Dermatology Life Quality Index Questionnaire Research Articles

Quality of life in patients with anogenital warts: A cross‐sectional study using the Dermatology Life Quality Index questionnaire

Quality of life in patients with anogenital warts: A cross‐sectional study using the Dermatology Life Quality Index questionnaire

Patient and family burden in pediatric atopic dermatitis and its treatment pattern in Japan.

This study evaluated the level of burden in pediatric and adolescent atopic dermatitis (AD) patients in Japan, the associated burden on caregivers/families, and whether this burden varied with age. Data were drawn from the Adelphi Pediatric AD Disease Specific Programme (DSP)™, a cross-sectional survey of physicians and their patients conducted in Japan between July and December 2022. Physicians reported patient demographics, clinical characteristics, disease burden, and current/previous therapies. Patients and/or caregivers reported perceived disease severity and impact of AD, including the Children's Dermatology Life Quality Index (CDLQI) and Dermatitis Family Impact questionnaire (DFI). Overall, 55 physicians provided data for 537 AD patients aged ≤17. Mean (SD) overall scores for CDLQI, POEM, and DFI were 9.3 (6.3), 8.3 (6.8), and 11.7 (7.2), respectively. Age was associated with higher patient and/or caregiver-reported CDLQI scores, which increased by 0.543 points per year of age (P = 0.01). Patients with severe disease reported a more significant impact on quality of life factors compared with mild patients (P < 0.001). Age was associated with higher caregiver-reported burden, with DFI scores increasing by 0.325 per year (P = 0.01). Physician-reported impact on caregivers showed that age was significantly associated with increased burden on sleep, daily activities, work, and mood (P < 0.05), with disease severity associated with impact across all factors (P < 0.01). Both increasing age and disease severity were associated with the increased impact of AD on patients and their caregivers. Disease control/modification through appropriate therapeutic intervention at a younger age may relieve the burden of pediatric AD on patients and their families.

Dietary Antioxidants May Support Cosmetic Treatment in Patients with Rosacea.

Rosacea is a chronic skin disease that significantly reduces the quality of life (QoL) of patients. The aim of this study was to assess whether dietary antioxidants can support the effect of cosmetic treatment in improving the QoL of patients with rosacea. Basic data about participants (N = 160) were collected using a self-reported survey. QoL was assessed using the standardized Dermatology Life Quality Index (DLQI) questionnaire. An interventional cosmetic treatment was performed using cavitation peeling and sonophoresis with a commercial capillary repair serum. The study was registered as a clinical trial (NCT06271135). To assess antioxidant diet quality, for the first time, a new dietary antioxidant quality index (DAQI) was developed, which consisted of 12 items: dietary total antioxidant capacity, dietary polyphenols, phytosterols, lignans, vitamin C, vitamin E, β-carotene, zinc, iron, copper, manganese and selenium. It was found that the highest tertiles of DAQI diminished the odds about 40-45% of the moderate, large and extremely large effect of rosacea on QoL and about 8-11% of the occurrence of rosacea symptoms compared with the lowest tertile. This study showed that rosacea has a negative impact on QoL, but a comprehensive approach to treatment, including antioxidant cosmetic treatment and dietary antioxidants, can improve the QoL of patients with rosacea.

Low prevalence of scabies and impetigo in Dakar/Senegal: A cluster-randomised, cross-sectional survey.

Scabies, a parasitic infection caused by Sarcoptes scabiei var. hominis, is a public health problem with significant morbidity worldwide, particularly in low-resource countries. Impetigo, a complication of scabies infection, is a risk factor for sepsis, glomerulonephritis and possibly acute rheumatic fever. Currently, the majority of epidemiological data has been collected in rural populations in the Pacific with limited applicability to urban populations in sub-Saharan Africa, where scabies is also believed to be a problem. To inform future public health programs, more reliable information about the burden of disease is required. In July/August 2022, we conducted a cross sectional, cluster-randomised, household survey in Pikine/Dakar using the 'International Association for the Control of Scabies (IACS)' criteria to diagnose scabies and impetigo. All participants underwent a standardised clinical examination by post-graduate dermatology students. For those diagnosed with scabies, an age-adapted 'Dermatology Life Quality Index (DLQI)' questionnaire was filled. We recruited and examined 1697 participants to detect 27 cases of scabies (prevalence: 1.6%, 95% CI 0.8-3.2), mostly in school aged children. Ten participants suffered from impetigo (prevalence: 0.6%, 95% CI 0.3-1.3), 5 of which were dually infected with scabies. Risk factors for scabies infection were young age, male gender and Koranic school attendance. Of those found to have scabies, in 7 out of 22 cases (31.8%) it had a large effect on their lives according to the DLQI questionnaires filled. This study adds to the mapping of the burden of scabies across Africa to support public health action. With a low prevalence of scabies that is concentrated amongst poor households and children attending Koranic schools, a focused public health approach targeting Koranic schools and poor households seems to be most appropriate in this community.

