Dermatology Life Quality Research Articles

Quality of life among dermatology patients: a systematic review of investigations using qualitative methods.

Quality of life may be assessed using quantitative or qualitative methods. Quantitative methods are commonly used in research settings; however, they may fail to capture the full range of patient experiences and impact on quality of life. Qualitative methods may be used to address this limitation. In this systematic review, we aim to synthesize data from articles utilizing qualitative methods to assess quality of life in dermatology patients. We performed a systematic review search using the MEDLINE, EMBASE, and SCOPUS databases. The search was conducted using the following search criteria: ("Dermatology" [MeSH]) AND ("Quality of Life" [MeSH]), AND ("Qualitative Research" [MeSH]), searching literature spanning from January 1, 1946 to October 5, 2016. The systematic review of 15 articles included 533 dermatology patients. Patients expressed frustration over the unpredictability of disease symptoms and having to compensate for the subsequent limitations by altering their daily routines. Patients also reported profound helplessness due to chronic skin disease and social isolation in an effort to hide their disease. Patients noted the patient-provider relationship as a source of support and information exchange, with the goal to form easy to use treatment plans that met both physician and patient expectations. Qualitative assessment of patient quality of life can provide new insights into the patient experience and the impact of their skin disease. Qualitative methodology may capture meaningful information that may be overlooked by quantitative methods, and it should be included in quality of life research.

Changes in dermatology quality of life, sleep, and symptoms during the 24-week open-label period of XTEND-CIU: A phase IV, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of omalizumab through 48 weeks

Changes in dermatology quality of life, sleep, and symptoms during the 24-week open-label period of XTEND-CIU: A phase IV, multicenter, randomized, double-blind, placebo-controlled study to evaluate the efficacy and safety of omalizumab through 48 weeks

Factors influencing cardiometabolic risk profile in patients with psoriasis.

Psoriasis has been associated with metabolic syndrome and with an increased cardiovascular risk especially in patients with severe disease. The goal of this study was to estimate the prevalence of metabolic syndrome and other cardiovascular risk factors and its association with the psoriasis severity, sex and age. Consecutive patients with psoriasis were enrolled in a prospective study over a 1-year period. Blood samples were collected. Psoriasis area and severity index (PASI) and body surface area scores and two dermatology quality of life (DQOL) questionnaires were used to evaluate psoriasis severity and the impact of the disease. Altogether 178 patients were included, of whom 44% had moderate-severe psoriasis. The overall prevalence of metabolic syndrome was 30% (men 34%, women 26%) without significant differences between patients with severe and mild disease. Age and menopause appeared to increase the risk for metabolic syndrome. Patients with severe psoriasis smoked more heavily, were more likely to have diabetes or insulin resistance and had higher homocysteine and lower high density lipoprotein cholesterol (HDL-C) levels than patients with mild psoriasis (P < 0.05). In women, a higher waist circumference was observed. Women had higher HDL-C levels and lower smoking and alcohol consumption rates. In accordance with the systematic coronary risk evaluation system, 18% of the patients had a high 10-year risk of fatal cardiovascular disease. Psoriasis severity was associated with diabetes, insulin-resistance, smoking habit and higher cardiovascular risk. Metabolic syndrome was related to age and menopause but not to psoriasis severity.

Family quality of life among families of children with atopic dermatitis.

