Introduction
Vitiligo is a chronic skin condition characterised by progressive depigmentation, or loss of pigment, which leads to the formation of white patches on the skin. It represents the most common depigmentation disorder worldwide [1]. It occurs predominantly in women and its overall prevalence worldwide ranges from 0.5% to 2%. Almost half of patients develop acquired vitiligo before the age of 20 and approximately 70% to 80% before the age of 30 [1]. Nowadays, physical appearance is becoming increasingly important, and the skin lesions accompanying this dermatosis can cause numerous emotional, social and psychological difficulties. For many people, the disease becomes a source of shame, leading to withdrawal from social life and lower self-esteem. Despite medical advances and the emergence of new therapeutic methods that can improve the appearance of the skin, vitiligo still poses a major challenge for both patients and practitioners dealing with this condition. Recent studies show that people affected by vitiligo often struggle with mental health issues such as depression, anxiety, suicidal thoughts, identity disorders, and a persistent sense of low self-esteem. In addition, they experience reduced life satisfaction, partly due to feelings of stigmatisation, discomfort with their appearance, and difficulties in interpersonal relationships [2]. The problems are not limited to the emotional sphere. Skin lesions can interfere with professional, social and intimate life. Patients with vitiligo often struggle to establish relationships, both friendships and romantic partnerships. Fear of rejection, as well as fear of negative reactions from others, lead to avoidance of intimacy, which in turn can affect the quality of intimate and marital life [3, 4].
Difficulties in accepting skin lesions, concerns about appearance and negative reactions from others often lead to reduced life satisfaction and significant deterioration in patients’ mental health. Skin lesions covering large areas of the body can be difficult to hide, which increases feelings of insecurity and fear of social stigmatisation. The disease not only alters physical appearance, but also affects emotions, mental health and social relationships, consequently leading to a reduced quality of life [5].
Cases of depression have been reported in 55% of patients with vitiligo, and patients themselves perceive lowered self-esteem, increased feelings of stress and discrimination in their environment [6].
Aim
The aim of the study was to assess the relationship between life satisfaction in individuals with vitiligo and the level of social support and degree of acceptance of the disease.
Material and methods
Study design
The cross-sectional study was conducted between February and March 2025 using a diagnostic survey method with an online questionnaire.
Setting and sample
The survey was conducted online by making the questionnaire available via a Google form. Respondents were invited to participate in the study via social media, namely the support group “Bielactwo – porady, wsparcie” on Facebook, which has over 6,600 members. Ultimately, 215 correctly completed questionnaires were analysed. Inclusion criteria for the study were voluntary consent to participate in the study, age over 18 years, and the presence of vitiligo skin lesions. The exclusion criteria were lack of consent to participate in the study, age below 18 years, and declared absence of vitiligo skin lesions. The questionnaire did not contain any data that enabled the identification of participants, and it took approximately 10 min to complete the questionnaire.
Research tools
The study used an author-designed questionnaire comprising 36 questions. Thirty of them concerned experiences related to the disease, and six questions were sociodemographic in nature (including age, gender, place of residence, marital status, education, duration of disease). The Satisfaction With Life Scale (SWLS) by Diener et al. in the Polish adaptation by Juczyński [7] was used to assess satisfaction with life. The scale consisted of five statements, which were rated on a seven-point Likert scale (1 – strongly disagree, 7 – strongly agree). The total score ranged from 5 to 35 points, with higher scores indicating greater satisfaction with life. Results and their interpretation: 5 to 9 – very low life satisfaction, 10 to 14 – low life satisfaction, 15 to 19 – moderate life satisfaction, 20 to 24 – medium life satisfaction, 25–30 – very high life satisfaction, and 31–35 – extremely high life satisfaction [7]. Acceptance of illness was assessed using the Acceptance of Illness Scale (AIS) by Felton et al. in the Polish adaptation by Juczyński [7]. The scale comprised eight statements describing the consequences of poor health. Answers were provided on a five-point Likert scale (1 – strongly agree, 5 – strongly disagree). The total score ranged from 8 to 40 points, with higher scores indicating better acceptance of the disease. There are three point ranges and corresponding levels of disease acceptance: 8–15 points – low level, 16–28 points – medium level, and 29–40 points – high level [8]. The level of perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS) by Zimet et al., in the Polish adaptation by Buszman and Przybyła-Basista [9]. The scale consisted of 12 statements rated on a seven-point Likert scale (1 – strongly disagree, 7 – strongly agree). It was possible to obtain results of both the subscales as and on the overall scale, with higher values indicating higher levels of perceived social support. Support score ranges: 0–28 points – low sense of support, 29–56 points – medium sense of support, and 57–84 points – high sense of support [9].
