Treatment delays during the COVID-19 pandemic were associated with poor outcomes in patients with vitiligo, according to study data published in Dermatologic Therapy. In a retrospective chart review of patients with vitiligo, COVID-19-related treatment delays were associated with greater odds for vitiligo progression and recurrence. However, the use of maintenance therapy was a major protective factor against disease recurrence, even in patients with care delays.
Investigators conducted a retrospective review of medical records at Huashan Hospital in Shanghai. Eligible patients had visited the dermatology outpatient clinic for vitiligo at least 2 times during the COVID-19 pandemic, defined as the time period between January and December 2020. Treatment delays were defined by a discontinuation of original treatments exceeding 1 month. Patients who discontinued treatment due to clinical response were excluded from analyses. Demographic and clinical information were extracted from medical records; clinical photographs of lesions were used to evaluate disease status. The primary outcomes were vitiligo progression and recurrence. Disease progression was defined as an increase in affected body surface area (BSA) over follow-up in patients with active vitiligo. Recurrence was defined as the appearance of new lesions or new regions of depigmentation in patients with previously stable disease. Multivariable logistic regression was used to identify predictors of disease progression and recurrence during the pandemic.
The study cohort comprised 322 patients, of whom 51.9% experienced treatment delays during the study period. Demographic and clinical characteristics were comparable between patients who experienced treatment delays and patients who had uninterrupted treatment. Treatment delays occurred most frequently during February and April of 2020. Median delay duration was 4.46 ± 2.02 months. The most frequently delayed treatment modality was systemic corticosteroid (38.9% of delays), followed by combination therapies (25.7%) and phototherapy (12.6%). Disease progression was significantly more common in the delayed group compared with the treatment as usual group (40.7% vs 12.3%; P =.002).
Recurrence was also more frequently observed in the delayed group (32.1% vs 12.2%; P =.018). In regression models, disease progression was significantly associated with treatment delays of any duration, although longer delays were associated with greater odds for progression. Other correlates of progression included greater affected BSA at baseline and self-reported fatigue and emotional dysregulation. Disease recurrence was associated with treatment delays of 3 months or greater, as well as longer disease duration and greater baseline affected BSA. Maintenance therapy emerged as a protective factor in models of disease recurrence. Specifically, maintenance therapy of duration of 2 years or more was associated with significantly reduced likelihood of recurrence during the study period (odds ratio [OR], 0.21; 95% confidence interval [CI], 0.06-0.75; P =.016).
Results from this study underscore the challenges of chronic disease management in pandemic conditions, the researchers believe. Both patients with active disease and patients with stable disease were affected by treatment delays. Other predictors of poor outcomes included self-reported fatigue and dysregulation.
As study limitations, investigators identified the retrospective design and small sample size. In addition, fatigue and emotional status were not measured using objective scoring systems; further study of the association between these factors and vitiligo is warranted.
“[O]ur findings revealed the independent adverse impact of treatment delays on the progression and recurrence of vitiligo and protective effect of maintenance therapy (>2 years) against recurrence, indicating the significance of continuous treatment for halting progression and long-term maintenance therapy for preventing recurrence,” investigators wrote.
Xu X, Zhang C, Jiang M, Xiang LF. Impact of treatment delays on vitiligo during the COVID-19 pandemic: a retrospective study. Dermatol Ther. Published online June 1, 2021. doi:10.1111/dth.15014