above MCID threshold Address visibility concerns (cosmetics/camouflage), counseling, adjust goals
Stable repigmentation PROMs improved ≥MCID Begin maintenance; taper NB-UVB; proactive tacrolimus

Tables & Forms (framework)

  • Downloadable 1-page DLQI + VitiQoL sheet for clinic intake.
  • Auto-calc MCID tracker to flag responders vs non-responders.
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