Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 50180

AbstractMaterial and MethodsResultsDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : March | Volume : 16 | Issue : 3 | Page : WC01 - WC05 Full Version

Knowledge and Attitude towards Vitiligo and Psoriasis among Undergraduate Medical Students: A Cross-sectional Observational Study


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53155.16094
Chandrika Nayyar, Rajashekar Talari Srinivas, Hanumanthayya Keloji, Suresh Kumar Kuppuswamy, Savana Waikhom

1. Junior Resident, Department of Dermatology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 2. Professor and Head, Department of Dermatology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 3. Professor, Department of Dermatology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 4. Assistant Professor, Department of Dermatology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India. 5. Junior Resident, Department of Dermatology, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, Karnataka, India.

Correspondence Address :
Dr. Rajashekar Talari Srinivas,
Professor and Head, Department of Dermatology, Sri Devaraj Urs Academy of
Higher Education and Research, Kolar, Karnataka, India.
E-mail: yeshits@rediffmail.com; dr.chandrikamehta@gmail.com

Abstract

Introduction: Understanding the perspective on vitiligo and psoriasis of undergraduate medical students enables us to focus on lacunae areas in their knowledge, and train them to disseminate accurate information to the public. A positive attitude towards vitiligo and psoriasis in society will reduce the psychosocial burden on the patients and deliver better clinical outcomes.

Aim: To assess medical student’s knowledge and attitudes towards vitiligo and psoriasis.

Materials and Methods: This cross-sectional, questionnaire-based, observational study was conducted on 351 undergraduate medical students (third semester onwards) at Sri Devaraj Urs Medical College, Kolar, Karnataka, India, from January 2021 to March 2021. Questionnaire consisted of 28 questions about knowledge and 18 about attitude towards vitiligo and psoriasis, presented through Google docs to the medical students. A score of 75% was considered as having ‘good knowledge’ and ‘positive attitude.’ Fischer’s-exact test was used as a test of significance for qualitative data. Analysis of Variance (ANOVA) was used as a test of significance to identify the mean difference between more than two quantitative variables. The p-value <0.05 was considered as statistically significant.

Results: The study included 351 participants, of which 171 (48.7%) were females and 180 (51.3%) were males. There were 89 (25.3%), 133 (37.9%), and 129 (36.8%) respondents from the second, third, and fourth years, respectively. Good knowledge was observed in 80.9% and 71.5%, and 87.7% and 72.4% had positive attitudes towards vitiligo and psoriasis, respectively. A statistically significant difference (p-value=0.002) was found in attitude between vitiligo and the year of MBBS. A statistically significant difference (p-value=0.004) was found in knowledge between psoriasis and the year of MBBS. Overall, 55.84% thought that psoriasis only concerns the skin. Good knowledge was directly proportional to a positive attitude.

Conclusion: The majority of the undergraduate medical students had ‘good knowledge’ and ‘positive attitude’ towards vitiligo and psoriasis. Good knowledge was highly proportional to a positive attitude. Unfortunately, a considerably high number of participants reported that they would not marry a person with vitiligo or psoriasis.

Keywords

Behaviour, Education, Psychosocial, Stigma, Treatment

Vitiligo is a chronic autoimmune skin disease characterised by chalky white depigmented macules on various body parts (1). Even though vitiligo is an asymptomatic disease, it affects the psyche of the vitiligo patients, especially amongst the Indians, as most of the population is coloured (Fitzpatrick scale IV or V). Two prior studies on the psychosocial aspects have shown that vitiligo may profoundly impact patient’s self-esteem and interpersonal relationships (1),(2),(3),(4). Vitiligo patients experience stigmatisation, embarrassment, and self-consciousness (4). Psoriasis is a chronic inflammatory disease characterised by erythematous scaly plaques (5). Earlier studies have shown a heightened risk for adverse effects such as severe mental health outcomes, including anxiety, depression, substance abuse, and suicidality (6),(7). Visible lesions are a part of the social stigma perceived by these patients (8),(9),(10),(11),(12).