Statistical analysis
The collected data were statistically analysed using the PQ STAT programme. The values of qualitative variables are presented as absolute values and percentages. For such variables, the significance of differences within individual groups was verified using Pearson’s χ2 test. The values of quantitative variables are presented using the mean and standard deviation, median, and minimum and maximum values. For calculation purposes, statistical significance was assumed at a level of p < 0.05.
Results
A total of 215 patients were included in the study. Women were predominant among the respondents (88.8%). The majority of study participants lived in cities (82.8%) and had higher education (65.6%). In the group studied, most of the individuals were married and employed, and their average age was 39. The earliest age of disease onset was birth, whereas the latest age of onset was 64 years. The average duration of the disease was 18 years. The characteristics of the study participants are presented in Table 1.
Table 1
Sociodemographic characteristics of study participants
During the study, respondents were asked to rate statements related to their acceptance of the disease and external appearance. Based on the results, it was possible to conclude that 33% (n = 71) of respondents felt that vitiligo hindered their social functioning and interpersonal relationships. A similar proportion of respondents (42.3%; n = 91) indicated that the disease negatively affected their quality of life. Despite these difficulties, the vast majority of respondents (58.6%; n = 126) declared that they accepted their disease. Slightly fewer people, 54.9% (n = 118), accepted their physical appearance, while only 17.7% (n = 38) indicated that vitiligo negatively affected their sex life. More than half of the respondents (53.4%; n = 115) felt discomfort, anxiety and embarrassment about exposing their bodies. Importantly, 57.2% of respondents (n = 123) attempted to hide the symptoms of the disease with clothing, make-up and other masking measures. The details are shown in Table 2.
Table 2
Statements related to the acceptance of the disease and external appearance
The level of illness acceptance was assessed based on responses to individual items of the Acceptance of Illness Scale (AIS). Half of the respondents scored no less than 36 points. The lowest acceptance of the disease was demonstrated by a person who scored 8 points, and the highest by a person who scored 40 points. Life satisfaction was assessed based on responses to individual questions in the SWLS questionnaire. The higher the score, the greater the satisfaction with life. Half of the patients scored no more than 24 points. The lowest score was 5 points and the highest 35 points. The MSPSS questionnaire was also used to assess the sense of support. The lowest sense of support was demonstrated by a patient who scored 20 points, and the highest by a patient who scored 80 points (Table 3).
Table 3
Descriptive statistics and scores for acceptance of the disease, sense of social support and life satisfaction
The study showed that the majority of respondents did not experience suicidal thoughts and social ostracism. However, half of the respondents (49.8%) did not experience prolonged low mood, while a slightly smaller portion (41.8%) experienced such episodes. The distribution of responses concerning prolonged low mood due to disease, suicidal thoughts and feelings of social ostracism was analysed. Statistically significant differences were found in long-term low mood due to disease, suicidal thoughts and feelings of ostracism. The vast majority of respondents denied suicidal thoughts and feelings of social ostracism. However, as many as 41.8% of respondents indicated that they had experienced a prolonged deterioration in their mood due to their disease (Table 4).
