Apparent Skin Research Articles

Gender bias in text-to-image generative artificial intelligence depiction of Australian paramedics and first responders

IntroductionIn Australia, almost 50 % of paramedics are female yet they remain under-represented in stereotypical depictions of the profession. The potentially transformative value of generative artificial intelligence (AI) may be limited by stereotypical errors, misrepresentations and bias. Increasing use of text-to-image generative AI, like DALL-E 3, could reinforce gender and ethnicity biases and, therefore, is important to objectively evaluate. MethodIn March 2024, DALL-E 3 was utilised via GPT-4 to generate a series of individual and group images of Australian paramedics, ambulance officers, police officers and firefighters. In total, 82 images were produced including 60 individual-character images, and 22 multiple-character group images. All 326 depicted characters were independently analysed by three reviewers for apparent gender, age, skin tone and ethnicity. ResultsAmong first responders, 90.8 % (N = 296) were depicted as male, 90.5 % (N = 295) as Caucasian, 95.7 % (N = 312) as a light skin tone, and 94.8 % (N = 309) as under 55 years of age. For paramedics and police the gender distribution was a statistically significant variation from that of actual Australian workforce data (all p < 0.001). Among the images of individual paramedics and ambulance officers (N = 32), DALL-E 3 depicted 100 % as male, 100 % as Caucasian and 100 % with light skin tone. ConclusionGender and ethnicity bias is a significant limitation for text-to-image generative AI using DALL-E 3 among Australian first responders. Generated images have a disproportionately high misrepresentation of males, Caucasians and light skin tones that are not representative of the diversity of paramedics in Australia today.

Gender and Ethnicity Bias of Text-to-Image Generative Artificial Intelligence in Medical Imaging, Part 2: Analysis of DALL-E 3.

Disparity among gender and ethnicity remains an issue across medicine and health science. Only 26%-35% of trainee radiologists are female, despite more than 50% of medical students' being female. Similar gender disparities are evident across the medical imaging professions. Generative artificial intelligence text-to-image production could reinforce or amplify gender biases. Methods: In March 2024, DALL-E 3 was utilized via GPT-4 to generate a series of individual and group images of medical imaging professionals: radiologist, nuclear medicine physician, radiographer, nuclear medicine technologist, medical physicist, radiopharmacist, and medical imaging nurse. Multiple iterations of images were generated using a variety of prompts. Collectively, 120 images were produced for evaluation of 524 characters. All images were independently analyzed by 3 expert reviewers from medical imaging professions for apparent gender and skin tone. Results: Collectively (individual and group images), 57.4% (n = 301) of medical imaging professionals were depicted as male, 42.4% (n = 222) as female, and 91.2% (n = 478) as having a light skin tone. The male gender representation was 65% for radiologists, 62% for nuclear medicine physicians, 52% for radiographers, 56% for nuclear medicine technologists, 62% for medical physicists, 53% for radiopharmacists, and 26% for medical imaging nurses. For all professions, this overrepresents men compared with women. There was no representation of persons with a disability. Conclusion: This evaluation reveals a significant overrepresentation of the male gender associated with generative artificial intelligence text-to-image production using DALL-E 3 across the medical imaging professions. Generated images have a disproportionately high representation of white men, which is not representative of the diversity of the medical imaging professions.

Gender and Ethnicity Bias of Text-to-Image Generative Artificial Intelligence in Medical Imaging, Part 1: Preliminary Evaluation.