BackgroundAtopic dermatitis (AD) may cause emotional distress and impairs the quality of life (QoL) in children and their families.ObjectiveWe examined family QoL of children with AD and explored associated factors such as disease severity and psychosocial factors among parents of children with AD.MethodsStudy participants were 78 children (1 month to 16 years old) diagnosed with AD and their parents visiting an outpatient clinic of the Department of Pediatrics in Inha University Hospital. Data were collected using structured questionnaires and medical record review. Parents completed the Dermatitis Family Impact questionnaire (DFI), the Positive Affect and Negative Affect Schedule, the Satisfaction with Life Scale, and the Korean Parenting Stress Index. For children aged below 6-year-old, parents were asked to complete the Infants' Dermatologic Quality of Life. SCOring Atopic Dermatitis (SCORAD), Children's Dermatology Life Quality Index, and the Pediatric Quality of Life Inventory version 4.0 Generic Core Scale were also completed.ResultsThe mean age of parents and children were 37.4 ± 5.3 years and 65.1 ± 45.7 months, respectively. Among them, 87.2% of parents were mothers and 60.3% of children were boys. The mean score of DFI was 11.2 ± 6.0. The mean SCORAD score was 28.3 ± 16.1. Family who experienced strong negative emotionality had a 3.8 times higher probability of experiencing a lower QoL than parents who did not (odds ratio [OR], 3.82; p = 0.041). Family of children with higher severity of AD had a 6.6 times (OR, 6.55; p = 0.018) higher probability of experiencing a low family QoL than their less-severe counterparts. Families of girls with AD had a lower QoL (OR, 8.40; p = 0.003) than families of boys.ConclusionFamily QoL among parents of children with AD was low and associated with parent’s psychosocial characteristics as well as disease severity of the children. Considering parental involvement in AD management for children, emotional support for parents can be helpful in long journey of disease management.

The importance of mindfulness in psychosocial distress and quality of life in dermatology patients.

SummaryBackgroundMindfulness, defined as purposively and nonjudgementally paying attention in the present moment, could be used within psychosocial interventions to reduce the distress associated with social anxiety and avoidance found in many skin conditions. However, little is known about the relationship between naturally occurring levels of mindfulness and distress in dermatology patients.ObjectivesTo examine the relationship between mindfulness and psychosocial distress in a dermatological population. It was hypothesized that higher levels of mindfulness would be associated with lower levels of social anxiety, anxiety, depression and skin shame, and with better quality of life.MethodsAdult dermatology outpatients (n = 120) from one hospital completed items assessing subjective severity, skin shame, fear of negative evaluation, anxiety and depression, quality of life, and levels of mindfulness.ResultsConsidering depression, 14% reported mild, 5% moderate and 2·5% severe symptoms. For anxiety, 22% reported mild, 23% moderate and 6% severe symptoms. In addition, 33·4% reported clinically significant social anxiety. After controlling for subjective severity, mindfulness explained an additional 19% of the variance in depression, 39% in anxiety, 41% in social anxiety, 13% in skin shame and 6% in dermatological quality of life. One specific facet of mindfulness (acting with awareness) was found to be the most consistent predictor of distress.ConclusionsThe findings indicate that higher levels of mindfulness are associated with lower distress. This suggests that facilitating mindfulness may be helpful in reducing distress in dermatology patients, and the use of mindfulness techniques warrants further investigation.

Depression, Anxiety and Stress among Saudi Arabian Dermatology Patients: Cross-sectional study.

This study aimed to determine the prevalence of depression, anxiety and stress among Saudi Arabian dermatology patients and to assess associations with sociodemographic and clinical characteristics. This cross-sectional study was conducted among 300 consecutive dermatology patients visiting King Abdulaziz Medical City in Riyadh, Saudi Arabia, in August 2015. The Arabic version of the Depression, Anxiety and Stress Scale was used to screen for symptoms of depression, anxiety and stress. Quality of life (QOL) was assessed using the Dermatology Life Quality Index. A total of 254 dermatology patients participated in the study (response rate: 84.7%). The prevalence of depression, anxiety and stress was 12.6%, 22.1% and 7.5%, respectively. The presence of at least one of these negative emotional states was noted among 24.4% of the cohort (95% confidence interval: 19.3-30.2%). Depression was significantly higher among subjects who lacked family support (26.5% versus 10.7%; P = 0.006) while anxiety was less common among patients who engaged in physical exercise (14.5% versus 29.4%; P = 0.005). According to the multivariate logistic regression analysis, poor QOL and a lack of family support were significant predictors of a negative emotional state. Almost a quarter of the studied Saudi Arabian dermatology patients were found to suffer from at least one negative emotional state. A lack of family support and poor QOL were the primary factors associated with a negative emotional state. Interventional studies are needed to examine the effects of social and family support on psychological conditions among Saudi Arabian dermatology patients.

