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Study Letters
87 (
5
); 723-725
doi:
10.25259/IJDVL_498_20
pmid:
34114412

Validity and feasibility of the self-assessment vitiligo extent score among Egyptian patients

Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University Hospital, Abbassia, Cairo, Egypt
Department of Family Medicine, Faculty of Medicine, Ain Shams University Hospital, Abbassia, Cairo, Egypt
Corresponding author: Dr. Marwa Abdallah, Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University Hospital, Cairo, Egypt. marwa.abdallah@cutis-clinic.com
Licence
This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Abdallah M, Nassar A, Samir M, Reda A, Hassan A, Allam MF, et al. Validity and feasibility of the self-assessment vitiligo extent score among Egyptian patients. Indian J Dermatol Venereol Leprol 2021;87:723-5.

Sir,

Vitiligo extent score is one of the reliable instruments recently validated and used by physicians to assess the extent of non-segmental vitiligo.1 However, according to the World Health Organization, if the patients themselves could score the extent of their vitiligo, it could bring about the participation of the patients in assessing the prognosis of their disease. Self-assessment vitiligo extent score was previously validated in patients with fairer skin types allowing them to score their vitiligo extent in an easy way.2 Both vitiligo extent score and self-assessment vitiligo extent score are available online and easy to calculate (https://www.vitiligo-calculator.com/Calculator for vitiligo extent score, https://www.vitiligo-calculator.com/Calculator?sa=trueforself-assessmentvitiligoextentscore). Further validation of the self-assessment vitiligo extent score on a different ethnic population (Middle East/North African), darker skin types with various cultural and educational levels would add to the generalisability of the new scoring system, as recommended by van Geel et al.2

After getting the approval of the university’s ethical committeee for the current case series (FMASU R 27/2017) and informed consent from all participants, 206 nonsegmental vitiligo patients were recruited. Patients with skin type I were excluded. Patients were of different educational levels including adult illiterates, since Ain Shams University Hospital is a government run non-profit hospital attended mostly by patients with low to low- medium socioeconomic levels. Validity for self-assessment vitiligo extent score was determined by comparing the results of both self-assessment vitiligo extent score and vitiligo extent score, while feasibility was determined by recording the completion time (1–4 min, 5–9 min, 10-15 min and >15 min), patient’s required mental ability level, ease of administration and comprehensibility of self-assessment vitiligo extent score.

Quantitative variables which were normally distributed were described using mean and standard deviation and those with skewed distribution were described using median and interquartile range. The statistical tests used for comparison were Mann Whitney, ANOVA and Kruskal–Wallis. The Cronbach alpha test was used to examine the internal consistency of vitiligo extent score and self-assessment vitiligo extent score.

Our study included 206 patients with vitiligo, of all age groups (adults [≥16 y, mean age 37.89 ± SD 16.12 y] and children [9.36 ± SD 3.58 y]), educational levels and skin types prevalent in Egypt. Almost half of the patients were children below the age of 16 and 82% were of skin types III and IV [Table 1].

Table 1:: Demographic data of included participants
Number (%)
Age group (y)
Adults (≥16) 105 (51)
Children (1–15) 101 (49)
Gender
Females 127 (61.7)
Males 79 (38.3)
Area of origin
Cairo and Delta 150 (72.5)
Upper Egypt 38 (18.4)
Unknown 18 (8.8)
Fitzpatrick’s skin phototype
II 9 (4.4)
III 71 (34.4)
IV 98 (47.6)
V 18 (8.7)
VI 10 (4.9)
Educational level
Adult illiterate 23 (11.2)
Preschool 18 (8.7)
Primary school 51 (24.8)
Preparatory school 34 (16.5)
High school 34 (16.5)
University student 11 (5.3)
Postgraduate 21 (10.2)
Not identified 14 (6.8)

In concordance with the study done by van Geel et al in 2017,2 the mean vitiligo extent score (1.93 ± SD 3.55) and self-assessment vitiligo extent score (1.79 ± SD 3.63) [Table 2] showed a significant bilateral positive correlation (r= + 0.923, P < 0.001) [Figure 1] and there was internal consistency of the assessment of vitiligo extent by the two scores (Cronbach alpha test = 0.96), indicating validity. Moreover, both the scores were not affected by gender (P = 0.977, 0.811) [Table 2], skin type (P = 0.977, 0.151) and educational level (P = 0.350, 0.632), respectively. However, both were less in children compared to adults (P = 0.009 and P = 0.033, respectively) which may be due to the progressive nature of disease with milder disease in childhood. Alternatively, it could be due to increased awareness and more concern of the parents resulting in early and prompt diagnosis and hence presenting with less/small surface area of lesions.