Biases against persons with other visible skin diseases are well documented among healthcare trainees and physicians. This adversely affects clinical care by hindering stigmatised individuals from receiving treatment (5),(13),(14). Effects of stigma on Quality Of Life (QOL) may be dependent on disease severity. Vitiligo patients are more likely to adopt alternative medicines than other cosmetic dermatoses, in which they commonly use allopathy (1). A study from India reported that 55.7% of vitiligo patients believed in the efficacy of alternative medicine compared to 51.7% having confidence in allopathy (1). Overall, uncovering medical professionals’ responses to questionnaires designed to evaluate their knowledge and attitude in persons with psoriasis and vitiligo will help promote steps in reducing stigma (5),(14),(15),(16),(17).

Assessing the knowledge and attitude of undergraduate medical students would give us a glance at their understanding of the disease. In addition, comprehending the lacuna in their knowledge would help develop educational campaigns to release appropriate knowledge and improve attitude. Medical students with sufficient knowledge about vitiligo and psoriasis will disseminate and educate the public. Adequate knowledge in public will significantly contribute to their attitude towards these patients (5),(11),(12),(13). Students will eventually counsel the patients and their families satisfactorily about the disease causes, course, prognosis, treatment options. Such modifications will reduce significant psychological stress, improving the patient’s treatment efficacy (5),(12),(13),(14),(15),(16). A cardinal feature of vitiligo and psoriasis that requires monitoring and intervention is the knowledge and attitude of society (14),(15),(16),(17).

Previous studies have concluded the public’s knowledge to be inadequate, along with negative attitude towards vitiligo and psoriasis patients (17),(18),(19). However, very few studies have approached this issue from a medical student’s perspective. The aim of this study was to explore the knowledge and attitude towards vitiligo and psoriasis amongst undergraduate medical students in a tertiary healthcare centre. A multifaceted understanding of medical student’s opinions of vitiligo and psoriasis will encourage advanced efforts to overcome stigma, enhance QOL, and improve treatment utilisation.

Material and Methods

This cross-sectional, questionnaire-based, observational study was conducted on 351 undergraduate medical students (third semester onwards) at Sri Devaraj Urs Medical College, Kolar, Karnataka, India, from January 2021 to March 2021. The Institutional Ethics Board approved the study (Ethical clearance number- DMC/KLR/IEC/722/2020-21). Confidentiality and privacy of the participants was ensured by excluding identification details. Authors considered 75% as the anticipated good knowledge and positive attitudes in the study population.

Sample size calculation: The sample size was calculated on a hospital-based study that showed that 66.3% of participants had a good knowledge score {95% Confidence Interval (CI)} (1). By taking the expected proportion to be 0.663, 95% CI with an α-error of 5%, the required sample size was 343.

Inclusion criteria: All third semester onwards MBBS students, who consented to be a part of the study, were included in study.

Exclusion criteria: Students with vitiligo or psoriasis, students whose first-degree relatives with these diseases were excluded from the study.

Procedure

All participants were asked to fill two questionnaires-

• One to assess their knowledge (consisted of 14 questions each about vitiligo and psoriasis),
• The other questionnaire had 9 questions each to assess their attitude.

Each questionnaire was given 10 minutes to complete. The questionnaires were adapted from two studies assessing the knowledge and attitude towards vitiligo and psoriasis (20),(21). Few questions were then modified as per the study needs by the researchers and validated by two dermatologists.

Participants filled the questionnaires online through google forms as provided by the principal investigator. Incomplete questionnaires were not accepted as a part of the study.

For the knowledge component of the study instrument, a score of 1 was given for every correct answer, and for the attitude component; a score of 1 was given for a positive attitude. The total score was 14 for knowledge, and 9 for attitude in vitiligo and psoriasis each. The participant who scored 75% and above was considered as having ‘good knowledge’ and below was considered to have ‘poor knowledge’. A score of 75% and above will be scored as ‘positive attitude’ and below will be considered to have ‘negative attitude’ in this study population.

Statistical Analysis

MS Excel, Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM SPSS Statistics, Somers NY, USA) was used to analyse data. Categorical data was represented in the form of frequencies and proportions. The Chi-square test or Fischer’s-exact test (for 2×2 tables only) was used as a test of significance for qualitative data. Continuous data were represented as mean and standard deviation. Independent t-test was used as a test of significance to identify the mean difference between two quantitative variables. Analysis of Variance (ANOVA) was used as a test of significance to identify the mean difference between more than two quantitative variables. Graphical representation of data: MS Excel and MS word was used to obtain various types of graphs. The p-value <0.05 was considered as statistically significant after assuming all the rules of statistical tests.