The Impact of Inflammatory and Infectious Diseases of Vulvar on Quality of Life.

ObjectivesThis study aimed to evaluate the effects of vulvar dermatoses (VD) and vulvar infections (VE) on anxiety, depression scores, general, and dermatological quality of life (QOL) of women.MethodsWe conducted a cross-sectional survey on patients diagnosed with VD and VE. All patients were assessed using a sociodemographic form, Skindex-29 scale, World Health Organization QOL (WHOQOL) BREF scale, Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D).ResultsHAM-A score was significantly higher in the VD group than in the control group. Based on age groups, all subscales of Skindex-29 were found to be higher in women > 50 years. For women with severe pruritus, the symptom subscale was higher in patients with skin involvement and the function and emotion subscales were higher in patients with and emotion subscales were higher in patients with mucosal involvement.ConclusionsWe found that VD was particularly significantly associated with decreased QOL.

Quality of life, self-esteem and psychosocial factors in adolescents with acne vulgaris.

BackgroundDermatological diseases, among which acne vulgaris, have psychological impact on the affected generating feelings of guilt, shame and social isolation.ObjectivesTo compare quality of life, self-esteem and other psychosocial variables amongst adolescents with and without acne vulgaris, and between levels of severity.MethodsCross-sectional observational study in a sample of 355 high school students from the city of João Pessoa. Data collection was performed with questionnaires and clinical-dermatological evaluation. The primary variables were the incidence of AV; quality of life, set by the Children's Dermatology Quality of Life Index and Dermatology Quality of Life Index; and self-esteem, measured by the Rosenberg Self-Esteem Scale. For calculation of statistical tests, we used the SPSS 20.0 software, considering p=0.05.ResultsThe sample, with an average age of 16, showed 89.3% prevalence of acne vulgaris. The most prevalent psychosocial issue was "afraid that acne will never cease", present in 58% of affected youth. The median score of Quality of Life in Children's Dermatology Index was different amongst students with and without acne vulgaris (p=0.003), as well as the Quality of Life in Dermatology (p=0.038) scores, so that students with acne vulgaris have worse QoL. There was a correlation between the severity of acne vulgaris and worse quality of life. Self-esteem was not significantly associated with the occurrence or severity of acne vulgaris.Conclusionsacne vulgaris assumes significance in view of its high prevalence and the effect on quality of life of adolescents, more severe at the more pronounced stages of disease (p<0.001). The psychosocial impact of acne vulgaris should be valued in the management of patients with this condition.

Screening for depressive disorders in outpatients with mild to moderate psoriasis: a study from North India.

Psoriasis and depressive disorders commonly occur together. Depressive disorders have an impact on the quality of life and the outcome of psoriasis. The aim of this study was to test the feasibility of using a modification of the Hindi translation of the Patient Health Questionnaire-9 (PHQ-9) as a verbal, clinician administered, short screening questionnaire for detecting depressive disorders. One hundred and four out-patients with psoriasis were recruited in the study. In the first stage of the study, socio-demographic data, Psoriasis Area Severity Index (PASI) score, and Dermatological Quality of Life (DLQI) score were recorded. The modified questionnaire was administered by the dermatologist. In the second stage, psychiatric diagnoses were confirmed using the Mini International Neuropsychiatric Interview. The prevalence of depressive disorders was 39.4%. Receiver operating curve (ROC) analysis showed that the questionnaire had a good discriminant ability in detecting depressive disorders (area under curve: 0.81, SE = 0.04, 95% confidence interval = 0.72-0.89). The sample size is small and more studies are needed with the screening questions in different languages to validate the findings of the study. The questionnaire can be a useful screening instrument for detecting depressive disorders in patients with psoriasis.

