J AM ACAD DERMATOL

732 Letters

APRIL 2015

education on health care policy in their training, and that many would become involved if given more opportunities for education and participation.

Table I. Visual analog scores for patient satisfaction with vitiligo treatments Treatment

N

Mean VAS score

95% Confidence interval

Mary E. Horner, MD,a A. Shadi Kourosh, MD,b and M. Alan Menter, MDa

NBUVB phototherapy Topical corticosteroids Topical 0.1% tacrolimus Skin grafting

78 82 51 20

78 52 41 64

73-83 46-59 32-50 48-80

Division of Dermatology, Baylor University Medical Center,a Dallas, Texas, and Department of Dermatology, Massachusetts General Hospital,b Boston Funding sources: None. Conflicts of interest: None declared. Correspondence to: Mary E. Horner, MD, Baylor University Medical Center, Division of Dermatology, 3900 Junius St. 145, Dallas, TX 75246 E-mail: [email protected] http://dx.doi.org/10.1016/j.jaad.2014.12.011

Patient satisfaction with different treatment modalities for vitiligo To the Editor: Vitiligo often has a negative effect on quality of life and several treatments are available; however, patient satisfaction with treatment is a seldom used outcome measure in trials, with a recent systematic review reporting only 7% of studies measuring patient satisfaction in the past 40 years.1-3 The goal of this cross-sectional study was to determine overall patient satisfaction with commonly used treatments for vitiligo. All patients enrolled in the Dallas Vitiligo Registry (DVR) at UT Southwestern Medical Center, Dallas, Texas, from April 2013 to August 2014 were surveyed regarding satisfaction with treatment. The DVR is approved by a local institutional review board and all patients gave informed consent. Treatments included narrowband ultraviolet B (NBUVB) phototherapy, topical corticosteroids, topical tacrolimus, and 1.5-mm punch grafts. Most patients were on combination therapy with at least 2 of the aforementioned treatments at the same time. All had been exposed to each therapy alone for at least 1 month. Patients were asked to assess overall satisfaction with each treatment they had received. Taking into account time commitment, cost, distance traveled, repigmentation achieved, and associated side effects, each patient marked a visual analog scale (VAS) in which 0 indicated extreme dissatisfaction and 100 indicated extreme satisfaction.

Phototherapy had the highest satisfaction score of 78, while topical tacrolimus had the lowest score of 41 (Table I). A one-way analysis of variance showed a statistically significant difference between the means (P \ .001). A multiple comparison analysis using a Tamhane post hoc test to determine which pairs of the group were significantly different showed a significant difference between phototherapy and topical corticosteroids (P \ .001) as well as between phototherapy and topical tacrolimus (P \.001). Although the size of the study was too small to compare topical therapies and grafting, it is clear that NBUVB phototherapy is the most satisfactory treatment to patients. Patients were not queried directly regarding the reasons for their choices, although many stated that NBUVB had superior efficacy in repigmenting their vitiligo lesions compared to topical therapies. A limitation of the study is that most of the patients were on combination therapy and all of the potential treatments were not an option in every patient, making comparison difficult. Another limitation is the lack of uniform duration of treatment for all patients and inclusion of all types of vitiligo. Additionally, 1 month of treatment may be too short a duration of treatment to expect a response. Future studies should control for these factors and compare satisfaction with individual treatments in a larger number of patients used over a longer period of time. Satisfaction with treatment should also be compared to disease severity. Although satisfaction with treatment is not often measured, there is a recent emphasis for more patient-centered approaches to the practice of medicine.4 Patient satisfaction can play an integral role in patient outcome measures and quality of care. As new payment models focusing on patient satisfaction to determine reimbursement rates for physicians and hospitals are developed, these studies will become even more important. Study data were collected and managed using REDCap electronic data capture tools hosted at the

J AM ACAD DERMATOL VOLUME 72, NUMBER 4

University of Texas Southwestern Medical Center. REDCap (Research Electronic Data Capture) is a secure, web-based application designed to support data capture for research studies, providing (1) an intuitive interface for validated data entry, (2) audit trails for tracking data manipulation and export procedures, (3) automated export procedures for seamless data downloads to common statistical packages, and (4) procedures for importing data from external sources. (Paul A. Harris, Robert Taylor, Robert Thielke, et al. Research electronic data capture (REDCap) A metadata-driven methodology and workflow process for providing translational research informatics support, J Biomed Inform. 2009;42:377-381.)