Results

The study included 351 participants, of which 171 (48.7%) were females and 180 (51.3%) were males. There were 89 (25.3%), 133 (37.9%), and 129 (36.8%) respondents from the second, third, and fourth years, respectively. The participant’s knowledge and attitude about vitiligo and psoriasis are summarised in (Table/Fig 1), (Table/Fig 2), (Table/Fig 3), (Table/Fig 4), (Table/Fig 5).

No statistically significant difference was found between knowledge regarding vitiligo and the year (in between second, third, and fourth years) of MBBS. However, there was a statistically significant difference (p-value=0.002) between attitude towards vitiligo and the year of MBBS (Table/Fig 6). A 73% (65/89), 84.1% (111/133), and 83.1% (108/129) of students from second, third, and fourth years, respectively, had good knowledge about vitiligo. A 79.8% (71/89), 85.6% (113/133), and 95.4% (124/129) of students from second, third, and fourth years, respectively, had a positive attitude towards vitiligo.

A 59.6% (53/89), 71.2% (94/133), and 80% (104/129) of students from second, third, and fourth years, respectively, had good knowledge about psoriasis. A 65.2% (58/89), 75% (99/133), and 74.6% (97/129) and of students from second, third, and fourth years, respectively, had positive attitude towards psoriasis. A statistically significant difference (p-value=0.004) was found between knowledge regarding psoriasis and the year of MBBS. Nevertheless, there was no statistically significant difference found between attitude towards psoriasis and year of MBBS (Table/Fig 6). Students had better knowledge and attitude scores regarding vitiligo than psoriasis.

The mean score of knowledge and attitude regarding vitiligo and psoriasis according to the year of MBBS were calculated. As per the overall mean score, p-value <0.001, therefore a statistically significant difference between knowledge and attitude regarding vitiligo among participants. The p-value <0.001; hence a statistically significant difference between knowledge and attitude regarding psoriasis among participants (Table/Fig 7).

A higher proportion of students with a positive attitude had good knowledge {90.1% (256/284)} in comparison to students with poor knowledge {77.6% (52/67)} towards vitiligo. A more significant percentage of students with negative attitude {22.4% (15/67)} had poor knowledge when compared to good knowledge {9.9% (28/284)} about vitiligo. Most of the students with a positive attitude had good knowledge {80.5% (202/251)} in comparison to students with poor knowledge {52% (52/100} towards psoriasis. A higher percentage of students with negative attitude had poor knowledge {48% (48/100)} when compared to good knowledge {19.5% (49/251)} about psoriasis.

Discussion

To the best of author’s knowledge, this is the first study to evaluate the knowledge and attitude of vitiligo and psoriasis among undergraduate medical students. Only one study documented that the most frequently endorsed myths among medical students about psoriasis were that the disease is not physically painful, is not a serious disease, does not negatively affect physical health, and can be cured (19). The current study was necessary, as previous studies have reported poor public understanding and negative attitude, which affect the lives of many patients with vitiligo and psoriasis (22),(23).

Remarkably, most of the students had sufficient knowledge about vitiligo and psoriasis. For example, 90.03% (316/351) and 82.05% (288/351) of students recognised that vitiligo and psoriasis, respectively, are non infectious diseases. More than two-thirds of respondents were aware that vitiligo and psoriasis are not contagious by touching or sharing things. Concurrent to the present study, the notion of contagiousness was maintained by less number (29.3%) of the participants in the study conducted in Saudi Arabia (24). In another study people assumed psoriasis is contagious and is elated to personal hygiene (25). Good knowledge about the disease was observed to be associated with positive attitude in vitiligo and psoriasis. Inadequate knowledge concerning the nature of these diseases may result in discrimination of these patients (20),(25).