Italian observational study in patients with metastatic colorectal cancer (mCRC) treated with first-line cetuximab based regimen (ObservEr study).

e14600 Background: After the Italian Drug Agency (AIFA) approval of cetuximab in mCRC KRASwt, the ObsrvevEr Study was initiated to evaluated quality of life (QoL), skin toxicity management and compliance of cetuximab based regimens in first-line chemotherapy (CT) Methods: ObservEr is a non interventional, observational, prospective study. The primary end point is the evaluation of QoL. Data on QoL (Dermatology Life Quality Index/DLQI, EORTC QLQ-C30) is assessed at baseline and weekly for the first 8 weeks of treatment Results: Between April 2011-November 2012, 233 pts were enrolled in 29 Italian centers, with 229 evaluable pts. Pt characteristics were: 154(67.2%) M, 75(32.8%) F; median age 65y (39-81); ECOG PS-0 78.2%, PS-1 21.8%%; adjuvant CT 81(35.4%); only liver metastasis 98(42.8%). Median interval between request and result of KRAS test in all Italian regions was 10d. The CT regimens in combinations with cetuximab were: IRI-based 149(65.1%), OXA-based 67(29.3%). Capecitabine regimens were administere...

Agreement between two instruments for measuring quality of life in dermatology

Dermatology-specific quality of life measures are now more often used in investigational studies on patients with skin disease. To examine the relationship among the quality of life scores obtained with two dermatology-specific measures. The study included 62 patients with skin diseases, whose quality of life was assessed by the use of the dermatology-specific measures (i.e., Dermatology Life Quality Index-DLQI and Skindex-16), designed for use in all skin diseases. The total scores of DLQI and Skindex-16 correlated strongly with each other (r=0.87; p<0.001). There was also a significant correlation between the DLQI total score and the symptoms, the emotions and the functioning subscale score of Skindex-16 instrument (r=0.53, r=0.77 and r=0.86, respectively). The Skindex-16 total score was not correlated with the treatment subscale score of DLQI; on the other hand, it was correlated with the symptoms and feelings, the daily activities, the leisure, the work or school and the personal relationships subscale score of DLQI (r=0.67, r=0.80, r=0.66, r=0.62 and r=0.68, respectively). Two dermatology-specific measures (e.g. the DLQI and Skindex-16), if used together, could provide complementary information in the evaluation of the quality of life of patients with skin disease.

The Polish version of Skindex-29: psychometric properties of an instrument to measure quality of life in dermatology

IntroductionSkin conditions have a negative impact on quality of life and it is necessary to quantify this impact. Skindex-29 is a self-report questionnaire developed to measure dermatology-specific quality of life.AimThe objective of this study is to adapt this questionnaire to Polish conditions. The adaptation procedure involved the works on the linguistic content of the items and testing psychometric properties of the Polish version of Skindex-29, including item characteristics, factorial structure, aspects of reliability and validity.Material and methodsTwo-hundred and ninety patients (63.4% women and 35.2% men) suffering from a range of skin conditions were recruited from several dermatological out-patient and in-patient clinics in Poland. Quality of life was measured using Skindex-29 and appropriate clinical data were collected.ResultsThe global score of Skindex-29 showed the normal distribution. Cronbach's α reliability coefficients were found to be high to very high for all Skindex-29 indexes. Factor analysis yielded four factors, in contrast to the original version of the questionnaire, for which a three-factor solution had been reported. Skindex-29 validity was demonstrated by showing the differences in the quality of life scores across different diagnostic categories, and between in-patients and out-patients. Skindex-29 global scores were found to be significantly predicted by the localization of the skin lesions on legs, anogenital areas and palms.ConclusionsThe findings of this study support reliability and validity of the Polish version of Skindex-29, but they also raise questions to its three-factor structure.