Generative artificial intelligence (AI) text-to-image production could reinforce or amplify gender and ethnicity biases. Several text-to-image generative AI tools are used for producing images that represent the medical imaging professions. White male stereotyping and masculine cultures can dissuade women and ethnically divergent people from being drawn into a profession. Methods: In March 2024, DALL-E 3, Firefly 2, Stable Diffusion 2.1, and Midjourney 5.2 were utilized to generate a series of individual and group images of medical imaging professionals: radiologist, nuclear medicine physician, radiographer, and nuclear medicine technologist. Multiple iterations of images were generated using a variety of prompts. Collectively, 184 images were produced for evaluation of 391 characters. All images were independently analyzed by 3 reviewers for apparent gender and skin tone. Results: Collectively (individual and group characters) (n = 391), 60.6% were male and 87.7% were of a light skin tone. DALL-E 3 (65.6%), Midjourney 5.2 (76.7%), and Stable Diffusion 2.1 (56.2%) had a statistically higher representation of men than Firefly 2 (42.9%) (P < 0.0001). With Firefly 2, 70.3% of characters had light skin tones, which was statistically lower (P < 0.0001) than for Stable Diffusion 2.1 (84.8%), Midjourney 5.2 (100%), and DALL-E 3 (94.8%). Overall, image quality metrics were average or better in 87.2% for DALL-E 3 and 86.2% for Midjourney 5.2, whereas 50.9% were inadequate or poor for Firefly 2 and 86.0% for Stable Diffusion 2.1. Conclusion: Generative AI text-to-image generation using DALL-E 3 via GPT-4 has the best overall quality compared with Firefly 2, Midjourney 5.2, and Stable Diffusion 2.1. Nonetheless, DALL-E 3 includes inherent biases associated with gender and ethnicity that demand more critical evaluation.

Clinical vs. chronological skin age: exploring determinants and stratum corneum protein markers of differential skin ageing in 351 healthy women

Apparent skin age can be determined by several clinical measurements and may differ from chronological age, hence defining age acceleration/deceleration (Age A/D). Using data from 360 women with dermatological scoring of 21 clinical signs, we defined 3 well-separated co-occurring classes capturing the dryness, the elasticity and the oily nature of the skin. We related the risk of each clinical signs to the stratum corneum levels of 5 pre-selected proteins, we identified specific chronological age-adjusted signatures of each clinical sign. Using variable selection approaches, we identified 6 (of the 21) clinical signs which were jointly predictive of chronological age and used to define the clinical skin age, and subsequently age A/D. Applying univariate and multivariate approaches we found that stratum corneum levels of insulin degrading enzyme (IDE) was protective against (β = − 1.74, p = 3.3 × 10−6; selection proportion > 90%) accelerated skin ageing. In conclusion, our results support the fact that molecular markers found in the stratum corneum could predict skin ageing acceleration/deceleration.

Indolent systemic mastocytosis (ISM) without skin lesions as a recurrent anaphylaxis: a case report study

Introduction and importance: Mastocytosis encompasses a diverse range of disorders characterized by the clonal accumulation of mast cells in various tissues, including the skin, bone marrow, and gastrointestinal tract. Case presentation: This case report describes a 32-year-old male patient who presented with a history of recurrent anaphylactic attacks and elevated serum tryptase levels without apparent skin involvement. The diagnostic process and clinical implications of non-cutaneous mastocytosis are discussed in the context of existing WHO criteria. Clinical discussion: Mastocytosis, although a rare disease, carries the potential for severe complications and can present with atypical symptoms, thereby complicating its diagnosis and management. Consequently, the development of a reliable diagnostic and therapeutic strategy is of paramount importance. Conclusion: There is a pressing need to delve deeper into the investigation of the potential impacts and manifestations of mastocytosis to further our understanding and enhance patient care.