510 - Dupilumab is efficacious in patients with prurigo nodularis regardless of stable use of topical corticosteroids and topical calcineurin inhibitors: pooled results from two phase 3 trials (LIBERTY-PN PRIME and PRIME2)

Abstract Introduction Prurigo nodularis (PN) is a chronic inflammatory skin condition characterized by severely itchy skin nodules, which substantially affects quality of life. Although topical treatments are frequently prescribed, these therapies are limited by insufficient demonstrated evidence for efficacy, and/or associated side effects. Objectives This study reports the effect of dupilumab on pruritus, skin lesions, and quality of life in patients with PN, with or without stable use of topical corticosteroids (TCS) and/or topical calcineurin inhibitors (TCI), in an analysis of pooled data from two phase 3 trials. Materials &amp; Methods LIBERTY-PN PRIME (NCT04183335) and PRIME2 (NCT04202679) were two randomized, double-blind, placebo-controlled, 24-week studies. Adults with PN inadequately controlled by topical prescription therapies, or for whom those therapies are inadvisable, were randomized 1:1 to dupilumab 300 mg every 2 weeks or matched placebo. “Stable use” was defined as maintaining the same medicine (low-to-medium potency TCS and/or TCI) during the study, with the same frequency of treatment (once or twice daily) as from 2 weeks prior to screening. Efficacy was assessed from baseline to Week 24 through the Worst Itch Numerical Rating Scale (WI-NRS; scored 0–10; high scores represent a poorer outcome), and the Investigator’s Global Assessment for PN-Stage score (IGA PN-S; scored 0–4; high scores represent a poorer outcome). Impact on Health-Related Quality of Life (HRQoL) was assessed through the Dermatology Life Quality Index questionnaire (DLQI; 10 questions scored 0–3 with a maximum score of 30; high scores represent poorer HRQoL). Results 311 patients were randomized (dupilumab/placebo n = 153/158), including 182 patients with stable use of TCI/TCS (dupilumab/placebo N = 91/91) and 129 patients without (dupilumab/placebo N = 62/67). Baseline demographics and disease characteristics were well balanced in both subgroups. At Week 24, significantly more patients treated with dupilumab with or without stable use of TCI/TCS achieved a ≥ 4-point improvement in WI-NRS (59.3%/58.1%) vs placebo (13.2%/26.9% [nominal P &amp;lt; 0.0001/P &amp;lt; 0.0001]). The proportion of patients achieving an IGA PN-S score of 0 or 1 at Week 24 was also significantly higher in the dupilumab group for patients with or without stable use of TCI/TCS (48.4%/43.5%), vs placebo (11.0%/25.4% [nominal P &amp;lt; 0.0001/P = 0.0319]). The positive impact of dupilumab treatment on HRQoL was greater, for patients with and without a stable use of TCI/TCS vs placebo, as suggested by the mean change from baseline in DLQI at Week 24 (−12.9/−11.9 vs −5.5/−7.1 [nominal P &amp;lt; 0.0001/P &amp;lt; 0.0001], respectively). Although the placebo response was higher for patients without stable use of TCI/TCS, the effect of dupilumab treatment was comparable in the two subgroups. Treatment-emergent adverse events (TEAEs) occurred with similar rates in dupilumab-treated patients with or without stable use of TCI/TCS (59.3%/60.7%), compared with placebo (53.3%/47.8%). Patients with or without stable use of TCI/TCS had similar rates of severe TEAEs in the dupilumab groups (2.2%/4.9%) and placebo groups (3.3%/4.5%). Conclusion Dupilumab treatment improves itch, skin lesions, and quality of life in patients with PN, with an acceptable safety profile, with little to no influence from concomitant treatment with topical therapies (TCI/TCS).

