{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:40:33Z","timestamp":1789479633704,"version":"build-2803163510"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2025,10,24]],"date-time":"2025-10-24T00:00:00Z","timestamp":1761264000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Vitiligo, particularly when involving the face, is associated not only with visible disfigurement but also with profound psychosocial consequences. Despite growing interest in the psychosomatic dimensions of skin diseases, the relationship between facial vitiligo and social appearance anxiety remains underexplored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate the level of social appearance anxiety in patients with facial vitiligo and to compare it with healthy controls. Further, to examine how this anxiety correlates with broader psychological and quality-of-life parameters. In addition, we conducted secondary analyses, including subgroup comparisons based on facial lesion location, and moderation analysis using general anxiety as a moderator.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional case\u2013control study was conducted among 156 patients with nonsegmental facial vitiligo and 143 demographically matched healthy controls. All participants completed the Social Appearance Anxiety Scale (SAAS) and the Hospital Anxiety and Depression Scale (HADS). Patients with vitiligo additionally completed the Dermatology Life Quality Index and a visual analogue scale assessing perceived disease severity. Facial lesion regions were classified anatomically (forehead, periorbital, perioral, mandibular) for subgroup analysis. Moderation analysis was performed to examine whether general anxiety (HADS-Anxiety) moderated the relationship between lesion visibility and SAAS scores.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>SAAS scores were markedly higher in the group with vitiligo (mean 55.2, SD 9.2) than in controls (mean 19.7, SD 8.4), with a large effect size (Cohen\u2019s d = 4.16; P &amp;lt; 0.001). In patients with vitiligo, SAAS scores were significantly correlated with anxiety (r = 0.75), depression (r = 0.50), quality-of-life impairment (r = 0.41) and perceived severity (r = 0.61); all P &amp;lt; 0.01. Subgroup analysis revealed significantly higher SAAS scores among patients with periorbital and perioral involvement than in those with mandibular or isolated forehead lesions (P &amp;lt; 0.05). Moderation analysis confirmed that the strength of association between lesion location and SAAS was significantly amplified in patients with high HADS-A scores (interaction term P &amp;lt; 0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Facial vitiligo imposes a substantial psychological burden, characterized by elevated social appearance anxiety that extends beyond general psychopathology. Our findings suggest that specific lesion sites, particularly periorbital and perioral areas, are more psychologically distressing and that general anxiety amplifies this impact. These results underscore the need for tailored psychosocial support depending on lesion location and baseline anxiety levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ced\/llaf471","type":"journal-article","created":{"date-parts":[[2025,10,23]],"date-time":"2025-10-23T12:21:58Z","timestamp":1761222118000},"page":"387-392","source":"Crossref","is-referenced-by-count":11,"title":["The impact of facial vitiligo on social appearance anxiety: a case\u2013control study"],"prefix":"10.1093","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3718-0458","authenticated-orcid":false,"given":"Faruk","family":"Kurhan","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, Y\u00fcz\u00fcnc\u00fc Y\u0131l University , Van ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0819-2871","authenticated-orcid":false,"given":"\u0130brahim Halil","family":"Yavuz","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Ba\u015fak\u015fehir \u00c7am and Sakura City Hospital , \u0130stanbul ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,10,24]]},"reference":[{"key":"2026022406164156300_llaf471-B1","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jaad.2016.12.041","article-title":"The Vitiligo Working Group recommendations for narrowband ultraviolet B light phototherapy treatment of vitiligo","volume":"76","author":"Mohammad","year":"2017","journal-title":"J Am Acad Dermatol"},{"key":"2026022406164156300_llaf471-B2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1111\/j.1600-0625.2007.00666_1.x","article-title":"Vitiligo pathogenesis: autoimmune disease, genetic defect, excessive reactive oxygen species, calcium imbalance, or what else?","volume":"17","author":"Schallreuter","year":"2008","journal-title":"Exp Dermatol"},{"key":"2026022406164156300_llaf471-B3","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/j.det.2016.11.014","article-title":"Vitiligo pathogenesis and emerging treatments","volume":"35","author":"Rashighi","year":"2017","journal-title":"Dermatol Clin"},{"key":"2026022406164156300_llaf471-B4","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-030-45582-8","volume-title":"The Essentials of Psychodermatology","author":"Jafferany","year":"2020"},{"key":"2026022406164156300_llaf471-B5","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1007\/s40257-021-00631-6","article-title":"Psychosocial effects of vitiligo: a systematic literature review","volume":"22","author":"Ezzedine","year":"2021","journal-title":"Am J Clin Dermatol"},{"key":"2026022406164156300_llaf471-B6","doi-asserted-by":"crossref","first-page":"833","DOI":"10.2165\/00128071-200304120-00003","article-title":"Psychiatric and psychological co-morbidity in patients with dermatologic disorders: epidemiology and management","volume":"4","author":"Gupta","year":"2003","journal-title":"Am J Clin Dermatol"},{"key":"2026022406164156300_llaf471-B7","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1038\/jid.2014.530","article-title":"The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries","volume":"135","author":"Dalgard","year":"2015","journal-title":"J Invest