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Original Article

Effect of Occurrence of Vitiligo in Children over Quality of Life of Their

Families: A Hospital‑based Study Using Family Dermatology Life Quality
Index

Abstract Pratik Gahalaut,

Introduction: Vitiligo in an adult patient has a profound effect on the quality of life (QoL) of that Sandhya Chauhan1,
particular patient. Although it is known that vitiligo in adult patient affects QoL in their family, Amit Shekhar,
very little information is available regarding QoL in a family having children suffering from vitiligo.
Materials and Methods: This is a cross‑sectional, hospital‑based study to ascertain the effect Madhur Kant
children suffering from vitiligo have on the QoL of their respective families. Study participants were Rastogi,
fifty healthy parent/immediate caregivers of fifty corresponding children suffering from vitiligo. The Nitin Mishra
QoL in the family of these vitiliginous children was assessed with the help of Family Dermatology Departments of Dermatology
Life Quality Index (FDLQI). Results: There was significantly more impairment of FDLQI among and 1Pediatrics, Shri Ram
respondents if vitiliginous child was female compared to male. The total FDLQI showed a significant Murti Smarak Institute of
negative correlation with duration of vitiligo in children. Analysis of individual items in FDLQI Medical Sciences, Bareilly,
revealed emotional distress as the most impaired facet of FDLQI and housework as the least affected Uttar Pradesh, India
item. Conclusion: Presence of vitiligo in children affects the QoL of that particular child and his/her
family. This impairment of FDLQI is more if the child suffering from vitiligo is female. Treatment
of vitiligo in pediatric age group should include psychological counseling and support for the child
as well as their parents/caregivers.

Keywords: Caregiver, Family Dermatology Life Quality Index, gender, health‑related quality of life,
parent, vitiligo

Introduction having vitiligo. For each child, either one

Vitiligo has a profound impact on the
quality of life (QoL) of patients.[1‑5] The
impact of many skin diseases is not
limited to the patient but may extend to
the rest of family. There is a dearth of
data regarding QoL among family having
children with vitiligo, and worldwide, only
a few studies have evaluated the effect of
children with vitiligo on QoL in family
members.[6‑11] Family Dermatology Life
Quality Index (FDLQI) has been validated
to measure the impact of dermatological
diseases on QoL of the patient’s family.[8,12]
The aim of the present study is to evaluate
the QoL in family members or immediate
caregivers of the children having vitiligo
with the help of FDLQI questionnaire.
Materials and Methods
Convenient sampling was used to enroll
fifty healthy parents/immediate caregivers
of fifty pediatric patients aged 3–16 years
parent/caregiver was included from the
corresponding family. A sample size of
fifty participants was chosen in accordance
with the study performed by Basra et al.
for validation of FDLQI questionnaire.[8]
This cross‑sectional study was conducted
from June 2014 to November 2015 at the
department of pediatrics and a vitiligo clinic
attached to the department of dermatology
of a tertiary level teaching hospital located
in northern India.
Inclusion criteria were a healthy
Address for correspondence:
parent/immediate caregiver of a child Dr. Pratik Gahalaut,
having vitiligo involving ≥10% body 69, Silver Estate, PO‑RKU,
surface area and having disease for at least Bareilly ‑ 243 006,
Uttar Pradesh, India.
3 months preceding the date of presentation.
E‑mail: drpratikg@rediffmail.
Pediatric patients having any chronic com
cutaneous/systemic disease in self or any
other siblings or family members were
excluded from the study. Since a validated Access this article online
Hindi language version of FDLQI is not Website: www.ijpd.in
available, respondents were included in the
DOI: 10.4103/ijpd.IJPD_136_16
study only if they were literate and able to Quick Response Code:

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For reprints contact: reprints@medknow.com
How to cite this article: Gahalaut P, Chauhan S,
Shekhar A, Rastogi MK, Mishra N. Effect of
occurrence of vitiligo in children over quality of life
of their families: A hospital-based study using family
dermatology life quality index. Indian J Paediatr
Dermatol 2018;19:21-5.