Comparing the Quality of Life of Patients and their Family Members with Dermatological and other Chronic Conditions, in The Bahamas

Background &amp; Objectives: Impact of dermatological and other chronic conditions not only affects the quality of life (QoL) of patients but also that of their family members. This pilot study aimed to compare the QoL impact of dermatological and other chronic conditions on patients with the QoL impact on their family members. Methods: A cross-sectional study using validated QoL questionnaires was conducted. In the dermatological group, patients (&gt;17 years) completed the Dermatology Life Quality Index (DLQI) questionnaire, while children (4-16 years) completed the Children’s Dermatology Life Quality Index (CDLQI) questionnaire. Family members (&gt;18 years) completed both Family Reported Outcome Measure (FROM-16) and Family Dermatology Life Quality Index (FDLQI) questionnaires. In the other chronic conditions group, patients (&gt;17 years) completed the World Health Organization Quality of Life -BREF (WHOQoL-BREF) questionnaire and children (4-17 years) completed The Revised Children’s Quality of Life Questionnaire (KINDL-r: Kiddy KINDL, Kid KINDL and Kiddo KINDL). Family members completed the FROM-16 questionnaire. Data were analysed using IBM SPSS™ statistical software. Results: Forty-four participants completed the study. In the dermatological group (n=26), there was a weak negative correlation between DLQI and FDLQI scores (r= –0.23, p=0.55) not between DLQI and FROM-16 (r = –0.04, p=0.92). There was a very strong positive relationship between both CDLQI and FDLQI (r=0.83, p=0.17) and CDLQI and FROM-16 (r=0.82, p=0.18). Although not statistically significant, there may be a correlation between the FROM-16 and FDLQI scores for family members of dermatology patients. In the chronic conditions group (n=18) the mean score of WHOQoL-BREF was 90.5 (SD=13) with a significant negative inverse relationship to FROM-16 (r= –1.000, p=&lt;0.001). The KINDL-r scores (mean=66, SD =11) showed no significant correlation (r= –0.24, p=0.61) with FROM-16 scores (mean=9.6, SD=3.7). Conclusion: The impact of a patient’s dermatological or other chronic condition can not only negatively affect the patient’s QoL but also the QoL of their family members.

Long-term efficacy and safety of nonablative monopolar radiofrequency in the treatment of moderate to severe acne vulgaris.

Acne vulgaris (AV) is a prevalent skin condition known for its potential to cause scarring and psychological distress, often leading to diminished self-esteem. While topical and oral treatments are commonly prescribed, some patients experience treatment failure, adverse effects, or contraindications to conventional therapies. In response to these challenges, laser and energy-based device therapies have emerged as promising alternatives for individuals who fall into these categories, showing considerable potential in the treatment of AV. This study aimed to evaluate the long-term efficacy and safety of a nonablative monopolar radiofrequency (NMRF) in treatment of moderate to severe AV. Twenty-four patients with moderate to severe AV underwent a series of two NMRF treatment sessions, spaced 4 weeks apart. To evaluate treatment outcomes, live in-person lesion counts and measurements of pore size and volume, and sebum production were quantified using Antera® 3D imaging system, and Sebumeter®, respectively. Patients' self-assessment data regarding degree of improvement and facial oiliness were gathered. Dermatology life quality index (DLQI) questionnaire was utilized to assess the impact of AV on their quality of life. All objective and subjective evaluations were conducted at the baseline, 1 month after the first treatment, and during follow-up visits 1, 3, and 6 months after the last treatment sessions. Adverse effects were also recorded during each visit. Twenty out of the 24 subjects completed the study protocol. The mean inflammatory lesion counts significantly reduced by 42.86% and 45.71% from the baseline at 3 (p = 0.027) and 6 months (p = 0.032) after the second treatment. Sebum excretion likewise significantly decreased from baseline by 11.62% (p = 0.012), 13.37% (p < 0.001), and 21.51% (p = 0.004), 1 month after the first treatment, 1 and 6 months after the second treatment, respectively. The pore volume continued to decrease by 35% (p = 0.003) and 41.5% (p < 0.001) at 1 and 6 months following the final treatment, respectively. The DLQI significantly decreased from 10.00 (interquartile range [IQR]: 6.50-15.00) to 2.00 (IQR: 1.00-4.75), corresponding to 80% improvement of the index, 1 month after the last treatment and was sustained up to the last follow-up visit. Patients' self-assessments on degree of improvement and facial oiliness also significantly improved following NMRF treatments. The treatments were well-tolerated without significant adverse effects. NMRF appears to be an effective and safe treatment for inflammatory AV, with therapeutic outcomes persisting up to 6 months after two treatment sessions.

