Perspectives on vitiligo treatment: A qualitative study using semi-structured interviews in 45 patients

Background There is not much information on what patients with vitiligo expect from treatment and what they think about the pigmentary changes that develop following treatment. There is also often a discordance between physician and patient perceptions of treatment response. Aim The aim of the study was to ascertain patient perspectives on their vitiligo treatment. Methods Semi-structured interviews were conducted with the help of an interview guide and picture probes, in 45 patients with vitiligo. Purposive sampling was done to include patients who were treatment naïve, currently on therapy or had discontinued treatment. Interviews were recorded, transcribed verbatim, translated to English, and analysed using a framework analytical approach to identify key themes. Results Patients prioritised long-term disease stability, complete repigmentation and lasting repigmentation with good colour match, especially in visible areas. They wanted lesions to be less visible socially and feared negative impact in employment and marriage. Any repigmentation was encouraging but not sufficient for many as a final outcome. Rapid response was preferred, but many were willing to undergo prolonged treatment in the hope of a cure. Treatment adherence was influenced by cost, side effects, regimen complexity, perceived efficacy and recommendation of the treating doctor. Therapy was viewed as self-care that sustained hope, even with incomplete outcomes. Limitations This hospital-based study may be biased toward patients more concerned about vitiligo, with under-representation of those who abandoned, completed, or never sought treatment. Reflexivity, interviewer influence, positionality, and participant vulnerability were not addressed. Conclusion Patients wished for stability and complete repigmentation in visible areas with good colour match but were willing to accept less when ideal outcomes were not possible. There is also significant individual variation in what a patient finds acceptable as a treatment response. The findings emphasise the need for individualised patient needs assessment, providing education and treatment as well as counselling, supported by a strong doctor−patient relationship.