Quality of life in dermatology: after 125 years, time for more rigorous reporting

Quality of life in dermatology: after 125 years, time for more rigorous reporting

Abstract P6-08-07: Out-of-pocket spending, dermatologic quality of life, and treatment satisfaction in breast cancer radiotherapy patients

Abstract Objective: Skin toxicity is one of the most common acute side effects of breast cancer radiotherapy (RT). Past research has largely neglected non-medical out-of-pocket (OOP) spending associated with this side effect. We therefore developed a Skin Toxicity Costs (STC) questionnaire to assess such spending. The primary goal of the present study was to use the STC to estimate non-medical out-of-pocket spending associated with acute skin toxicity in breast cancer RT patients. Secondary goals included exploration of the associations between the STC, dermatologic quality of life, and satisfaction with RT. Methods: 185 consecutive female breast cancer RT patients (Stage 0-III) participated in the research from 2008 to 2013. All participants received a course of standard fractionated external beam RT. Demographics: mean age = 55.4; 74% White, 10% African American, 16% Other; and 10% Latina. In regard to employment, 46% reported working full-time, 12% part-time, and 42% were not employed. 68% had at least a college degree and 66% reported a household income of ≥ $60,000/year. On their penultimate day of RT, participants completed the STC, the Dermatologic Life Quality Index (DLQI), and a Patient Satisfaction Questionnaire (PSQ). Patients also completed a demographics questionnaire and an Importance of Appearance Scale (IAPP) at the commencement of RT. Note: all patients were provided with skin creams free of charge through the clinic. Results: Analyses revealed no differences in the STC, DLQI, or PSQ based on recruitment site (all ps &amp;gt; .45). Results revealed that 83% of the sample reported OOP spending associated with skin toxicity. Mean STC spending was $245.11 (95% CI: 135.34 to 354.87; Median = $75.00). Multiple regression of demographic factors (ethnicity, race, marital status, employment, education, income) and IAPP revealed that IAPP and marital status uniquely predicted STC spending (ps &amp;lt; .02; total model R2 = .24), such that increased STC was associated with increased importance of appearance and being unmarried. Controlling for IAPP and marital status, STC was significantly associated with DLQI (p&amp;lt;.001), such that increased STC was associated with decreased dermatologic quality of life. Lastly, we examined whether the STC was associated with treatment satisfaction controlling for IAPP, marital status, and DLQI. Results revealed that only STC was uniquely associated with patient satisfaction (p&amp;lt;.001; total model R2 = .39), such that patients with higher STC scores were less satisfied with their RT. Discussion: Results are consistent with recent research suggesting that OOP spending can be considered a “financial toxicity” of cancer treatment, and is associated with lower levels of satisfaction with cancer care. However, the present study is the first to examine this issue with a focus on skin toxicity-related spending in breast cancer patients. The results suggest that OOP spending is linked to patient satisfaction with care. OOP may be a marker of skin toxicity. Future research seeking to manage skin toxicity may have the beneficial downstream consequence of reducing OOP spending and improving overall satisfaction with RT. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-08-07.

The impact of itch on dermatological patients' quality of life, emotional wellbeing and family function

The impact of itch on dermatological patients' quality of life, emotional wellbeing and family function

Management of skin toxicity and cetuximab-based regimen compliance in first-line chemotherapy of metastatic colorectal cancer (mCRC) patients (pts): Results of observer study.

e14557 Background: Cetuximab significantly improves efficacy when added to chemotherapy in mCRC pts. The ObservEr Study evaluated quality of life (QoL), skin toxicity management and treatment compliance of cetuximab-based regimens in first-line treatment of mCRC pts. Methods: ObservEr is a non-interventional, multicenter, prospective study. Primary endpoint is change in QoL during first-line treatment, with focus on the impact of dermatological toxicity. QoL (Dermatology Life Quality Index/DLQI and EORTC QLQ C30) is assessed at baseline and weekly for the first 8 weeks of treatment, then at every evaluation visit until PD or withdrawal. Secondary endpoints are efficacy, rate of liver metastasis resections, incidence of serious adverse events. Results: Between Apr 2011 and Nov 2012, 29 Italian centers enrolled 233 pts, with 226 evaluable pts. Pt characteristics: 152(67.3%) males, 74(32.7%) females; median age 65 (39-81) years; PS ECOG 0-1 95.5%; potentially resectable liver metastasis 59(27.1%); irinotecan regimens 129(57.1%), oxaliplatin regimens 60(26.5%), other regimens 37(16.4%). Median interval between request and result of KRAS test was 10 (6-15) days. Prophylactic skin treatment with vitamin K1 cream was used in 159(70.4%) pts, reactive treatment included vitamin K1 in 59(26.1%). Grade (gr) 1-2 skin toxicity was observed in 128(56.6%) pts, gr 3 in 28(12.4%); no gr 4 was detected. No significant difference in gr 3 skin toxicity was observed between males vs females (13.8 vs 9.5%; p=0.351), age &lt;60 vs ≥60 years (18.1 vs 9.7%; p=0.077), irinotecan vs oxaliplatin regimens (12.4 vs 18.3%; p=0.278), prophylactic vs reactive treatment (15.1 vs 6.8%; p=0.339). Dose reduction, temporary and permanent discontinuation of cetuximab due to skin toxicity was required in 9(4.0%), 32(14.2%) and 7(3.1%) pts respectively; cetuximab compliance ≥70% of dose was reached in 208(92.0%) pts. Conclusions: These results suggest that appropriate skin toxicity management and prophylactic or reactive treatment with Vitamin K1 cream can improve the gr 3 skin toxicity control and the cetuximab compliance. QoL results will be shown at the 2013 ASCO Meeting. Clinical trial information: ID239.