© 2017 Indian Journal of Paediatric Dermatology | Published by Wolters Kluwer - Medknow 21

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Gahalaut, et al.: HRQoL in family of children having vitiligo

read and write English. So far, a specific vitiligo family Table 1: Demographic profile of the study groups
impact questionnaire has not been developed. Hence, we Parameter Values
adopted FDLQI to evaluate the effect of child with vitiligo Age group of child
on QoL of a family. Range (years) 5‑12
Each parent/caregiver was asked to complete the 10‑item Mean 8.64±2.08
validated FDLQI questionnaire after taking an informed Sex of child (%)
consent. Each question inquires about the family member’s Male 22 (44)
perception of a certain specific impact on his/her Female 28 (56)
health‑related QoL over the past 1 month and is scored Family member relationship to patient
on a 4‑point scale (0–3).[8,12] FDLQI has been validated Mother 28
to measure the impact of dermatological diseases on QoL Father 10
of the patient’s family. This questionnaire measures the Grandmother 6
following issues: emotional distress, increased household Grandfather 6
expenditure, social life, relationships, others’ reaction to the Sex of family member (%)
disease, physical well‑being reaction, taking care of patient, Female 34 (68)
housework, and job.[8,12] FDLQI score ranges from 0 to 30. Male 16 (32)
A higher score indicated more impairment. The scoring Age of respondent
Range (years) 21‑66
method for each question was as follows:[8]
Mean 36.42±26.78
• Not at all: 0
Number of Family members (mean±SD) 5.32±1.93
• A little: 1
Occupation of family member
• Quite a lot: 2
Housewife 25
• Very much: 3
Farmer 14
• Question unanswered: 0.
Salaried employee 11
Data analysis was done with the help of SPSS software Native residence
version 20.0 (IBM SPSS software for windows, version 20.0). Urban 20
Rural 30
QoL for a family was deemed to be impaired if FDLQI
Duration of disease (mean±SD), months 19.32±12.69
score was ≥2.[7] Requisite approval was taken from
Body surface area (n)
Institutional Ethics committee.
10%‑20%/>20% 32/18
Results Site of involvement (n)
Exposed 22
Altogether, fifty healthy family members of fifty children Unexposed 28
having vitiligo vulgaris were included in this study. The Total FDLQI score (mean±SD) 8.88±3.08
particular family member was included in the study if he/she FDLQI ‑ Family Dermatology Life Quality Index; SD ‑ Standard
was the immediate caregiver of the vitiliginous child. Table 1 deviation
gives the demographic profile and clinical characteristics
of the children and their families. Among family member
Mean FDLQI scores for individual items
respondents, 76% were parents and 24% were grandparents. 1.8
1.6 1.56
Emotional distress
Figure 1 gives a detailed description of FDLQI (item‑wise) 1.4 1.36 Physical wellbeing
in the study population. QoL in the family members was 1.2 Relationships
affected (i.e., FDLQI ≥2) in 50/50 (100%) respondents. 1 0.88
1 1
0.92
People,s reaction
Social life
Although the QoL was affected more in female 0.8
0.8
Leisure activities
respondents (9.28 ± 3.20) compared to male respondents 0.6 0.52 0.56 Burden of care
(8.45 ± 3.88), this difference was statistically not significant 0.4 0.28
House work

(P = 0.68). Widowed/single family members showed more 0.2

impairment in QoL compared to married members though
it was statistically insignificant (P = 0.839)
There was significantly more impairment of FDLQI
(P = 0.047) if vitiliginous child was female (9.64 ± 2.97)
compared to male (7.90 ± 3.00). The total FDLQI showed
a significant negative correlation with vitiligo duration,
i.e., the QoL of family members was affected more if the
duration of vitiligo was less and vice versa (P = 0.01,
Spearman’s rho correlation coefficient was −0.363).
Job/schooling
Expenditure
0
FDLQI
Figure 1: Item‑wise FDLQI scores
Although total FDLQI score was more among family
members of children having vitiligo on exposed
parts (mean = 9.187 ± 3.50) compared to children having
vitiligo on unexposed parts (mean = 8.33 ± 2.11), this
difference was also statistically nonsignificant (P = 0.352).

