Delayed Vitiligo Treatment Potential Risk Factor for Progression, Recurrence

Jonathan Alicea

The COVID-19 pandemic had forced vitiligo patients to delay treatments; however, not much is known about the effects of delaying on disease course.

Findings from a new study suggested that delay of treatment due to the COVID-19 pandemic adversely affected patients with vitiligo.

In the context of lockdowns, many patients have had to forego treatment and maintenance therapies—therefore, disrupting treatment patterns.

“However, virtually nothing is known about vitiligo, a common chronic autoimmune cutaneous depigmenting disorder, requiring active treatment to halt progression, maintenance therapy to prevent recurrence,” the investigators wrote.

A team, led by Xinya Xu, MD, PhD, of Fudan University in China, conducted a retrospective cohort study among vitiligo patients in Huashan Hospital in Shanghai. All patients had visited the outpatient clinic at least 2 times from January – December, 2020.

Their goal was to assess outcomes in these patients over the course of the pandemic.

The Study

As such, the team grouped the patients into either a treatment delay cohort (n = 167) or normal treatment cohort (n = 155). Patients who discontinued treatment were also grouped into the treatment delay cohort.

Patients experienced treatment delays of 4.46 months, which occurred mainly through February-April.

“Among treatment modalities, systemic corticosteroid therapy (38.9%) was the most frequently delayed, followed by combination therapy (two or more therapies, 25.7%) and phototherapy,” Xu and colleagues reported.

There were also no differences in demographics or characteristics between the treatment groups.

The investigators performed univariate and multivariate analyses to determine whether treatment delays were an independent risk factor for disease progression and recurrence.

Based on univariate analysis, there was a notable association between treatment delay and disease progression (P<.05) and recurrence (P<.05). However, patients who had delays <3 months were not at increased risk for recurrence.

Multivariate analysis revealed that delaying treatment, large affected body surface area (BSA, >10%), emotional dysregulation, and fatigue were independent risk factors for progression (P<.05).

Treatment delays >3 months, large affected BS disease duration >5 years, emotional dysregulation, and fatigue were the independent risk factors for disease recurrence (P<.05).

Maintenance therapy of >2 years notably had a protective effect against progression and recurrence (odds ratio [OR], 0.21; 95% CI, 0.06-0.75; P = .016).

“Strikingly, treatment delays were the most important risk factor associated with both progression and recurrence,” the investigators wrote. “The longer duration of treatment delays, the higher risk for progression and recurrence.”

In light of these findings, they urged a need to develop clear recommendations for vitiligo management, particularly during pandemics. Even more, these recommendations should be based a full understanding of delayed treatments on disease.

Of course, more research into these effects is warranted, considering the limiting nature of data. For this particular study, the investigators acknowledged limitations to be the small sample size, retrospective nature of it, and patients selection bias.

Nonetheless, the underscored the importance and implications of the study goals and their findings.

“Our 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,” Xu and colleagues wrote.

“Therefore, teledermatology and home phototherapy would be recommended, especially for the patients with risk factors.”

The study, "Impact of treatment delays on vitiligo during the COVID-19 pandemic: A retrospective study," was published online in Dermatologic Therapy.