Vitiligo is a common acquired, idiopathic and often familiar depigmentation disorder that affects both sexes equally worldwide. Although not painful or life-threatening, this disfiguring disorder can have a devastating effect on a patient’s psychosocial wellbeing and social life

1. DLQI SCORE IN VITILIGO PATIENTS
IN RE-MEDIKA HOSPITAL
Cross-sectional study
M.Sc. Natasa Teovska Mitrevska MD

2. Macedonia –REMEDIKA general hospital
Department of dermatology

3. Vitiligo
Vitiligo is a common acquired, idiopathic and often
familiar depigmentation disorder that affects both
sexes equally worldwide.
Although not painful or life-threatening, this
disfiguring disorder can have a devastating effect
on a patient‟s psychosocial wellbeing and social
life

4. Patients often experience stigmatization, including
curiosity, by other people, rejection and discrimination
at work, low self-esteem, embarrassment, impaired
quality of life and a higher prevalence of sexual
difficulties, especially in women .
Stigmatization is the most influential factor in the
variance of Dermatology Life Quality Index (DLQI)
measurements.

5. Doctor/patients relationship
Additionally, many healthcare professionals still
regard vitiligo as a harmless cosmetic skin
problem, truly underestimating the importance of
treating these patients.
The emotional aspect of diseases vitiligo is gravely
underestimated because clinicians fail to include
the psychological and sociological components
that are so closely tied to this disease

6. Quality of life-QL
Definition
Quality of Life as individuals perception of their
position in life in the context of the culture and
value systems in which they live and in relation to
their goals, expectations, standards and concerns.
It is a broad ranging concept affected in a complex
way by the person's physical health, psychological
state, level of independence, social relationships,
personal beliefs and their relationship to salient
features of their environment.

7. Quality of life at dermatology
patients
• Dermatology-specific Quality of Life instruments
• Skindex
• DLQI
• Dermatology Quality of Life Scales
• Chronic Skin Disease on Daily Life).

8. DLQI Dermatology Life
Quality Index
DLQI Dermatology Life Quality Index
• First
• The most used questionnaire
• Simple questionnaire self administrated who used
to measure the health-related quality of life of
adult patients suffering from a skin disease.

9. DLQI
(Dermatology Life Quality Index)
• It is a simple 10-question validated questionnaire
which has been used in 33 different skin
conditions in 32 countries and is available in 55
languages.
• Its use has been described in over 500
publications including 30 multinational studies.

10. DLQi scores for vitiligo patients
-review the literature worldwide
-Porter et al. studied the effect of vitiligo on sexual
relationships and found that embarrassment during
sexual relationships was especially frequent for men
with vitiligo
-Salzer and Schallreuter reported that 75% found their
disfigurement moderately or severely intolerable
-Weiss et al compared the difficulties faced by patients
with vitiligo with those with leprosy in India
-Al-Abadie et al. indicated that psychological stress
increases levels of neuroendocrine hormones, affects
the immune system and alters the level of
neuropeptides, which may be the initial steps in
pathogenesis of vitiligo

11. DLQi scores for vitiligo patients
-review the literature worldwide
Sampogna, Patients older than 40 years old, have lower
QoL. Patients with vitiligo reported a higher prevalence
of both alexithymia (a state of deficiency in
understanding, processing, or describing emotions) and
depression or anxiety than the general population.
In white populations, the prevalence's of depression and
alexithymia are both estimated as approximately 10%,
while in this study the prevalence was 39%, and of
patients with alexithymia 24%

12. DLQi scores for vitiligo patients
-review the literature worldwide
Papadopoulos et All.have shown that psychological
counseling not only helps to improve body image,
self-esteem and quality of life of patients with
vitiligo, but also provides better control of disease.
Ongenae K, Quality of life in female patients has
shown to be more impaired than men and was
equal to the impairment caused by psoriasis.

13. Motivation

14. Motivation
• Knowledge: What is the knowledge of health
information regarding his/her dermatology
illness.
• Attitude: What is the attitude of the patient
regarding his dermatology condition?
• Behaviors: What exactly the patient is doing
regarding his dermatology condition?
• Group behaviors: What is the group behavior
in accepting of patient with dermatology
illness?
• Behavior of health system: What the health
system is doing to change to change this

15. Aim of the study
• To determine score od DLQI in patients with
vitiligo in ReMedika general hospital, Skopje,
R.Macedonia.
• To determine the dominate factors that affects on
quality of life
• From the conclusion of this study to get the
information's in order to start with interventions for
improving and strength the quality of life in
patients with vitiligo

16. Materials and Methods
• Study design: prospective research-(cross
section) study for every new patient with vitiligo
attending the clinic. Using a standard “forward-
backward” translation procedure, the English
language version of the questionnaire was
translated into Macedonian.
• Place of study: Dermatology department,
ReMedika general hospital. Skopje, Macedonia

17. DLQI questionnaire
(Cardiff University's )
1. Questions about basic demographics characters
2. Symptoms and feelings (questions 1 and 2),
3. Daily activities (questions 3 and 4),
4. Leisure (questions 5 and 6),
5. Personal relationships (questions 8 and 9)
6. Work and school (question 7),
7. and treatment (question10) .