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Gahalaut, et al.: HRQoL in family of children having vitiligo
There was no significant correlation between FDLQI scores
and the involved body surface area (P = 0.761, Pearson
correlation = 0.583) or age of the child (P = 0.839, Pearson
correlation = −0.041).
The mean scores for individual items in FDLQI were
analyzed. Highest scoring items/domains were found to be
emotional distress, expenditure, people’s reaction, and burden
of care in that order. The least affected item was housework.
Individual items of FDLQI were further compared in
children having vitiligo on exposed and nonexposed
sites. Family respondents of vitiliginous children had
significantly more impairment in the domain of the reaction
of other people in response to the patient’s skin appearance
(P = 0.03), leisure activities (P = 0.015), and the effect
on social life (P = 0.01) compared to other domains of
FDLQI, if vitiligo involved exposed sites more compared
to nonexposed sites.
Scores for individual items of FDLQI were compared
for vitiligo involving >20% body surface area in a child
with vitiligo involving <20% body surface area. Domains
of expenditure (P = 0.003), loss of job (P = 0.04), and
housework (P = 0.002) were significantly more impaired
among family members of children having vitiligo in >20%
of body surface area.
Discussion
In dermatological and other chronic diseases, QoL of
a patient affects the QoL of family. Hence, efforts to
improve the QoL of a patient should also address the issue
regarding QoL of the families or caregivers.[8] Family QoL
is considered an important outcome of services and policies
and should be analyzed independently to the QoL of the
patient.[12,13]
Vitiligo rarely causes physical discomfort, but patients may
develop inferiority complexes, fear, anxiety, depression,
suicidal thoughts, social communication difficulties,
embarrassment, irritability, and fear of stigmatization.[6]
They may be subjected to stigmatization, nasty comments,
or distress.[7] A disease may impair social, financial,
and health aspects of the family members of diseased
individual. Patients of vitiligo often rely heavily on support
from family members to overcome these psychosocial
obstacles.[7] Vitiligo adversely affects the QoL of people
close to the patient including his/her family member and
other close contacts.[7] Parents are the most sensitive and
closest caregivers for children. Parents of children suffering
from vitiligo may experience psychological problems or
social pressure.[6] Past studies have promoted the use of
psychiatric screening questionnaires that might help in
recognizing psychiatric morbidity in parents who have
children with vitiligo.
There are only a couple of past studies describing the use
of FDLQI for determining family QoL in patients with
23 Indian Journal of Paediatric Dermatology | Volume 19 | Issue 1 | January-March 2018
vitiligo.[7,9] Both these studies, Bin Saif et al. from Saudi
Arabia and Hindjani from Iran, included only adult patients
of vitiligo. Another recent study from China by Amer et al.
addressed the issue of QoL in parents of pediatric patients
with vitiligo with the help of Dermatitis Family Impact
Questionnaire (DFIQ).[6] Basra et al. included both adult
and pediatric patients having different chronic inflammatory
and noninflammatory skin ailments including vitiligo in
their study for developing FDLQI.[8] In this study, patients
of vitiligo comprised a miniscule proportion among the
total number of study participants.
The fact that all the respondents in our study were affected
with total FDLQI scores of ≥2 reinforces the findings of
the past study which stigmatized parents as the new victims
of vitiligo.[6] This same past study stated that the presence
of vitiligo in children affects the mental state and QoL of
parents to various degrees.[6] This finding is also similar to
the past study done among family members of adult patients
having vitiligo where family members’ QoL was affected
in 91.5% of participants.[7] It is noteworthy that Basra et al.
reported that among patients having chronic skin ailments,
statistically significant and greater impairment of FDLQI
were recorded in families having patients <12 years of
age compared to families having patients >12 years of
age.[8] It is possible that FDLQI as a generic tool reports a
higher impairment of QoL in a family having patients aged
<12 years compared to families having patients >12 years
of age for the same disease.
Bin Saif et al. reported a total FDLQI of 9.24 in parents of
patients with vitiligo which is quite similar to our study.[7] In
that study, only adult patients with vitiligo along with their
immediate caregivers were included in the study unlike our
present study which includes family respondents of only
pediatric patients. It is noteworthy that majority of both
Indian and Saudi population is Fitzpatrick Skin Type IV
and V. Vitiligo in darker skin individuals is associated with
greater social and psychological implications.[14,15] A total
FDLQI score of 8.88 in our present study is less than that
reported by Handjani et al., namely 14.40.[9] This disparity
may be due to small sample size, adult age group of study
subjects, and variations in the geographic distribution and/or
sociocultural practices of the past study. Effect of vitiligo on
family member’s QoL in the present study was also more
compared to another study done in the past by Basra et al.
on patients having multiple noninflammatory skin conditions
including vitiligo.[8] This difference may be due to relatively
small sample size as mentioned earlier in this past study.
In the present study, significantly more impairment in
FDLQI was noticed if the affected child was female.
This finding assumes more significance in the backdrop
of recent epidemiological study from India which reports
