Vitiligo Patients Experience Barriers in Accessing Care
Vitiligo is a loss of pigment occurring in approximately 0.4% to 2% of the worldwide population. The aim of this study was to determine and characterize barriers to access of care in US patients with vitiligo. An Internet-based, deidentified survey consisting of 82 questions about topics including demographics, recommendations for care, and/or barriers to receiving recommended care was designed and distributed to member participants in an online vitiligo support community consisting of patients (and parents/guardians of adolescents). Results indicated that treatment cost, relationships, work schedule, school schedule, number of sites affected, and female sex may be barriers to receiving prescribed care in some patients with vitiligo. Exploration of mechanisms by which these barriers can be reduced in the medical care of vitiligo may allow more patients to successfully receive treatment.
Practice Points
- Patients with vitiligo may experience difficulty receiving the care prescribed to them.
- It is best to identify barriers such as work schedule or distance before recommending a treatment plan.
Comment
It has been reported that patients with vitiligo may have difficulty related to treatment compliance for a variety of reasons.5 We identified notable barriers that arise for some, if not all, patients with vitiligo in the United States at some point in their care, including interference with other aspects of daily life, lack of coverage by current health insurance provider, and high out-of-pocket expenses, in addition to the negative effects of vitiligo on quality of life that have already been reported.6,7 These barriers are not a function of race/ethnicity, income level, or age of onset, but they may be impacted, as in the case of tacrolimus, by female sex. It is clear that, based on this study’s numbers, many patients will be unable to receive and/or comply with recommended treatment plans.
A limitation of this analysis is the study population, a select group of patients who had not been prescribed all the therapies in question. The sample size may not be large enough to demonstrate differences between level of education, race, or income level; however, even with a sample size of 87 respondents, the barriers to access of care are prominent. Larger population-based surveys would potentially tease out patterns of barriers not apparent with a smaller sample. No data were generated specific to calcipotriene, and this medication was not specified as a write-in agent on open question by any respondents; therefore, access to topical calcipotriene cannot be projected from this study. Phototherapy was queried as a nonspecific term and the breakdown of NB-UVB versus psoralen plus UVA was not available for this survey. Data suggesting a burden of socioeconomic barriers have been reported for atopic dermatitis8 and psoriasis,9 which corroborate the need for greater research in the field of access to care in dermatology.
Despite some advancement in the care of vitiligo, patients often are unable to access preferred or recommended treatment modalities. Standard recommendations for care are initial usage of calcineurin inhibitors for facial involvement and topical high-potency corticosteroids for involvement of the body.3,4 Based on this survey, it would seem that many patients are not able to receive the standard of care. Similarly, NB-UVB phototherapy and excimer laser therapy are recommended for widespread vitiligo and lesions unresponsive to topical care. It would seem that almost half of our respondents did not have access to one or more of the recommended therapies. Barriers to care may have substantial clinical and psychological outcomes, which were not evaluated in this study but merit future research.