More than two-thirds of respondents identified that vitiligo and psoriasis are not dangerous diseases or caused due to lack of hygiene. Likewise, >90% of students knew that vitiligo or psoriasis is different from leprosy. Similar to this study >50% of the participants were aware that vitiligo and psoriasis are different from leprosy and not caused due to lack of hygiene (26). A 42.29% (173/351) of students were wrongly under the impression that vitiligo is a hereditary disease, whereas 36.47% (128/351) thought that psoriasis is a hereditary disease. In concurrent with this study, Alshammrie FF et al., found that the majority of surveyed participants considered vitiligo an inherited disease (59%) (18).

Only 55.84% (196/351) knew that psoriasis is not a disease that concerns only the skin. The 76.35% (268/351) and 79.49% (279/351) students classified vitiligo and psoriasis, respectively, as immune system diseases. Most of the students were aware that vitiligo and psoriasis result from an unknown cause. 76.92% (270/351) and 85.19% (299/351) students were cognizant that vitiligo and psoriasis, respectively, were more prevalent and exaggerated with exposure to psychological stress. In addition, because vitiligo and psoriasis are often instantly visible to others, patients become victims of social anxiety and emotional stress (25),(27).

An 86.04% (302/351) of students were aware of available treatments for psoriasis, but only 71.51% (251/351) knew that there is a treatment for vitiligo. Lack of sufficient knowledge about the availability of numerous treatment options for vitiligo and psoriasis might result in patients adopting alternative medicine rather than allopathy. As seen in a study conducted by Bhalla M and Thami GP, most vitiligo patients preferred complementary and alternative systems of medicine (28). A relatively higher proportion of subjects responded that vitiligo and psoriasis are not contagious by having a meal together or by air transmission and are not correlated with consumption of specific foods. In contrast, a study conducted in Saudi Arabia showed that the most popular misconception related to vitiligo was taking certain foods, such as milk or fish (29).

In the present study, 87.7% and 72.4% of students showed positive attitude towards vitiligo and psoriasis, respectively. ‘Good knowledge’ about vitiligo and psoriasis was directly proportional to ‘positive attitude’ towards these diseases. For example, they would sympathise with the patients, shake their hands, and eat or share food prepared by them. In contrast to this study, research conducted by Yong SS et al., reported that 42.9% of respondents had concerns about shaking hands, 61.6% about sitting next to patients with psoriasis, and 36.6% about eating foods prepared by patients with psoriasis (30). More than two-thirds of these medical students were ready to engage these patients as their employees. In addition, >90% of students said that they would not stare at these patients.

The 80.91% (284/351) and 70.37% (247/351) of students were ready to continue marital lives with vitiligo and psoriasis, respectively. The most awful response was that many respondents were not willing to marry individuals affected by vitiligo or psoriasis. This might be why it is difficult for these patients to initiate relationships (30). Similar to this study, 69.14% of participants were unwilling to marry a vitiligo patient even when he or she was otherwise a suitable match (1). More than half of the students were ready to ask vitiligo and psoriasis patients about their disease. Supporting this, it has been observed that vitiligo and psoriasis patients tend to develop negative feelings about their condition because of their past experiences (22).

Although according to the year of MBBS, there was no statistically significant difference about knowledge of vitiligo yet there was a statistically significant difference (p-value=0.002) about attitude. Alternatively, there was a statistically significant difference (p-value=0.002) regarding knowledge of psoriasis but there was no statistically significant difference in attitude, according to the year of MBBS. Education of every detailed aspect about vitiligo and psoriasis, especially among medical students, might change the attitude that could prevent the isolation of patients with these diseases. A study conducted in Central India found that being married or engaged in a healthcare-related occupation significantly predictors of good attitude levels (1).

Good knowledge about vitiligo was associated with positive attitude (90.1%). Likewise, good knowledge about psoriasis was associated with positive attitude (80.5%). Thus, in the present study, authors found that the medical student’s knowledge about vitiligo and psoriasis had a significant relationship with their attitude, concurrent with previous studies (20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30).

Focusing on training undergraduate medical students about vitiligo and psoriasis will empower them to disperse correct information about these diseases. Hence, creating awareness in society about these diseases is an essential step to change the attitude towards these illnesses and reduce the emotional burden of these patients.

Limitation(s)

This research was a self-reported and a single-institutional study.

