Patients with pigmentary disorders are at high risk for psychiatric disorders that directly correlate to disease severity, according to study data published in the European Academy of Dermatology and Venereology. The investigators noted that the refractory nature and stigma of pigmentation disorders such as vitiligo, melasma, and acquired dermal macular hyperpigmentation (ADMH) increase the risk for psychiatric comorbidities, as do the long-term natural courses of these disorders and their treatments.
Researchers compiled data from questionnaires completed by 272 patients (mean age 37.1 ± 11.12 years) in India with skin lesions on exposed body parts from vitiligo, melasma, or ADMH. The results revealed a higher than normal prevalence of anxiety, depression, and somatoform disorders in this population.
Overall, depression was the most commonly reported psychiatric disorder, in 12.8% of patients with melasma, in 24.1% of those with ADMH, and in 27% of patients with vitiligo. Distribution of anxiety disorder followed a similar pattern, with a prevalence of 11.6%, 18.7%, and 21%, respectively. Patients with vitiligo had the highest prevalence of somatoform disorder (17.9%), which was reported in 14.3% of those with ADMH and in 8.1% of those with melasma.
Several tools were used to measure the presence of mental health disorders. According to the PRIME-MD Patient Health Questionnaire (PHQ) scale, 30.5% of the study group had one psychiatric disorder and 9.5% had at least two concomitant disorders. Again, depression, measured by a PHQ-9 score of >10, was most commonly recorded in 21.7% of patients, followed by anxiety (measured by a generalized anxiety disorder [GAD-7] score of >8) in 17.3% and somatoform disorders in 13.6%. A total of 16 patients (5.9%) had both anxiety and depression. In addition, 6.6% of the cohort had an eating disorder and 4.8% were reported to abuse alcohol.
Quality of life was most adversely affected in the vitiligo group, although the prevalence of one or more psychiatric disorders was higher in the ADMH group (32.6% vs 34.8%, respectively). Mean PHQ-9 and PHQ-15 scores measuring depression and somatization were highest in the vitiligo group, while the ADMH group reported higher GAD-7 scores for anxiety. Those in the melasma group scored lower on all PHQ measures.
The need for treatment of depression was also greatest in the vitiligo group, compared with in those with ADMH or melasma (27.1%, 24.2%, and 12.8%), which was statistically significant (P =0.04).
The authors concluded there is a high frequency of psychiatric disorders in patients with pigmentary disorders. The incidence is highest in those with vitiligo, followed by those with ADMH and melasma, and the incidence increases with severity of each disorder. The authors emphasized the importance of screening for psychiatric disorders in patients with pigmentary dysfunction through use of common tools such as the PHQ-9, PHQ-15, and GAD-7 scales.
Dabas G, Vinay K, Parsad D, Kumar A, Kumaran MS. Psychological disturbances in patients with pigmentary disorders: A cross-sectional study [published online September 30, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15987