Location, Spreading and Oral Corticosteroids are Associated with Insomnia in Vitiligo Patients: A Case–Control Study

Figures & data

Table 1 Basic Information of the Included Patients

Clinical Parameters	Values
Age (Years, Mean±SD)	30.0±4.5
Gender (Female, n [%])	229 (56.0)
Education (≥Bachelor, n [%])	215 (52.6)
Workplace (Urban, n [%])	293 (71.6)
Smoking (n [%])	40 (9.8)
Alcohol (n [%])	74 (18.1)
Duration of vitiligo(≥3 years, n [%])	199(48.7)
Area of vitiligo (VASI≥6%, n [%])	34 (8.3)
Exposure area (Face and neck, n [%])	237 (57.9)
Insomnia (n [%])	204(49.9)
Progress of vitiligo
Progression	235(57.5)
Stability/Regression	174(42.5)
Treatments
Oral glucocorticoid	85 (20.8)
Glycyrrhiza	266 (65.0)
External ointment	319 (78.0)
Masking agent	29 (7.1)
Psoralen	33 (8.1)
Phototherapy	135 (33.0)
Comorbidity
Hypertension (n, %)	7 (1.7)
Cardiac diseases (n, %)	4 (1.0)
Diabetes mellitus (n, %)	4 (1.0)
Hyperthyroidism (n, %)	31 (7.6)
Depression (n, %)	12 (2.9)

Figure 1 The flow chart of this study.

Table 2 Incidence of Subtypes of Insomnia

Insomnias	Number and Percentage of Patients (n [%])
Primary insomnias
Adjustment sleep disorder	114 (55.9)
Psychophysiological insomnia	28 (13.7)
Insomnia due to mental disorder	17 (8.3)
Inadequate sleep hygiene	13(6.4)
Idiopathic insomnia	6 (2.9)
Total percentage	178 (87.3)
Secondary insomnias
Insomnia due to medical condition	14 (6.9)
Insomnia due to drug or substance	5 (2.5)
Physiological (organic) insomnia	4 (2.0)
Others (such as lactation, ambient noise)	3 (1.5)
Total percentage	26 (12.7)

Table 3 Specific Analysis for the Vitiligo-Related Insomnia (Adjustment Sleep Disorder)

Factors	Number and Percentage of Patients (n [%])	Examples
Development, aggravation, or recurrence of vitiligo	81 (71.1)	Concern about the development, aggravation or reoccur of vitiligo, which may result in constant nightmares
Appearance	77 (67.5)	Physiologically devastating of disfigurement caused by vitiligo which makes them have a singular appearance
Working/campus life	55 (48.2)	Experienced discriminative or unpleasant event due to vitiligo in working or campus life
Fertility problems	54 (47.4)	Concern about the inheritance tendency of vitiligo, hesitate about childbearing
Non-working/ recreational activities	45 (39.5)	Feel embarrassed when changing clothes or expose affected body areas during non-working activities
Financial burden	42 (36.8)	Medical expenses including medicines, camouflage cosmetics, and traffic expenses, etc
Side effects from vitiligo-related drugs	32 (28.1)	Worry about other side-effect caused by steroid such as weight gain, or acne eruption;
Marital relationship or other intimate relationship	31 (27.2)	Vitiligo affect intimate relationship, such as discounted sexual intercourse in marriage bonds, loss of confidence in front of their children

Table 4 Comparisons Between Insomnia Patients and Non-Insomnia Patients in Vitiligo

Clinical Parameters	Insomnia Patients (n=204)	Non-Insomnia Patients (n=205)	P value
Age (Years)	32.1±4.1	27.9±4.2	<0.001*
Gender (Female, n [%])	128 (62.8)	101 (49.3)	0.006*
Education (≥Bachelor, n [%])	97 (47.5)	118 (57.6)	0.851
Workplace (Urban, n [%])	157 (77.0)	136 (66.3)	0.017*
Smoking (n [%])	24 (11.8)	16 (7.8)	0.120
Alcohol (n [%])	42 (20.6)	32 (15.6)	0.191
Duration of vitiligo (≥3 years, n [%])	101(49.5)	98(47.8)	0.806
Area of vitiligo (VASI≥6% , n [%])	19 (9.3)	15(7.3)	0.581
Exposure area (Face and neck, n [%])	137 (67.2)	100 (48.8)	<0.001*
Progress of vitiligo
Progression	134(65.7)	101(49.3)	0.001*
Stability/Regression	70(34.3)	104(50.7)
Treatments
Oral corticosteroids	51 (25.0)	34 (16.6)	0.036*
Glycyrrhiza	136 (66.7)	130 (63.4)	0.558
Topical steroid/calcineurin ointment	153 (75.0)	166 (81.0)	0.181
Camouflage agent	14 (6.9)	15 (7.3)	0.858
Psoralen	17 (8.3)	16 (7.8)	0.844
Phototherapy	71 (34.8)	64 (31.2)	0.441
Comorbidity
Hypertension (n, %)	2 (1.0)	5 (2.4)	0.255
Cardiac diseases (n, %)	3 (1.5)	1 (0.5)	0.313
Diabetes mellitus (n, %)	2 (1.0)	2 (1.0)	0.996
Hyperthyroidism (n, %)	14 (6.9)	17 (8.3)	0.585
Depression (n, %)	11 (5.4)	1 (0.5)	0.003*

Note: *Means significantly different between groups.

Table 5 Analysis of Risk Factors for Vitiligo Patients with Insomnia

Variables	Univariate		Multivariate
	OR (95% CI)	P value	OR^# (95% CI)	P value
Age (years)≥30	1.85(1.19–2.73)	0.006*	–	–
Female	1.52(1.00–2.31)	0.048*	–	–
Vitiligo in face and neck	2.32(1.76–2.87)	0.012*	2.62(2.03–3.17)	0.032*
Progression in vitiligo	2.10(1.23–2.92)	0.023*	2.50(1.62–3.31)	0.002*
Oral corticosteroids	2.41(1.65–3.03)	0.013*	2.71(2.11–3.19)	0.021*
Depression	2.52(1.92–2.93)	0.001*	–	–

Notes: *Indicates statistical significance; ^#adjusted for age, gender and comorbidity; Odds ratios, as well as 95% CIs, were shown.

Abbreviations: OR, odds ratio; CI, confidence interval.