Conclusion

The majority of the undergraduate medical students had ‘good knowledge’ and a ‘positive attitude’ towards vitiligo and psoriasis. Good knowledge was highly proportional to a positive attitude. Unfortunately, a considerably high number of participants reported that they would not marry a person with vitiligo or psoriasis. To reduce stigma, educational campaigns for the medical trainees are the need of the hour, which will lead to a positive attitude and further will decrease the discriminatory behaviour towards the patients and their relatives. Consequently, an increased self-confidence, social integration, and psychological well-being of the patients will result in better treatment outcomes.

References

1.
Asati DP, Gupta CM, Tiwari S, Kumar S, Jamra V. A hospital-based study on knowledge and attitude related to vitiligo among adults visiting a tertiary health facility of central India. J Nat Sci Biol Med. 2016;7(1):27-32. [crossref] [PubMed]
2.
Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in vitiligo: Prevalence and correlates in India. J Eur Acad Dermatol Venereol. 2002;16(6):573-78. [crossref] [PubMed]
3.
Hautmann G, Panconesi E. Vitiligo: A psychologically influenced and influencing disease. Clin Dermatol. 1997;15(6):879-90. [crossref]
4.
Ongenae K, Dierckxsens L, Brochez L, van Geel N, Naeyaert JM. Quality of life and stigmatisation profile in a cohort of vitiligo patients and effect of the use of camouflage. Dermatology. 2005;210(4):279-85. [crossref] [PubMed]
5.
Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: A systematic review of incidence and prevalence. J Invest Dermatol. 2013;133:377-85. [crossref] [PubMed]
6.
Ferreira BI, Abreu JL, Reis JP, Figueiredo AM. Psoriasis and associated psychiatric disorders: A systematic review on etiopathogenesis and clinical correlation. J Clin Aesthet Dermatol. 2016;9(6):36-43.
7.
Kurd SK, Troxel AB, Crits-Christoph P, Gelfand JM. The risk of depression, anxiety, and suicidality in patients with psoriasis: A population-based cohort study. Arch Dermatol. 2010;146(8):891-95. [crossref] [PubMed]
8.
Vardy D, Besser A, Amir M, Gesthalter B, Biton A, Buskila D. Experiences of stigmatisation play a role in mediating the impact of disease severity on quality of life in psoriasis patients. Br J Dermatol. 2002;147(4):736-42. [crossref] [PubMed]
9.
Richards HL, Fortune DG, Griffiths CE, Main CJ. The contribution of perceptions of stigmatisation to disability in patients with psoriasis. J Psychosom Res. 2001;50(1):11-15. [crossref]
10.
Schmid-Ott G, Schallmayer S, Calliess IT. Quality of life in patients with psoriasis and psoriasis arthritis with a special focus on stigmatisation experience. Clin Dermatol. 2007;25(6):547-54. [crossref] [PubMed]
11.
Ginsburg IH, Link BG. Psychosocial consequences of rejection and stigma feelings in psoriasis patients. Int J Dermatol. 1993;32(8):587-91. [crossref] [PubMed]
12.
Hawro M, Maurer M, Weller K, Maleszka R, Zalewska-Janowska A, Kaszuba A, et al. Lesions on the back of hands and female gender predispose to stigmatisation in patients with psoriasis. J Am Acad Dermatol. 2017;76(4):648-54.e2. [crossref] [PubMed]
13.
Pichaimuthu R, Ramaswamy P, Bikash K, Joseph R. A measurement of the stigma among vitiligo and psoriasis patients in India. Indian J Dermatol Venereol Leprol. 2011;77:300-06. [crossref] [PubMed]
14.
Homayoon D, Hiebler-Ragger M, Zenker M, Weger W, Unterrainer H, Aberer E. Relationship between skin shame, psychological distress and quality of life in patients with psoriasis: A pilot study. Acta Derm Venereol. 2020;100(14):adv00205. [crossref] [PubMed]
15.