Gender Bias in Text-to-Image Generative Artificial Intelligence When Representing Cardiologists

Introduction: While the global medical graduate and student population is approximately 50% female, only 13–15% of cardiologists and 20–27% of training fellows in cardiology are female. The potentially transformative use of text-to-image generative artificial intelligence (AI) could improve promotions and professional perceptions. In particular, DALL-E 3 offers a useful tool for promotion and education, but it could reinforce gender and ethnicity biases. Method: Responding to pre-specified prompts, DALL-E 3 via GPT-4 generated a series of individual and group images of cardiologists. Overall, 44 images were produced, including 32 images that contained individual characters and 12 group images that contained between 7 and 17 characters. All images were independently analysed by three reviewers for the characters’ apparent genders, ages, and skin tones. Results: Among all images combined, 86% (N = 123) of cardiologists were depicted as male. A light skin tone was observed in 93% (N = 133) of cardiologists. The gender distribution was not statistically different from that of actual Australian workforce data (p = 0.7342), but this represents a DALL-E 3 gender bias and the under-representation of females in the cardiology workforce. Conclusions: Gender bias associated with text-to-image generative AI when using DALL-E 3 among cardiologists limits its usefulness for promotion and education in addressing the workforce gender disparities.

Skin deposition and permeation kinetics of cannabidiol and delta-9-tetrahydrocannabinol from cannabis extract containing gels

The study aimed to investigate the deposition and permeation characteristics of phytocannabinoids, namely delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), from cannabis extract containing gels. Cannabis extract with 26.3 % CBD and 28.4 % THC was used. The impact of permeation enhancers, namely propylene glycol, diethylene glycol monoethyl ether (DEGEE), ethanol (EtOH), and terpenes (eucalyptol and menthol), was examined. All cannabis extract gels had a pH range of 6.71–6.81 and a viscosity range of 456.6–4068.7 mPa⋅s. The phytocannabinoid release from the gels followed Zero-order kinetics with a rate of 14.5–25.7 μg⋅h−1 for CBD and 10.0−22.6 μg⋅h−1 for THC. A gel containing 12.5 % DEGEE and 12.5 % EtOH exhibited the highest release rate. The initial skin deposition followed Zero-order kinetics and reached a maximum level after 4 h. Permeation of phytocannabinoids closely followed Higuchi kinetics, with a rate of 0.14–54.21 μg⋅h−1/2 for CBD and 0.23−67.02 μg⋅h−1/2 for THC. A gel containing 25 % DEGEE and 25 % EtOH exhibited the highest apparent skin partition coefficient (K) value, resulting in the greatest phytocannabinoid deposition and permeation. Terpene introduction (5 %) significantly reduced the release rate, K value, and total skin absorption of phytocannabinoids. These findings offer useful insights into selecting the appropriate vehicle for cannabis extract topical products.

Gender and ethnicity bias in generative artificial intelligence text-to-image depiction of pharmacists.

In Australia, 64% of pharmacists are women but continue to be under-represented. Generative artificial intelligence (AI) is potentially transformative but also has the potential for errors, misrepresentations, and bias. Generative AI text-to-image production using DALL-E 3 (OpenAI) is readily accessible and user-friendly but may reinforce gender and ethnicity biases. In March 2024, DALL-E 3 was utilized to generate individual and group images of Australian pharmacists. Collectively, 40 images were produced with DALL-E 3 for evaluation of which 30 were individual characters and the remaining 10 images were comprised of multiple characters (N = 155). All images were independently analysed by two reviewers for apparent gender, age, ethnicity, skin tone, and body habitus. Discrepancies in responses were resolved by third-observer consensus. Collectively for DALL-E 3, 69.7% of pharmacists were depicted as men, 29.7% as women, 93.5% as a light skin tone, 6.5% as mid skin tone, and 0% as dark skin tone. The gender distribution was a statistically significant variation from that of actual Australian pharmacists (P < .001). Among the images of individual pharmacists, DALL-E 3 generated 100% as men and 100% were light skin tone. This evaluation reveals the gender and ethnicity bias associated with generative AI text-to-image generation using DALL-E 3 among Australian pharmacists. Generated images have a disproportionately high representation of white men as pharmacists which is not representative of the diversity of pharmacists in Australia today.