Dermatol"},{"key":"2026022406164156300_llaf471-B8","doi-asserted-by":"crossref","first-page":"67","DOI":"10.2340\/00015555-1193","article-title":"Patients with psoriasis feel stigmatized","volume":"92","author":"Hrehor\u00f3w","year":"2012","journal-title":"Acta Derm Venereol"},{"key":"2026022406164156300_llaf471-B9","doi-asserted-by":"crossref","first-page":"234","DOI":"10.4274\/haseki.galenos.2021.7183","article-title":"Social appearance anxiety in patients with acne vulgaris: a case\u2013control study","volume":"59","author":"Kurhan","year":"2021","journal-title":"Haseki Tip Bulteni"},{"key":"2026022406164156300_llaf471-B10","doi-asserted-by":"crossref","first-page":"589","DOI":"10.5505\/ejm.2021.52280","article-title":"Social appearance anxiety in patients with contact dermatitis","volume":"26","author":"Kurhan","year":"2021","journal-title":"East J Med"},{"key":"2026022406164156300_llaf471-B11","doi-asserted-by":"crossref","first-page":"216","DOI":"10.14744\/nci.2025.26928","article-title":"Exploring the phenomenon of social appearance anxiety in individuals suffering from seborrheic dermatitis: comprehensive insights derived from a case\u2013control study","volume":"12","author":"Tumturk","year":"2025","journal-title":"North Clin Istanb"},{"key":"2026022406164156300_llaf471-B12","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav Res Methods"},{"key":"2026022406164156300_llaf471-B13","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1177\/1073191107306673","article-title":"Development and examination of the Social Appearance Anxiety Scale","volume":"15","author":"Hart","year":"2008","journal-title":"Assessment"},{"key":"2026022406164156300_llaf471-B14","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1111\/j.1600-0447.1983.tb09716.x","article-title":"The Hospital Anxiety and Depression Scale","volume":"67","author":"Zigmond","year":"1983","journal-title":"Acta Psychiatr Scand"},{"key":"2026022406164156300_llaf471-B15","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/j.1365-2230.1994.tb01167.x","article-title":"Dermatology Life Quality Index (DLQI): a simple practical measure for routine clinical use","volume":"19","author":"Finlay","year":"1994","journal-title":"Clin Exp Dermatol"},{"key":"2026022406164156300_llaf471-B16","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis","author":"Hayes","year":"2022","edition":"3rd edn"},{"key":"2026022406164156300_llaf471-B17","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/j.1468-3083.2005.01369.x","article-title":"Psychosocial effects of vitiligo","volume":"20","author":"Ongenae","year":"2006","journal-title":"J Eur Acad Dermatol Venereol"},{"key":"2026022406164156300_llaf471-B18","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1016\/S0190-9622(96)90112-7","article-title":"Psychologic effects of vitiligo: a critical incident analysis","volume":"35","author":"Kent","year":"1996","journal-title":"J Am Acad Dermatol"},{"key":"2026022406164156300_llaf471-B19","first-page":"203","article-title":"Psychodermatology: a guide to understanding common psychocutaneous disorders","volume":"9","author":"Jafferany","year":"2007","journal-title":"Prim Care Companion J Clin Psychiatry"},{"key":"2026022406164156300_llaf471-B20","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1111\/bjd.16049","article-title":"The prevalence of psychological comorbidity in people with vitiligo: a systematic review and meta-analysis","volume":"178","author":"Osinubi","year":"2018","journal-title":"Br J Dermatol"},{"key":"2026022406164156300_llaf471-B21","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1111\/ced.14511","article-title":"Evaluation of the Dermatological Life Quality Index, sexual dysfunction and other psychiatric diseases in patients diagnosed with vitiligo with and without genital involvement","volume":"46","author":"Yucel","year":"2021","journal-title":"Clin Exp Dermatol"},{"key":"2026022406164156300_llaf471-B22","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1038\/s41398-023-02644-7","article-title":"A brain model of altered self-appraisal in social anxiety disorder","volume":"13","author":"Jamieson","year":"2023","journal-title":"Transl Psychiatry"},{"key":"2026022406164156300_llaf471-B23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1348\/000711299160077","article-title":"Coping with the disfiguring effects of vitiligo: a preliminary investigation into the effects of cognitive-behavioural therapy","volume":"72","author":"Papadopoulos","year":"1999","journal-title":"Br J Med Psychol"},{"key":"2026022406164156300_llaf471-B24","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1348\/014466502163949","article-title":"Psychological stress, distress and disability in patients with psoriasis: consensus and variation in the contribution of illness perceptions, coping and alexithymia","volume":"41","author":"Fortune","year":"2002","journal-title":"Br J Clin Psychol"},{"key":"2026022406164156300_llaf471-B25","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1016\/j.jpsychores.2006.09.002","article-title":"Alexithymia and global psychosocial functioning: a study on patients with skin disease","volume":"62","author":"Picardi","year":"2007","journal-title":"J Psychosom Res"}],"container-title":["Clinical and Experimental Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ced\/advance-article-pdf\/doi\/10.1093\/ced\/llaf471\/64925332\/llaf471.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/51\/3\/387\/64925332\/llaf471.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ced\/article-pdf\/51\/3\/387\/64925332\/llaf471.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T11:16:52Z","timestamp":1771931812000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ced\/article\/51\/3\/387\/8301030"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,24]]},"references-count":25,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,10,24]]},"published-print":{"date-parts":[[2026,2,24]]}},"URL":"https:\/\/doi.org\/10.1093\/ced\/llaf471","relation":{},"ISSN":["0307-6938","1365-2230"],"issn-type":[{"value":"0307-6938","type":"print"},{"value":"1365-2230","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,3]]},"published":{"date-parts":[[2025,10,24]]}}}