that pediatric vitiligo has a female predilection.[16,17] Amer
et al. failed to report any statistically significant impact of
children’s gender on DFIQ in China.[6] The social stigma
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Gahalaut, et al.: HRQoL in family of children having vitiligo
of vitiligo in India and fear of difficulty in marriage in the
future may be responsible for the increased impairment in
QoL observed in the present study among parents having a
female child with vitiligo. Earlier studies assessing gender
differences and the effect of chronic skin diseases showed
that women have significantly more overall impairment of
QoL as compared with men having vitiligo.[2,18] Past studies
have confi rmed that QoL in patients with vitiligo and
their family members are related psychosocial constructs.
However, Bin Saif et al. reported higher scores of FDLQI
if affected patient was a male. The authors stated that this
finding may be specific to Saudi Arabian culture since men
play a more dominant role in the family setting there.[7]
The difference of adult and pediatric age groups in study
populations along with different sociocultural believes
among the past and present studies may be responsible for
these variable results.
In the present study though FDLQI score was more among
family members of patients having lesions of vitiligo on
unexposed part, site of vitiligo in a child had no significant
correlation with FDLQI scores. This is similar to the
findings of Amer et al. and Bin Saif et al., who reported
that deterioration in DFI and FDLQI scores, respectively,
was not related to vitiliginous patch visibility.[6,7] This
finding is also consistent with past studies done for
assessing the impact of psoriasis and atopic dermatitis on
QoL in a family member.[19‑21]
In the present study, gender difference among respondents
was seen though not statistically significant. Past studies
have failed to report a clear‑cut association between
FDLQI and gender of family member.[6,7] While one study
has reported that in a family having vitiliginous children,
mothers tend to be more affected and more distressed,
recording higher impairment of QoL compared with
fathers; another study reported significant greater FDLQI
scores in females for the domain of social life only.[6,7]
Similar to our study, past studies reported the domain of
emotional distress as the most common and main concern
among the family members.[7,9] This finding suggests that
vitiligo as a disease affects the QoL of family members
in similar extent and domains, irrespective of vitiliginous
patient’s age.
Individually domains of leisure activities were affected more
if vitiligo affected exposed parts. This is self‑explanatory
as such children and/or their parents will be subjected to
more questions and discrimination from society.
A shorter disease duration resulted in significantly greater
impairment of QoL in family respondents. This is expected
as prolonged disease duration enhances the partner/family
members’ abilities to adjust and acquire coping skills to
better deal with vitiligo.
A relative smaller sample size, single‑center hospital‑based
study, and exclusion of parents or caregivers if they were
Indian Journal of Paediatric Dermatology | Volume 19 | Issue 1 | January-March 2018
not able to read and write English are the limitations of this
study. Nevertheless, these shortcomings cannot negate the
findings of this study altogether.
Conclusion
To conclude this study from Indian subcontinent measures,
the QoL in family members of children having vitiligo with
the help of a standardized, reproducible, and validated tool.
There is a significant detrimental effect on QoL of parents
if vitiliginous child is a female. Furthermore, the fall in
QoL had a significant inverse relationship with duration of
vitiligo in the child.
Although this is a single‑center study with a small
sample size, findings of the present study should help
the dermatologists/pediatricians/treating physicians while
dealing with parents of a vitiliginous child in a more
productive way. Parents/caregivers of a child having
vitiligo should be counseled appropriately and should be
provided psychological support.
Acknowledgments
The authors would like to thank the management of Shri
Ram Murti Smarak Institute of Medical Sciences, Bareilly,
for providing logistical support while preparing this
manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Parsad D, Pandhi R, Dogra S, Kanwar AJ, Kumar B.
Dermatology Life Quality Index score in vitiligo and its impact
on the treatment outcome. Br J Dermatol 2003;148:373‑4.
2. Mishra N, Rastogi MK, Gahalaut P, Agrawal S. Dermatology
specific quality of life in vitiligo patients and its relation with
various variables: A hospital based cross‑sectional study. J Clin
Diagn Res 2014;8:YC01‑3.
3. Amer AA, Gao XH. Quality of life in patients with vitiligo: An
analysis of the dermatology life quality index outcome over the
past two decades. Int J Dermatol 2016;55:608‑14.
4. Pahwa P, Mehta M, Khaitan BK, Sharma VK, Ramam M. The
psychosocial impact of vitiligo in Indian patients. Indian J
Dermatol Venereol Leprol 2013;79:679‑85.
5. Belhadjali H, Amri M, Mecheri A, Doarika A, Khorchani H,
Youssef M, et al. Vitiligo and quality of life: A case‑control
study. Ann Dermatol Venereol 2007;134(3 Pt 1):233‑6.
6. Amer AA, Mchepange UO, Gao XH, Hong Y, Qi R, Wu Y,
et al. Hidden victims of childhood vitiligo: Impact on
parents’ mental health and quality of life. Acta Derm Venereol
2015;95:322‑5.
7. Bin Saif GA, Al‑Balbeesi AO, Binshabaib R, Alsaad D,
Kwatra SG, Alzolibani AA, et al. Quality of life in family
members of vitiligo patients: A questionnaire study in Saudi
Arabia. Am J Clin Dermatol 2013;14:489‑95.
8. Basra MK, Sue‑Ho R, Finlay AY. The Family Dermatology Life
24
[Downloaded free from http://www.ijpd.in on Tuesday, January 30, 2018, IP: 202.164.43.126]