Gender bias in generative artificial intelligence text-to-image depiction of medical students

Introduction: In Australia, 54.3% of medical students are women yet they remain under-represented in stereotypical perspectives of medicine. While potentially transformative, generative artificial intelligence (genAI) has the potential for errors, misrepresentations and bias. GenAI text-to-image production could reinforce gender biases making it important to evaluate DALL-E 3 (the text-to-image genAI supported through ChatGPT) representations of Australian medical students. Method: In March 2024, DALL-E 3 was utilised via GPT-4 to generate a series of individual and group images of medical students, specifically Australian undergraduate medical students to eliminate potential confounders. Multiple iterations of images were generated using a variety of prompts. Collectively, 47 images were produced for evaluation of which 33 were individual characters and the remaining 14 images were comprised of multiple (5 to 67) characters. All images were independently analysed by three reviewers for apparent gender and skin tone. Consequently, 33 feature individuals were evaluated and a further 417 characters in groups were evaluated ( N = 448). Discrepancies in responses were resolved by consensus. Results: Collectively (individual and group images), 58.8% ( N = 258) of medical students were depicted as men, 39.9% ( N = 175) as women, 92.0% ( N = 404) with a light skin tone, 7.7% ( N = 34) with mid skin tone and 0% with dark skin tone. The gender distribution was a statistically significant variation from that of actual Australian medical students for individual images, for group images and for collective images. Among the images of individual medical students ( N = 25), DALL-E 3 generated 92% ( N = 23) as men and 100% were of light skin tone ( N = 25). Conclusion: This evaluation reveals the gender associated with genAI text-to-image generation using DALL-E 3 among Australian undergraduate medical students. Generated images included a disproportionately high proportion of white male medical students which is not representative of the diversity of medical students in Australia. The use of DALL-E 3 to produce depictions of medical students for education or promotion purposes should be done with caution.

Subcutaneous Basal Cell Carcinoma arising from Surgical Drain Insertion Site: A Case Report

Basal cell carcinoma (BCC) is the most common type of skin cancer and primarily affects the sun-exposed areas of the body. It usually presents as visible skin lesions; cases of subcutaneous BCC without apparent skin involvement are extremely rare. Here, we present the case of an 81-year-old female who underwent hysterectomy for an ectopic pregnancy 50 years prior and presented with a subcutaneous mass in the lower abdomen that gradually increased in size over the previous 6 months. The mass only displayed a mild hypertrophic scar the color of skin at the site where a surgical drain had been inserted. Ultrasonography revealed a nonspecific soft tissue tumor, for which we recommended an ultrasound-guided biopsy. Histopathological analysis indicated the need to differentiate between BCC and trichoblastoma. Subsequent wide excision with a 5-mm margin confirmed the BCC diagnosis. This case highlights the challenges in diagnosing and managing subcutaneous BCC with unusual clinical symptoms.

Solubilization mechanism of α-glycosylated naringin based on self-assembled nanostructures and its application to skin formulation

We previously reported that α-glycosylated naringin (naringin-G), synthesized by enzyme-catalyzed transglycosylation, can enhance the solubility of poorly water-soluble compounds without surface-active property. However, the solubilization mechanism has not been fully elucidated. In this study, the solubilization mechanism of naringin-G was investigated using nuclear magnetic resonance (NMR) spectroscopy, and its application in skin formulations was further investigated. 1H NMR and dynamic light scattering measurements at various concentrations confirmed the self-assembled nanostructures of naringin-G above a critical aggregation concentration of approximately 2.2 mg/mL. Two-dimensional 1H–1H nuclear Overhauser effect spectroscopy and solubility tests revealed that flavone with poor water solubility, could be solubilized in its self-assembled structure with a stoichiometric relationship with naringin-G. When naringin-G was included in the skin formulation, the permeated amount and permeability coefficient (Papp) of flavones improved up to four times with increasing amounts of naringin-G. However, flavone solubilization by adding an excessive amount of naringin-G resulted in a decreased permeated amount and Papp of flavones, indicating the interplay between the apparent solubility and skin permeability of flavones. Naringin-G, which forms a nanoaggregate structure without exhibiting surface-active properties, has the potential to enhance the solubility and skin permeation of poorly water-soluble compounds.