Prince Adotama, BS,a Lucio Zapata, Jr, BS,a Sharif Currimbhoy, MD,a Linda S. Hynan, PhD,b and Amit G. Pandya, MDa Departments of Dermatologya and Clinical Sciences (Biostatistics) and Psychiatry,b University of Texas Southwestern Medical Center, Dallas, Texas Funding sources: The database program used in this study, REDCap, is funded at the University of Texas Southwestern Medical Center as follows: Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1TR001105. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Conflicts of interest: None declared. Correspondence to: Amit G. Pandya, MD, Department of Dermatology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, Texas 75390-9190 E-mail: [email protected] REFERENCES 1. Alikhan A, Felsten LM, Daly M, et al. Vitiligo: a comprehensive overview, Part I. Introduction, epidemiology, quality of life, diagnosis, differential diagnosis, associations, histopathology, etiology, and work-up. J Am Acad Dermatol. 2011;65:473-491. 2. Teovska Mitrevska N, Eleftheriadou V, Guarneri F. Quality of life in vitiligo patients. Dermatol Ther. 2012;25(Suppl 1): S28-S31. 3. Eleftheriadou V, Thomas KS, Whitton ME, Batchelor JM, Ravenscroft JC. Which outcomes should we measure in vitiligo? Results of a systematic review and a survey among patients and clinicians on outcomes in vitiligo trials. Br J Dermatol. 2012;167: 804-884. 4. Capko J. The patient-centered movement. J Med Pract Manage. 2014;29:238-242. http://dx.doi.org/10.1016/j.jaad.2014.12.012

Letters 733

Randomized, parallel group trial comparing home-based phototherapy with institutionbased 308 excimer lamp for the treatment of focal vitiligo vulgaris To the Editor: Vitiligo is a disease associated with the loss of melanin pigments and impaired melanocyte functioning. Phototherapy is a treatment of choice1 but it is time-consuming and can be carried out only at a health institution. As such, many patients tend to be inconsistent with treatment regimens resulting in treatment failure. Home-based phototherapy seems be a viable option for the treatment of focal vitiligo but to date there is no study to our knowledge that determines its effectiveness. We report a randomized parallel group trial comparing home-based phototherapy with institution-based phototherapy using excimer lamp. This trial was approved by the local research ethics committee (National Healthcare Group, Singapore) and all participants gave informed consent. Based on the data by Anbar et al,2 we assumed that approximately 75% of the patients with localized vitiligo treated with narrowband ultraviolet B would show a repigmentation of more than 50%, and calculated that at least 44 patients would be required to show a difference in effectiveness of 10% or more. We recruited 44 patients with stable focal vitiligo and randomized them into 2 groups: 1 using home-based phototherapy (Daavlin Dermapal system, power 5.5 mW/cm2, distance 5 cm [Daavlin, Bryan, OH]) thrice a week, and 1 using institution-based excimer lamp (USHIO [Tokyo, Japan], power 50 mW/cm2, distance 15 cm) treatment twice a week for 6 months. Images were taken at 0 (baseline), 3, and 6 months. At the end of the study, the percentage repigmentation was graded by independent dermatologist as: worsening of vitiligo, no change, slight repigmentation (\50%), good repigmentation ([50% but \75%), excellent repigmentation ([75% but less than complete), and complete repigmentation. There was no statistical difference in baseline variables between the 2 groups in terms of demographics and clinical characteristics (Table I). The home-based phototherapy group seemed to have better efficacy with 72% and 50% in the group achieving good and excellent repigmentation, respectively, in contrast to only 54% and 36% in the excimer group (Table II). However, this difference in response was not statistically significant. As both the excimer lamp and the home-based phototherapy work in the same manner,3-5 this

Patient satisfaction with different treatment modalities for vitiligo.

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