Figure 1:: Positive correlation between vitiligo extent score and self-assessment vitiligo extent score with high correlation coefficient (Pearson correlation coefficient, r = +0.923, P < 0.001).
Table 2:: VES, SA-VES and SA-VES time values
VES
(n=206)
SA-VES
(n=206)
SA-VES time in minutes (n=130)
Mean 1.93±SD 3.55 1.79±SD 3.63 3.19±SD 2.17 min
Median 0.62
(IQR 0.20–1.82)
0.56
(IQR 0.20–1.59)
3 min
Range 0.003–31.13 0.01–36.69 1–10 min
Children
Adults*
1.46±SD 3.46
2.38±SD 3.59
P=0.009
1.33±SD 3.94
2.22±SD 3.27
P=0.033
3.31±SD 2.01
3.10±SD 2.3
P=0.65
Females
Males*
1.92±SD 3.85
1.95±SD 3.04
P=0.977
1.81±SD 4.07
1.74±SD 2.81
P=0.811
3.30±SD 2.22
3.03±SD 2.11
P=0.436

Mann–Whitney U-test, VES: Vitiligo extent score, SA-VES: Self-assessment vitiligo extent score

The score was feasible, as the mean self-assessment vitiligo extent score time (done by 130 patients) was 3.19 ± SD 2.17 min. Most of the participants (101, 77.69 %) completed self-assessment vitiligo extent score in 1–4 min, 26 (20%) in 5–9 minutes, three (2.31%) in ten min and no one exceeded ten minutes. It was not affected by age (P = 0.65), gender (P = 0.436) [Table 2], skin type (P = 0.57) (Kruskal–Wallis) or educational level (P = 0.21) (Kruskal–Wallis). This is in agreement with study by van Geel et al in 2017,2 where none of the patients rated the self-assessment vitiligo extent score scoring as difficult or very difficult.

Self-assessment vitiligo extent score was easy and needed less time to complete than the patient’s self-assessment scores of the vitiligo area severity index (SA-VASI), where only 35% of the patients were able to complete the questionnaire in five minutes.3 Self-assessment vitiligo extent score is a visually illustrated tool which makes it easier to comprehend and complete. Assistance was minimal in patients older than nine years (only 16% were assisted). Assistance required in adults was significantly less than that in children (P = 0.0001). There was a statistically significant association between low educational level and need for assistance (P = 0.0001). Adult illiterates were the group who needed more assistance and took the longest time (4.60 ± SD2.92 vs. 2.25 ± SD 1.58 min for university graduates) in completing self-assessment vitiligo extent score.

Thus, clearly, there are some discrepancies in self-assessment vitiligo extent score among patients related to their age. Most of the children presented with milder form of the disease as evidenced by having lower score compared to adults. In addition, a significant number of children, in contrast to adults, required assistance; nevertheless, patients’ age did not influence the timing needed to complete the questionnaire.

In conclusion, self-assessment vitiligo extent score demonstrated excellent feasibility and validity (highly significant correlation with vitiligo extent score) in an Egyptian patient population. It could be implemented in different cultural groups, in darker skin types and in different age groups. It represents a valuable tool in everyday clinical practice as well as in clinical trials.

Limitations

Our study limitation was that we did not assess test-retest reliability of self-assessment vitiligo extent score and we depended on internal consistency using Cronbach alpha with vitiligo extent score. Vitiligo extent score and self-assessment vitiligo extent score, despite the ease of their use, have their limitations in that they do not have separate representation of the palms, soles and mucosae, such as lips and genitalia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

  1. , , , , , , et al. Development and validation of the vitiligo extent score (VES): An International Collaborative Initiative. J Invest Dermatol. 2016;136:978-84.
    [CrossRef] [Google Scholar]
  2. , , , , , , et al. Development and validation of a patient-reported outcome measure in vitiligo: The self-assessment vitiligo extent score (SA-VES) J Am Acad Dermatol. 2017;76:464-71.
    [CrossRef] [Google Scholar]
  3. , , , , , . Vitiligo Area Scoring Index and vitiligo European task force assessment: Reliable and responsive instruments to measure the degree of depigmentation in vitiligo. Br J Dermatol. 2015;172:437-43.
    [CrossRef] [Google Scholar]

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