Abstract
Purpose Previous studies confirmed that chronic arsenic exposure could lead to pigmentary changes and hyperkeratosis. However, skin health-related quality of life (HRQoL) among people under lifetime arsenic exposure remains underappreciated. Our study is aimed at investigating several patient-reported outcomes in a population under chronic arsenic exposure. Patients and Methods. A cross-sectional study was conducted in communities in Shimen, China. Dermatologists performed skin examinations for participants. Patient-reported outcomes (PROs) included HRQoL, itch, sleep quality, and symptoms of anxiety and depression. The Dermatology Life Quality Index (DLQI) was used to measure skin HRQoL. The numerical rating scale (NRS) was used to measure the intensity of itching. Sleep disturbance was measured by Pittsburgh Sleep Quality Index (PSQI). Anxiety and depression were measured by two-item Generalized Anxiety Disorder (GAD-2) and Patient Health Questionnaire (PHQ-2), respectively. Results A total of 464 participants suffering from arsenic-related skin lesions finished the assessment of DLQI. Pigmentary changes and arsenical keratosis were not associated with the patient-reported outcomes except PHQ-2. Hair arsenic exceeding 1 μg/g was associated with higher itch NRS and DLQI (P < 0.05). Itch NRS (adjusted β = 0.80, 95% CI: 0.70–0.90, P < 0.01) and hair arsenic concentration (adjusted β = 0.12, 95% CI: 0.01–0.24, P < 0.05) were independently associated with the DLQI. Conclusion HRQoL, sleep quality, and mental wellbeing are impaired in residents under chronic arsenic exposure. Itching and hair arsenic are independent risk factors for impaired HRQoL.
Highlights
In the study of the global burden of diseases, disfigurement and cutaneous symptoms are used to determine the disability weights of skin diseases [1]
Healthrelated quality of life (HRQoL), an important aspect of health outcomes, has been rarely reported among residents suffering from arsenicosis
There were 771 of 1092 participants who were diagnosed with arsenic-related skin lesions (ArSL), and 464 (60%) of them finished the assessment of Dermatology Life Quality Index (DLQI) completely
Summary
In the study of the global burden of diseases, disfigurement and cutaneous symptoms (itch and pain) are used to determine the disability weights of skin diseases [1]. While skin symptoms cause unpleasant feelings and impair quality of life, the impact of disfigurement varies across cultures and regions. In some specific settings such as regions of arsenicosis, how skin lesions and symptoms affect the quality of life remains underappreciated. Arsenic can exert a latent effect to cause skin and internal cancers [2]. Skin lesions were reported as the first sign to indicate arseniasis [3]. Healthrelated quality of life (HRQoL), an important aspect of health outcomes, has been rarely reported among residents suffering from arsenicosis
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