Feline tibial osteosynthesis

Diaphyseal fractures of the tibia occur as a result of trauma to the pelvic limb and are a rupture in the continuity of the diaphyseal corticosteroid bone. Animals with this type of fracture must be evaluated to determine whether it is the result of contusion or pathology, such as neoplasms. The study reports the case of a three-year-old mixed-breed feline, weighing three and a half kilos, with non-weight-bearing lameness on the right pelvic limb. The patient was attacked by a dog five days before the appointment. Upon physical examination, it was possible to observe loss of bone continuity in the right pelvic limb in the tibia region. There was an increase in volume, without apparent skin lesions. Radiographic, blood count and biochemical exams were performed. Based on clinical presentation, physical examination, imaging diagnosis and laboratory results, it was concluded that the animal had a fracture of the distal third diaphyseal tibia. Osteosynthesis of the tibia was indicated as treatment, in addition to prescription analgesics to alleviate the patient's pain.

Juvenile eosinophilic fasciitis: a single center case series

BackgroundEosinophilic fasciitis (EF) is a rare disease characterized by skin induration and musculoskeletal abnormalities. Diagnostic criteria for EF are based on adult populations. There is a need to expand the literature on EF in children due to limited reported cases and potential differences compared to adults.MethodsWe conducted a retrospective review of medical records for six pediatric patients diagnosed with EF at our institution between November 2011 and April 2023. Inclusion criteria required patients to be under 18 years of age at the time of diagnosis and to have confirmed diagnosis through clinical history, imaging, and histology.ResultsMost of our cohort were female (83%) and non-Hispanic white (50%). Age at diagnosis ranged from 4 to 16 years. Duration of symptoms before diagnosis varied from 1 to 12 months. Follow-up periods ranged from 14 to 123 months. Concurrent medical conditions included localized scleroderma, acquired thrombophilia, and juvenile idiopathic arthritis. Patients presented with progressive painful swelling, severe joint limitations, and positive prayer sign. Initial regimens involved corticosteroids and methotrexate. Hydroxychloroquine, immunoglobulin, mycophenolate mofetil, rituximab, and tocilizumab were also used depending on the patient’s disease severity and course.ConclusionsJuvenile EF may manifest as swelling and progressive induration without apparent skin abnormalities. Unlike adult populations, no underlying malignancies or associations with trauma were observed in our cohort. Our cases did not exhibit systemic involvement observed in previous studies on juvenile EF. While non-specific, the prayer sign may aid in early recognition of juvenile EF and help prevent long-term disability.

Species- and sex-specific chemical composition from an internal gland-like tissue of an African frog family.

Intraspecific chemical communication in frogs is understudied and the few published cases are limited to externally visible and male-specific breeding glands. Frogs of the family Odontobatrachidae, a West African endemic complex of five morphologically cryptic species, have large, fatty gland-like strands along their lower mandible. We investigated the general anatomy of this gland-like strand and analysed its chemical composition. We found the strand to be present in males and females of all species. The strand varies in markedness, with well-developed strands usually found in reproductively active individuals. The strands are situated under particularly thin skin sections, the vocal sac in male frogs and a respective area in females. Gas-chromatography/mass spectrometry and multivariate analysis revealed that the strands contain sex- and species-specific chemical profiles, which are consistent across geographically distant populations. The profiles varied between reproductive and non-reproductive individuals. These results indicate that the mandibular strands in the Odontobatrachidae comprise a so far overlooked structure (potentially a gland) that most likely plays a role in the mating and/or breeding behaviour of the five Odontobatrachus species. Our results highlight the relevance of multimodal signalling in anurans, and indicate that chemical communication in frogs may not be restricted to sexually dimorphic, apparent skin glands.

