Insomnia is very common in patients with vitiligo, with most iterations of the sleep disorder caused by vitiligo itself, according to a new study.
In new data from case-control studies in China, a team of investigators reported that about half of all observed patients with vitiligo surveyed via an online questionnaire also suffered from insomnia. The results underscore the need for wellness assessments conducted by dermatologists, as well as care plans that focus on individual burdens beyond skin condition.
The team, led by Jia-Wei Liu of the Dermatology Department at Peking Union Medical College Hospital, conducted the trial to assess the prevalence, severity, and risk factors for insomnia in patients with diagnosed vitiligo.
As they noted, the skin condition causing disfigurement has been commonly associated with impaired social functions and physiological disorders, including depression, stress, and insomnia.
“In the meantime, various autoimmune diseases are associated with sleep disturbances,” they wrote. “Patients with sleep disorders may be at potential risk for vitiligo. Therefore, a two-way relationship exists between vitiligo and sleep disturbances.
The onset of vitiligo may be a causal trigger for sleep disturbances, noted Liu and colleagues, or the sleep disturbance can induce or worsen cases of vitiligo.
Their case-control evaluation by remote survey was carried out in March 2021, via an online questionnaire sent to 762 adult patients with vitiligo. The questionnaire included a survey of basic patient information, as well as a 45-item sleep-related instrument.
Vitiligo activity was assessed via a 6-point Vitiligo Disease Activity Score (VIDA) assessment. The sleep-related instrument helped define insomnia through diagnosis; Insomnia Severity Index (ISI); specific type of insomnia; instruments and requisition of history to rule out other sleep disorders; and specific disruption faces.
Liu and his colleagues included a total of 409 patients with vitiligo. The mean age of the patients was 30.0 years, of which 56.0% were women. Almost half (48.7%) of the patients observed had suffered from vitiligo for ≥ 3 years.
A total of 204 (49.9%) patients had experienced insomnia, of which 114 (55.9%) suffered from some form of adaptive sleep disorder caused by their vitiligo. Another 81 (71.1%) reported the development, worsening or recurrence of vitiligo as the primary reason for their insomnia.
Investigators observed significant differences in age between vitiligo patients with insomnia and those without insomnia (32.1 vs. 27.9, respectively; P <.001 patients with vitiligo and insomnia were more likely to be female>P = 0.006), work in urban areas (77.0%; P = .017), suffer from vitiligo in the face and neck (67.2%; P <.001 patients with both conditions were also more likely to receive oral corticosteroids for their vitiligo and experience depression than those solitary vitiligo.>
Adjusting for baseline demographics, investigators observed vitiligo of the face and neck (OR: 2.62; P = 0.032), progression of vitiligo (OR, 2.50; P = 0.002) and the use of oral corticosteroids (OR: 2.71; P = 0.021) as being important risk factors for insomnia in patients with vitiligo.
Liu and his colleagues observed that the present study demonstrated the widespread risk of insomnia in their patient population with vitiligo.
“Apparently this sleep problem affected their quality of life through a psychopathological condition such as depression and stress,” they wrote. “Therefore, it may be important for dermatologists to have a general identification of these conditions in patients with vitiligo, both psychological and physical, and to offer individualized therapy.”
Although no previous relevant research has observed an association between the treatment of insomnia and the control of vitiligo disease, the researchers hypothesized that improving sleep quality may positively influence l skin condition of their patients.
“It should be noted that different patients with vitiligo have specific concerns about this disease and these problems,” they concluded. “Dermatologists must identify them with care, in particular the humanistic factors of social life, and carry out individualized ‘non-drug’ treatment. “
The study, “Location, spread, and oral corticosteroids are associated with insomnia in patients with vitiligo: a case-control study, ”Was published online in Clinical, aesthetic and experimental dermatology.