Table 4
Significance of differences in long-term low mood, suicidal thoughts and feelings of social ostracism due to their disease (n = 215)
Respondents were also asked about the negative impact of vitiligo on their social functioning, interpersonal relationships and intimate life, which is indirectly related to life satisfaction. The results showed that there are statistically significant differences in the negative impact of vitiligo on social functioning, interpersonal relationships and intimate life. Respondents indicated that vitiligo does not have a negative impact on social functioning, interpersonal relationships and intimate life (Table 5).
Table 5
The negative impact of vitiligo on social functioning, interpersonal relationships and intimate life
The analysis of the relationship between variables showed that life satisfaction correlates significantly positively with acceptance of the disease (p < 0.001), which means that a higher level of acceptance of one’s own disease is associated with increased life satisfaction. A statistically significant positive correlation was also found between life satisfaction and social support (p < 0.001), indicating that people who experience greater social support have a higher quality of life (Table 6).
Discussion
Vitiligo is a chronic, autoimmune skin disease characterised by selective loss of melanocytes and the appearance of discoloured patches. The disease affects a variety of age groups and occurs in approximately 0.5–2% of people in the global population, causing both dermatological symptoms and significant psychosocial consequences. Although usually classified as an autoimmune skin disease, vitiligo has a significant impact on patients’ life satisfaction. Systematic reviews and population-based studies confirm that patients with vitiligo experience reduced mental well-being, higher rates of anxiety and depression, and limitations in social and occupational functioning – effects that translate directly into lower life satisfaction [2, 10]. The mean age of onset in the study group was 20 years, which is consistent with the literature. Tang et al. indicated that in over half of patients, vitiligo begins between the ages of 10 and 30, with the average age of onset being around 20 [11]. Similar results were presented by Al-Smadi et al., who emphasised that the disease most often appears between the ages of 20 and 24, usually between the ages of 10 and 30 [12]. A study by Clemente Hernández et al. found that around 50% of patients develop vitiligo before the age of 20, and 70–80% before the age of 30. The age of onset of vitiligo tends to decrease with the age of the patient [13]. Developing vitiligo at a young age has particular psychological importance, as it coincides with a period of identity formation, relationship building and the development of self-esteem. During this time, physical appearance often plays a key role in self-esteem, so skin lesions can cause significant psychological distress. For this reason, young patients should receive special psychological and educational support. In turn, studies by Rosmarin et al. have shown that significant predictors of reduced satisfaction are: greater body surface area (BSA) involvement, location of lesions in visible areas (especially on the face and hands) and darker skin phototype. The authors also emphasise that younger age and shorter time since diagnosis intensify patients’ negative experiences [14].
Our own research showed that the average duration of the disease was 18 years, with a standard deviation of 12 years and a median of 16 years. The shortest duration of vitiligo was 1 year and the longest was 58 years. A study conducted by Wang et al. found that age, marital status and duration of the disease were among the most important factors affecting the psychosocial well-being of patients with vitiligo. Older patients, married patients, and patients with a long history of the disease performed better in terms of self-assessment compared to younger patients, single patients, or patients who had been recently diagnosed. These results suggest that a longer duration of vitiligo may be associated with better psychosocial adjustment in patients [15, 16]. A study conducted by Kruger et al. showed that factors such as longer duration of the disease were associated with a greater impact of vitiligo on life decisions. The most affected choices were those related to clothing, social interactions and lifestyle [17].