A non-invasive mouse model that recapitulates disuse-induced muscle atrophy in immobilized patients

Disuse muscle atrophy occurs consequent to prolonged limb immobility or bed rest, which represents an unmet medical need. As existing animal models of limb immobilization often cause skin erosion, edema, and other untoward effects, we here report an alternative method via thermoplastic immobilization of hindlimbs in mice. While significant decreases in the weight and fiber size were noted after 7 days of immobilization, no apparent skin erosion or edema was found. To shed light onto the molecular mechanism underlying this muscle wasting, we performed the next-generation sequencing analysis of gastrocnemius muscles from immobilized versus non-mobilized legs. Among a total of 55,487 genes analyzed, 787 genes were differentially expressed (> fourfold; 454 and 333 genes up- and down-regulated, respectively), which included genes associated with muscle tissue development, muscle system process, protein digestion and absorption, and inflammation-related signaling. From a clinical perspective, this model may help understand the molecular/cellular mechanism that drives muscle disuse and identify therapeutic strategies for this debilitating disease.

Ginger Extract-Loaded Transethosomes for Effective Transdermal Permeation and Anti-Inflammation in Rat Model.

Ginger extract (GE) has sparked great interest due to its numerous biological benefits. However, it suffers from limited skin permeability, which challenges its transdermal application. The target of the current work was to develop transethosomes as a potential nanovehicle to achieve enhanced transdermal delivery of GE through the skin. GE-loaded transethosomes were prepared by cold injection using different edge activators. The fabricated nanovesicles were evaluated for particle size, ζ-potential, encapsulation efficiency, and in vitro drug release. The selected formulation was then laden into the hydrogel system and evaluated for ex vivo permeability and in vivo anti-inflammatory activity in a carrageenan-induced rat-paw edema model. The selected formulation comprised of sodium deoxycholate exhibited particle size of 188.3±7.66 nm, ζ-potential of -38.6±0.08 mV, and encapsulation efficiency of 91.0%±0.24%. The developed transethosomal hydrogel containing hydroxypropyl methylcellulose was homogeneous, pseudoplastic, and demonstrated sustained drug release. Furthermore, it exhibited improved flux (12.61±0.45 μg.cm2/second), apparent skin permeability (2.43±0.008×10-6 cm/second), and skin deposition compared to free GE hydrogel. In vivo testing and histopathological examination revealed that the GE transethosomal hydrogel exhibited significant inhibition of edema swelling compared to free GE hydrogel and ketoprofen gel. The animals that were treated with ginger transethosome hydrogel showed a significant decrement in reactive oxygen species and prostaglandin E2 compared to untreated animals. Transethosomes might be a promising new vehicle for GE for effective skin permeation and anti-inflammation. To the best of our knowledge, this work is the first utilization of transethosomes laden into hydrogel as a novel transdermal delivery system of GE.

The Effect of Background Color on Skin Color Variation of Juvenile Plectropomus leopardus.

Fish skin color is usually strongly affected by the background color of their environment. The study investigated the effects of five different background colors on the skin color of leopard coral groupers (Plectropomus leopardus). More than 450 juveniles were reared in Blue, Red, Black, White, and Transparent background tanks for 56 days. The paraffin section showed that the skin melanin zone of fish in the White group was smaller, whereas the Black and Red groups (especially Black) were nearly the largest. The apparent skin color of P. leopardus was red on the white background, which darkened in response to the other color backgrounds. The Black group revealed the blackest skin color, followed by the transparent group. Moreover, the White group had the highest L*, a*, and b* values. The melanin content and tyrosinase activity in the dorsal and ventral skin of the Black group were significantly higher than those in the other groups (p < 0.05), and the serum α-MSH level was higher in the Black group as well. The carotenoid and lutein contents showed completely different trends among the experimental groups, as carotenoid content was higher in the Red and White groups, while lutein content was higher in the Transparent group. The expression level of scarb1 was highest in the Blue and White groups, followed by the Transparent group, and lowest in the Black group (p < 0.05). The expression trend of scarb1 was similar to the skin color in different backgrounds, indicating that the background color regulated scarb1 expression level through visual center, then influenced the uptake and transport of carotenoids, then influenced the skin color formation of P. leopardus. Moreover, lighter colors inhibited the formation of melanocytes and had a significant effect on carotenoid and lutein contents. Pigment-related genes were involved in the regulation of fish skin color, and they were affected by background color in P. leopardus. These results indicate that a white background is more conducive to maintaining red skin color in juvenile P. leopardus.