Sampogna F, Raskovic D, Guerra L, Pedicelli C, Tabolli S, Leoni L, et al. Identification of categories at risk for high quality of life impairment in patients with vitiligo. Br J Dermatol. 2008;159(2):351-59. [crossref] [PubMed]
16.
Chan MF, Thng TGS, Aw CWD, Goh BK, Lee SM, Chua TL. Investigating factors associated with quality of life of vitiligo patients in Singapore: Vitiligo patients in Singapore. Int J Nurs Pract. 2013;19(Suppl 3):03-10. [crossref] [PubMed]
17.
Alghamdi KM, Moussa NA, Mandil A, Alkofidi M, Madani A, Aldaham N, et al. Public perceptions and attitudes toward vitiligo. J Cutan Med Surg. 2012;16(5):334-40. [crossref] [PubMed]
18.
Alshammrie FF, Al Reshidi IG, Al Rashidy MO, Al Anazi SM. Knowledge, attitude, and misconceptions of public regarding vitiligo. J Dermatol Dermatol Surg. 2019;23:16-19. [crossref]
19.
Pearl RL, Wan MT, Takeshita J, Gelfand JM. Stigmatising attitudes toward persons with psoriasis among laypersons and medical students. J Am Acad Dermatol. 2019;80(6):1556-63. [crossref] [PubMed]
20.
Juntongjin P, Rachawong C, Nuallaong W. Knowledge and attitudes towards vitiligo in the general population: A survey based on the simulation video of a real situation. Dermatol Sin. 2018;36:75-78. [crossref]
21.
Özer İ, Yildirim Dİ. Social awareness about psoriasis: Misconceptions, negative prejudices and discriminatory behaviour. Dermatol Ther. 2020;33(6):e14059. [crossref]
22.
Nguyen CM, Beroukhim K, Danesh MJ, Babikian A, Koo J, Leon A. The psychosocial impact of acne, vitiligo, and psoriasis: A review. Clin Cosmet Investig Dermatol. 2016;9:383-92. [crossref] [PubMed]
23.
Bae JM, Lee SC, Kim TH, Yeom SD, Shin JH, Lee WJ, et al. Factors affecting quality of life in patients with vitiligo: A nationwide study. Br J Dermatol. 2018;178(1):238-44. [crossref] [PubMed]
24.
Fatani MI, Aldhahri RM, Al Otaibi HO, Kalo BB, Khalifa MA. Acknowledging popular misconceptions about vitiligo in western Saudi Arabia. J Dermatol Dermatol Surg. 2016;20(1):27-31. [crossref]
25.
Halioua B, Sid-Mohand D, Roussel ME, Maury-le-Breton A, de Fontaubert A, Stalder JF. Extent of misconceptions, negative prejudices and discriminatory behaviour to psoriasis patients in France. J Eur Acad Dermatol Venereol. 2016;30(4):650-54. [crossref] [PubMed]
26.
Tsadik AG, Teklemedhin MZ, Mehari Atey T, Gidey MT, Desta DM. Public knowledge and attitudes towards vitiligo: A survey in Mekelle city, Northern Ethiopia. Dermatol Res Pract. 2020;2020:3495165. [crossref] [PubMed]
27.
Morales-Sánchez MA, Vargas-Salinas M, Peralta-Pedrero ML, Olguín-García MG, Jurado-Santa Cruz F. Impact of vitiligo on quality of life. Actas Dermosifiliogr. 2017;108(7):637-42. [crossref] [PubMed]
28.
Bhalla M, Thami GP. Factors predicting the preference of complementary and alternative systems of medicine in treatment of vitiligo. Indian J Dermatol Venereol Leprol. 2010;76(6):705-07. [crossref] [PubMed]
29.
AlShehri M, Bahashwan E, Alakloby S. Acknowledging popular misconceptions about vitiligo in the Eastern Province of Saudi Arabia. IJMDC. 2021;5(1):23-28. [crossref]
30.
Yong SS, Tan LL, Ch'ng CC, Yahya F, Pok SL, Ch'ng PY, et al. Personal experience and knowledge about psoriasis reduce misconceptions and discriminatory behaviour toward people living with psoriasis in Malaysia. Dermatol Sin. 2020;38:35-38. [crossref]

DOI and Others

DOI: 10.7860/JCDR/2022/53155.16094

Date of Submission: Nov 04, 2021
Date of Peer Review: Nov 30, 2021
Date of Acceptance: Feb 15, 2022
Date of Publishing: Mar 01, 2022

AUTHOR DECLARATATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Nov 08, 2021
• Manual Googling: Feb 14, 2022
• iThenticate Software: Feb 18, 2022 (10%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com