Cosmetic camouflage of visible skin lesions enhances life quality indices in leprosy as in vitiligo patients: an effective stigma reduction strategy

The use of cosmetic camouflage for blemishes on skin of affected people is known to improve their Dermatology Life Quality Index (DLQI). Although the use and benefits of cosmetic camouflage is known and reported in vitiligo, its value in leprosy, where visible skin lesions are a reason for stigma and discrimination, is yet to be explored. A key resolution of the WHO Global Leprosy Strategy 2016-2020 is to stop discrimination and promote inclusion of persons affected by leprosy into society. Improving the DLQI of leprosy patients with the use of cosmetic camouflage is an effort in that direction. Objectives: We undertook this study to examine the change brought about by cosmetic camouflage in the DLQI of leprosy patients with visible skin lesions and, to compare the results with its use in vitiligo, as both are disorders associated with pigment dilution in the skin. Methods: The DLQI score was calculated for 9 consenting leprosy and 14 vitiligo patients at the time of enrolment. All patients were taught the simple technique of cosmetic camouflage of their skin patches on exposed parts of the body, such as face and arms/forearms. The DLQI scoring was calculated again after one month of use of cosmetic camouflage and compared with the baseline value. Results: The mean DLQI improved significantly (p < 0.0001) after the use of cosmetic camouflage in both vitiligo and leprosy groups, indicating the efficacy of camouflage in improving the quality of life. In addition, it was observed that the mean improvement in DLQI was higher in the leprosy group (14.67 +/- 3.87) than in the vitiligo group (8.64 +/- 2.96), the difference being statistically significant (p < 0.05), suggesting that camouflage has a very high impact on the quality of life in leprosy. Conclusions: Leprosy-related stigma and discrimination are pervasive in almost all cultures of the world. Such stigma affects many aspects of social participation. The WHO global strategy document 2016-2020 advocates inclusion of at least one stigma reduction strategy in all leprosy programme plans. Use of cosmetic camouflage for visible skin lesions on exposed parts of the body in leprosy patients could be one such strategy.