Makeup applied to facial features increases perceived skin evenness

Facial cosmetics have powerful effects on person perception, such as increasing perceived attractiveness and competence. One specific aspect of facial appearance affected by makeup is apparent skin evenness. Here, we tested the notion that makeup makes facial skin look more homogeneous in part because of changes made not to the skin, but to the facial features. In two studies, participants made ratings of perceived skin evenness. Ratings were made on two versions of the same faces. In one version, no makeup of any kind was worn, while in the other version, the faces had makeup applied only on the features (digitally in Study 1 and by a professional makeup artist in Study 2). Critically, no makeup was worn on the skin in either condition, such that the physical skin homogeneity was identical. Across both studies, skin was rated as appearing more even in the condition with makeup applied to the facial features. This indicates that cosmetics make facial skin appear more even partly due to products applied only to the facial features. These findings are consistent with recent work demonstrating that skin appearance is affected by contrast with adjacent surfaces, possibly via contrast gain control.

A mould in the fold should never grow old: cutaneous aspergillosis in a preterm neonate

A boy born at 25 weeks of gestation (birth weight 560 g) due to feto-fetal transfusion syndrome (mono-chorionic, di-amniotic gemini) was noticed on his ninth day of life to have multiple skin lesions on the abdomen, buttocks, and thighs (Figure 1A, B). The mother and his twin brother had no apparent skin abnormalities. Microbiological cultures from skin swabs and scrapings yielded growth of moulds, suggestive of Aspergillus species (Figure 1C-G). Matrix assisted laser desorption/ionization time-of-flight mass spectrometry confirmed Aspergillus fumigatus.

Psychosocial Distress and Quality of Life Among Patients With a Chronic Skin Disorder at a Tertiary Care Hospital in Eastern India: A Hospital-Based Case-Control Study.

Background Chronic skin disorder affects the physical and psychological well-being of patients. The impact of psychological burden ranges from low self-esteem and stress to anxiety and depression. Hence, this study was conducted to compare the psychological distress and quality of life (QoL) of patients with a comparative group without any apparent skin disorders. Methods This hospital-based case-control study was done on adult patients (≥18 years) suffering from any chronic skin disorder for three or more months and attending the dermatology out patient department (OPD) of a tertiary care institution of Eastern India. Data was collected from 101 patients and 101 controls (matched for age, gender, and place of residence) after obtaining written informed consent in May and June, 2017. Depression was assessed using the Patient Health Questionnaire-9, anxiety was assessed using the Generalised anxiety disorder-7 scale, and health-related quality of life (HRQoL) was assessed using the World Health Organization Quality-of-Life Scale (WHOQoL-BREF). Prevalence and mean scores were compared using Chi-square test and t-test. Results About half (49.5%) of the cases had clinically significant impairment of their dermatological quality of life. Clinically significant depression and anxiety was found in 45.54% and 41.58% patients respectively. Depression (OR=4.13, 95% CI 2.06-8.45) and anxiety (OR=4.42, CI=2.13-9.51) were significantly higher in cases as compared to the controls. No significant difference was seen in HRQoL scores. Conclusion Screening for anxiety, depression, and QoL should be done for patients of chronic skin disorders attending dermatology OPD so that appropriate psychiatric consultation can be offered to those in need.