Gahalaut, et al.: HRQoL in family of children having vitiligo

Quality Index: Measuring the secondary impact of skin disease.
Br J Dermatol 2007;156:528‑38.
9. Handjani F, Kalafi A. Impact of dermatological diseases on family
members of the patients using Family Dermatology Life Quality
Index: A preliminary study in Iran. Iran J Dermatol 2013;16:128‑31.
10. Manzoni AP, Pereira RL, Townsend RZ, Weber MB,
Nagatomi AR, Cestari TF. Assessment of the quality of life of
pediatric patients with the major chronic childhood skin diseases.
An Bras Dermatol 2012;87:361‑8.
11. Bilgiç O, Bilgiç A, Akis HK, Eskioglu F, Kiliç EZ. Depression,
anxiety and health‑related quality of life in children and
adolescents with vitiligo. Clin Exp Dermatol 2011;36:360‑5.
12. Basra MK, Finlay AY. The family impact of skin diseases: The
greater patient concept. Br J Dermatol 2007;156:929‑37.
13. Bailey DB, McWilliam RA, Darkes LA, Hebbeler K,
Simeonsson RJ, Spiker D, et al. Family outcomes in early
intervention: A framework for program evaluation and efficacy
research. Except Child 1998;64:313‑28.
14. Al Robaee AA. Assessment of quality of life in Saudi patients
with vitiligo in a medical school in Qassim province, Saudi
Arabia. Saudi Med J 2007;28:1414‑7.
15. Linthorst Homan MW, Spuls PI, de Korte J, Bos JD,
Sprangers MA, van der Veen JP. The burden of vitiligo: Patient
characteristics associated with quality of life. J Am Acad
Dermatol 2009;61:411‑20.
16. Puri N. A clinico‑epidemiological study on childhood vitiligo.
Indian J Paediatr Dermatol 2016;17:101‑3.
17. Raju BP, Nagaraju U. Profile of childhood vitiligo with
associated ocular abnormalities in South India. Indian J Paediatr
Dermatol 2016;17:179‑85.
18. Borimnejad L, Parsa Yekta Z, Nikbakht‑Nasrabadi A, Firooz A.
Quality of life with vitiligo: Comparison of male and female
Muslim patients in Iran. Gend Med 2006;3:124‑30.
19. Ben‑Gashir MA, Seed PT, Hay RJ. Are quality of family life
and disease severity related in childhood atopic dermatitis? J Eur
Acad Dermatol Venereol 2002;16:455‑62.
20. Richards HL, Chong SL, Mason DL, Griffiths CE. The impact
of psoriasis on healthy partners of patients with psoriasis. Br J
Dermatol 2002;147 Suppl s62:40.
21. Eghlileb AM, Davies EE, Finlay AY. Psoriasis has a major
secondary impact on the lives of family members and partners.
Br J Dermatol 2007;156:1245‑50.

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