18. DLQI questionnaire
(Cardiff University's )
• The DLQI is calculated by summing the score of
each question resulting in a maximum of 30 and
a minimum of 0.
• The higher the score, the more quality of life is
impaired.
• The DLQI can also be expressed as a
percentage of the maximum possible score of 30.

19. Materials and Methods
There were no restrictions on patient selection with
regard to extension of lesions.
The patients were introduced to the subject of this
study and informed about the personal nature of
the questionnaire, and all those who gave consent
were given the DLQI questionnaire to complete.

20. Selection of patients
Criteria for participation
All the patients who are coming in dermatology
department
Criteria for elimination
Children, babies.
Patients with other dermatology condition.
Defined time
May-2011 to May 2012

21. Statistical analyses
Responses on the DLQI will be scored according to
the guidelines of Finlay and Khan.
All statistical analyses is carried out using the
Statistical Package for the Social Sciences (SPSS
11.0 for Windows).
To test the reliability, the internal consistency of the
questionnaire will be assessed by Cronbach's α
coefficient and α equal to or greater than 0.70 was
considered satisfactory.

22. Bias in Research Study
• Selection bias
-Only patients from Re-Medika hospital
dermatology department is involved in this study
• Bias from nonresponse -refusing from patients
• Reporting bias-lack of information regarding their
condition

23. Results

24. Results
From May –October 2011
• Age of patients
25 - 85 (middle age 53). Most of them (49, 49%)
were 45-65 years old.
Place of living:
½ of the patients (53, 53%) are from Skopje.

25. Demographics characteristics of patients
Parameters Number %
Gender 50 %
Male 16 32%
Female 34 68%
Age
25-34 11 22%
35-44 2 4%
45-54 15 30%
55-64 12 24%
65-74 10 20%
Над 75 1 2%
Place of living
Skopje 35 70,00%
Out side Skopje 15 30,00%

26. Distribution of patients regarding
the age
16 15
14
12 25-34
12 11
10 35-44
10
45-54
8
55-64
6
65-74
4
2 Над 75
2 1
0

27. Comparison of mean DLQI scores
and demographic variables
Sex Mean DLQI
Male 7,50
Female 9,53
Marital status
Single 8,23
Maried 7,25
Place of living
Skopje 9,25
Out side from Skopje 7,38

28. Comparison of mean DLQI scores
and demographic variables
Educational level DLQI
Illiterate 8,00
Under graduate 8,20
Graduate 8,38
Bachelor degree 9,56
Doctorate 7,00
Visibility of lesion
Exposed 9,45
Unexposed 8,23

29. As a conclusion
The chronic nature of disease, long term
treatment, lack of uniform effective therapy and
unpredictable prognosis of disease/therapy make
the patients suffer more from the disease.

30. DLQI score in vitiligo patients
Questions Parameters Mean DLQI
1. Symptoms 1,16
2 Feelings 2,22
3 Daily activities 1,56
4 Kind of clothes 2,22
5 Social or leisure activities 2,16
6 Physical exercise 2,11
7 Educational activities 2,02
8 Interpersonal relationships 2,88
9 Sexual activities 1,06
10 Treatment 1,86

31. Why is important in Macedonia?
• Pilot project first one in Macedonia
• At the end of this study we will give the answer of
influence of demographics characteristics of
patients in Macedonia regarding the quality of life
Review from literature is showing that DLQI not
only can measure the quality of life but can also
be used as a instrument of measuring the quality
of doctors working.

32. Conclusions
Our study quantifies the burden on the quality of life
caused by vitiligo and indicates specific areas of
patients' lives which are most affected by the disease..
These results should awake the
interest of physicians in this „cosmetic‟ disease, since
appropriate treatment is likely to improve the quality of
life of vitiligo patients.

33. Suggestions activities
Holistic approaching is not only treatment of illness
of the patients but it is treatment of a patient as
human been and not only threatening illness.
So thinking about the DLQI at patient with
dermatology illness is thinking about the factors
who determinate the quality of life which are
individual and changeable.
DLQI can help in identifying the dominant needs and
searching of the patients the solution for those.
.

34. Conclusion
With more effective treatment options and a closer
patient/ physician relationship, patients can
improve their quality of life and overall well-being.
Before beginning on a specific treatment course,
both patient and healthcare provider should be
aware of patient's current QoL and monitor it
closely throughout the course of a treatment
regimen.

35. Conclusion
• Doctor must give the right and adequate
information and education regarding the condition
of the patient
• On this way educated patient will have more
control of his disease and he will accept emotional
more his condition.
• So with this DLQI will became a part of every
clinical examinations of the patients, and with this
we will increase the relationships between doctors
and patient.

36. Greetings from Macedonia