Skin toxicity and treatment compliance of first-line cetuximab with irinotecan, oxaliplatin, and fluoropyrimidines-based chemotherapy in metastatic colorectal cancer (mCRC): The preliminary analysis of observer study.

530 Background: The ObservEr study evaluated the quality of life (QoL), skin toxicity control and treatment compliance of cetuximab plus first-line chemotherapy in a general cohort of patients with mCRC. Methods: ObservEr is a non interventional, observational, multicenter, prospective study. The primary end point is the evaluation of change in QoL during the period in which a first line treatment chemotherapy is given, with specific focus on the impact of the dermatological toxicity of this treatment. Data on QoL (Dermatology Life Quality Index/DLQI and EORTC QLQ C30) is assessed at baseline weekly for the first 8 weeks of treatment. Results: Between April 2011 and September 2012, the expected 210 patients (pts) were enrolled in 31 Italian centers. This preliminary analysis includes 112 pts enrolled to until April 2012. Pt characteristics were: 77(68.7%) males, 35(31.3%) females; median age 70 years (44-80 years); PS ECOG-0 86(76.8%), ECOG-1 36(23.2%); potentially resectable liver metastasis 32(28.6%); chemotherapy regimen FOLFIRI 55(49.1%), XELIRI 13(11.6%), FOLFOX 22(19.6%), XELOX 10(8.9%), irinotecan 4(3.6%), 5FU/AF (de Gramont) 2(1.8%), others 6(5.4%). The interval time between request and result of KRAS test was 10 days (7-16 days). Prophylactic skin toxicity with vitamin K1 cream was performed in 79(70.5%) pts, and reactive skin toxicity treatment included vitamin K1 cream in 32(28.6%). Grade 1-3 skin toxicity was observed in 87(77.7%) pts, and grade 3 in 10(8.9%). No significant difference in grade 3 skin toxicity was detected between males vs females (10.4 vs 5.7%; p=0.722), age &lt;60 vs ≥60 years (9.7 vs 8.6%; p=1.000), and prophylactic vs reactive treatment (7.6 vs 12.5%; p=0.470). Cetuximab temporary and permanent discontinuation relation to skin toxicity was observed in 15(13.4%) and 2(1.8%) pts, respectively. Conclusions: This results suggest that the introduction of K1 cream in the prophylactic or reactive treatment reduce the incidence of grade 3 skin toxicity with improvement of cetuximab compliance. The results of QoL will be available for the 2013 ASCO GI Meeting. Clinical trial information: ID239.

