Comparative effectiveness of basic and complex therapy for non-segmental vitiligo with comorbid anxiety and anxiety-depressive adjustment disorders

Rationale. Vitiligo is associated with a high psychosocial burden and comorbid anxiety and depressive adjustment disorders, which reduce treatment adherence and quality of life in patients. Basic therapy does not always provide reduction of nosogenic reactions, which justifies the need for a comprehensive approach including psychopharmacotherapy.

Objective. To conduct a comparative analysis of the effectiveness of basic and combination therapy (including alimemazine or maritupirdine) in patients with non-segmental vitiligo and concomitant anxiety and anxiety-depressive adjustment disorders, and to evaluate the clinical significance of repigmentation at the stage of prolonged dermatological treatment.

Materials and methods. A single-center, randomized, prospective study included 80 patients (39 men, 41 women; mean age 38.2±13.0 years) with nonsegmental vitiligo (VIDA ≥ +1) and clinically significant manifestations of anxiety and/or depression according to the Hospital Anxiety and Depression Scale (HADS-A and/or HADS-D ≥11). Adjustment disorder (F43.2) was verified during the initial consultation. Patients were randomized into three groups: group 1 – basic therapy (UVB-311 nm and external agents), group 2 – basic therapy and alimemazine (10–20 mg/day), group 3 – basic therapy and maritupirdine (20–40 mg/day). Basic treatment was carried out in two courses of 20 sessions with a 30-day interval; Psychopharmacotherapy – during the first 8 weeks. The condition was assessed at baseline, 8, and 20 weeks using the HADS, DIQI, VASI, and VES scales.

Results. After 20 weeks, the median relative reduction in VASI in group 1 was 32.1 % (27.4–41.7), in group 2–36.4 % (28.8–45.0), and in group 3–39.6 % (30.2–47.8) (p=0.192). According to VES, by week 20, the dynamics were 36.5 % (21.7–49.4) in group 1, 44.2 % (27.7–56.1), and in group 3–45.1 % (40.9–52.5) (p=0.137). Normalization of anxiety (HADS-A <8) after 20 weeks was noted in the first group in 13/26 (50.0 %), in the second – 25/27 (92.6 %) and in the third – 4/26 (15.4 %), 2nd – 17/27 (63.0 %) and 3rd – 20/27 (74.1 %) (p<0.001).

Conclusion. Stress-associated nosogenic adjustment disorders with anxiety and anxiety-depressive symptoms, developing against the background of  dermatosis, clinically aggravate the course of non-segmental vitiligo and reduce the quality of life of patients receiving basic therapy. The inclusion of alimemazine or maritupirdine in the combination treatment regimen is associated with a significantly more pronounced reduction in anxiety and depression according to the HADS and an increase in clinically significant improvements in the DIQL. Positive dynamics are noted in all groups for the VASI/ VES dermatological indices, however, early and sustained clinically significant repigmentation is more often achieved in the combination therapy groups.

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