The studies analysed the impact of vitiligo on social functioning, interpersonal relationships and intimate life. Respondents were asked to assess the statements. Patients disagreed with the statements: Vitiligo hinders my functioning in society and interpersonal relationships, Vitiligo negatively affects my quality of life, and Vitiligo negatively affects my sex life. In turn, most respondents agreed with the statements: I accept my disease, I accept my appearance, Exposing my body makes me feel uncomfortable, anxious, embarrassed, and I try to hide my disease with make-up. Statistical tests showed that there are statistically significant differences in the negative impact of vitiligo on social functioning, interpersonal relationships and intimate life. Respondents indicated that vitiligo does not have a negative impact on social functioning, interpersonal relationships and intimate life. Kruger et al.’s study involved 96 patients with vitiligo and 23 individuals in the control group. The results showed that stigmatisation was a common phenomenon among people with vitiligo – as many as 90% of respondents experienced unwanted attention, such as questions or intrusive stares, and almost a quarter (24%) encountered unpleasant comments. In addition, 66.7% of patients admitted that they avoid certain social situations or try to hide their skin lesions. People with vitiligo also scored significantly higher on all psychological scales compared to the control group: Social anxiety and avoidance: 36.9 vs. 22.1; Helplessness: 27.3 vs. 16.0; Anxious-depressive mood: 19.4 vs. 15.6. In the entire group of patients, 66.7% avoided certain situations due to vitiligo, i.e. shaking hands, swimming, sports. In addition, two-thirds of the respondents (65.6%) declared that they “quite often” or “very often” try to hide their patches in public spaces, most often with clothing (15.6%), make-up or cosmetic camouflage (14.6%) and appropriate body positioning (7.3%). Importantly, most patients used a combination of all these methods – as many as 40.6% of respondents indicated combining clothing, body posture and camouflage to cover skin lesions [17]. According to the VALIANT study, at least 40% of patients worldwide reported that vitiligo often affects aspects of their daily life, including their choice of clothing (55.2%). The majority of patients (59.4%) reported that they often hide their vitiligo. A systematic review revealed that disorders related to depression (41 studies, 0.1–62.3%) and anxiety (20 studies, 1.9–67.9%) were the most commonly reported psychosocial comorbidities. The most common psychosocial comorbid disorders were feelings of stigmatisation (8 studies, 17.3–100%), adjustment disorders (12 studies, 4–93.9%), sleep disorders (7 studies, 4.6–89.0%), relationship difficulties, including sexual dysfunction (ten studies, 2.0–81.8%), and avoidance or restriction behaviours (12.5–76%). Their prevalence was significantly higher compared to healthy individuals [2]. The results of large population studies conducted by Bibeau et al. indicate that the intensity of psychosocial stress correlates with clinical features: a higher percentage of body surface area (BSA) affected, the location of lesions in visible areas (especially on the face and hands) and a darker skin phototype are associated with greater deterioration in HRQoL and greater emotional distress in patients [10]. In turn, research conducted by Kaundinya et al. showed that involvement of the genital area was a risk factor for sexual dysfunction [18]. The data collected clearly indicate that, despite their declared acceptance of their own appearance, patients with vitiligo often take measures to mask their condition and avoid social situations, which may indicate internal conflict, insecurity or experiences of stigmatisation. The results confirm that vitiligo can significantly affect various aspects of life: social functioning, interpersonal relationships and quality of sexual life. Mental discomfort, the need to hide the disease, and frequent stress and depression should be important signals for medical staff.
The care of patients with vitiligo should include not only dermatological aspects, but also regular assessment of their emotional state, monitoring of depressive symptoms and their sense of social support. Early recognition of prolonged low mood and offering psychological and educational support can significantly improve the adaptation process and life satisfaction of patients.
The study conducted was cross-sectional in nature, which limits the possibility of drawing conclusions about the directionality of the relationship between acceptance of the disease, life satisfaction, social support and the occurrence of low mood. The sample was not fully representative – it was dominated by women, people with higher education and city dwellers, which may limit the generalisation of the results to the entire population of patients with vitiligo. Additionally, relying solely on self-reported psychometric tools carries the risk of under- or overestimating symptoms due to subjective factors (e.g. response style, cultural norms).
Conclusions
Although the majority of participants denied having suicidal thoughts and experiencing social ostracism, a significant proportion of participants reported long-term low mood, which highlights the need for regular monitoring of emotional well-being in this population. Vitiligo was not commonly perceived as a significant barrier to social relationships or intimate life, however, many respondents experienced discomfort associated with exposing their bodies and made attempts to hide skin lesions through clothing or make-up, indicating persistent challenges in the area of self-presentation. The results highlight the need for holistic care that combines dermatological treatment with psychological and social support to enhance adaptive processes and improve the overall quality of life of people with vitiligo.