Comparison of the Psychological Impacts of Asymptomatic and Symptomatic Cutaneous Diseases: Vitiligo and Atopic Dermatitis

BackgroundVitiligo and atopic dermatitis (AD) are common dermatological disorders which may cause significant psychological and social distress leading to impaired quality of life (QoL) in patients.ObjectiveWe evaluated the degree of psychological stress and impairment of QoL in vitiligo patients as compared with AD patients and normal controls (NCs).MethodsA total of 60 patients from each group and 60 NCs were enrolled. Five questionnaires on depression (Beck depression inventory, BDI), state anxiety (SA) and trait anxiety (TA), interaction anxiousness (IAS), private body consciousness (PBC) and dermatologic QoL were used.ResultsThe vitiligo patients had a significantly higher level of TA (p<0.01), PBC (p<0.001) and impaired QoL (p<0.001) than NCs, but not BDI, SA and IAS. The AD patients had significantly higher scores for all five questionnaire items compared with NCs. In the comparison between the AD and vitiligo groups, all of the indexes except body consciousness were higher in AD patients than in vitiligo patients: BDI (p<0.01), SA (p<0.05), TA (p<0.001), IAS (p<0.01) and impaired QoL (p<0.001). Exposure of vitiligo lesions was not a significant variable in the analysis of the contribution of clinical variables of vitiligo on psychological stress and QoL.ConclusionVitiligo, which is not accompanied by any symptoms, involves less psychological impact than AD, which is accompanied by itching. Compared to NCs, however, the elevated general anxiety and body consciousness in patients with vitiligo suggests that they may be more concerned with the aggravation of hypopigmented patches than difficulties in social interactions.

The Effect of Weight Loss in Obese Patients with Chronic Stable Plaque-Type Psoriasis

Background. Chronic plaque psoriasis is frequently associated with obesity. The effect of a low-calorie diet on psoriasis has not been investigated. Objective. The objective was to investigate whether moderate weight loss increases the therapeutic response to topical treatment in obese patients with chronic stable plaque-type psoriasis. Material and Method. A 24-week clinical trial was conducted in 10 patients. The efficacy of a low-calorie diet with topical treatment was compared with baseline in obese patients with chronic stable plaque-type psoriasis. The primary measure of clinical response was the Psoriasis Area and Severity Index at weeks 12 and 24. Results. At week 12, the mean reduction in body weight was 9.6 percent. There was an improvement from baseline of 50 percent or more in the Psoriasis Area and Severity Index in 50 percent of the patients. The responses as measured by improvements in the Psoriasis Area and Severity Index were paralleled by improvements in global assessments by the physician and the patients and in the Dermatology Life Quality Index. Conclusion. Obese patients with chronic stable plaque-type psoriasis increase their response to a low-calorie diet. Lifestyle modifications, including a low-calorie diet, may supplement the pharmacologic treatment of obese psoriasis patients.

A systematic review of patient-reported outcome instruments of nonmelanoma skin cancer in the dermatologic population

Treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) has traditionally focused on minimizing recurrence and complication rates. However, the assessment of patient satisfaction and quality of life (QOL) is also important. These outcomes are best assessed by patient-reported outcome (PRO) instruments. We sought to conduct a systematic review of published PRO instruments purporting to measure aspects associated with QOL and/or patient satisfaction in the dermatologic BCC/SCC population and evaluate their development, content, and psychometric properties. PubMed, Embase, Cochrane via Wiley, PsycINFO, CINAHL, and HaPI from inception to April 2011 were searched. Articles that discussed the instrument development and validation process were included. A total of 2212 articles were identified. Twenty met our inclusion criteria resulting in 6 PRO instruments: 3 general dermatology (Skindex, Dermatology Life Quality Index, dermatology quality of life scales), 1 general plastic surgery (Patient Outcomes of Surgery-Head/Neck), and 2 skin cancer-specific (Skin Cancer Index, disease-specific questionnaire). The 6 instruments all underwent some degree of formal development and validation, however, only the Skin Cancer Index was developed and validated in the BCC/SCC population. The review may not have included all relevant PRO instruments. The Skin Cancer Index demonstrates the most evidence of its usefulness in patients with BCC/SCC. The Skindex-16, Dermatology QOL Scales, and Dermatology Life Quality Index target different aspects of QOL and should be used depending on the specific question being investigated. The Patient Outcomes of Surgery-Head/Neck may be beneficial to assess perceptions in appearance before and after surgical intervention.