Individualised Homoeopathic Medicine Resolved Multiple Recalcitrant Verruca Vulgaris: An Evidence-Based Case Report

Abstract Background Verruca vulgaris commonly known as warts are characterised by common, benign, localised epidermal lesions caused by human papilloma viruses. Various treatment options are available but many of them are invasive and destructive, which may cause damage to the epidermis or discomfort to the patient. Objective The main objective of this case report is to produce pieces of evidence systematically, favouring homoeopathy. Method This is a reported case of verruca vulgaris, presented with multiple rough, itchy, cauliflowers like warty growth on the dorsal aspect of both the feet. Outcome Related to Impact on Daily Living (ORIDL) scale was used as a patient-reported outcome measure for subjective assessment. Dermatology Life Quality Index (DLQI) questionnaire was used to assess the improvement in the quality of life. Photographs were taken as objective evidence. Lastly, possible causal attributions were evaluated by using Modified Naranjo Criteria for Homeopathy (MONARCH). Result The case was improved on the ORIDL scale (score +4). Quality of life was improved (score 10 to 0) and documented through the DLQI questionnaire. Photographs were presented as objective evidence. The high total score (+9) of MONARCH established the possible causal attributions between the homoeopathic intervention and clinical improvement in the patient. Conclusion In this case, individualised homoeopathic medicine, Thuja occidentalis, is proved to be effective in the resolution of all warts within a plausible time frame of medicine intake. Further documentation and studies are warranted in the future.

The effects of long-pulsed alexandrite laser therapy on facial redness and skin microbiota compositions in rosacea: Aprospective, multicentre, single-arm clinical trial.

Rosacea is a chronic skin disorder characterised by abnormal neurovasculature and inflammation in the central region of the face. The efficacy of pulsed-dye laser and intense pulsed light treatments for rosacea have been demonstrated in several clinical trials. However, there is currently no research on the efficacy of long-pulsed alexandrite laser (LPAL) therapy alone for rosacea-related facial redness and its effect on skin microbiota. To evaluate the efficacy of LPAL therapy on facial redness in rosacea and assess changes in skin microbiota composition. Subjects with rosacea (n = 21, mean age: 39.2 ± 11.3 years) were recruited from two medical institutions and received monthly LPAL treatments (Clarity II™, Lutronic Corp.) for 3 months. At each visit, clinical photographs were taken, and erythema was measured using a spectrometer. At the initial and final visits, the Dermatology Life Quality Index (DLQI) and Skin Sensitivity Questionnaire (SSQ) were evaluated. Skin swabs were obtained at the initial and final visit, and facial microbiome composition was analysed using 16S rRNA amplicon sequencing. After three LPAL treatment sessions, the average facial erythema index, measured using Mexameter® decreased significantly from 360.0 ± 96.7 at baseline to 312.0 ± 94.5 at the final visit (p < .05). The DLQI and SSQ showed significant improvement of symptoms. Skin microbiome diversity and relative abundance were altered significantly, particularly in the genera Clostridium, Lawsonella, Bacteroides, and Lactobacillus. LPAL therapy alone showed favourable efficacy for the treatment of facial redness in rosacea, with some impacts on the skin microbiota composition.

Gender differences in quality of life of vitiligo patients attending a tertiary care center

Background: Vitiligo is a common depigmenting dermatosis characterized by milky-white macules or patches. Any pathological discoloration of the skin has been linked to an impact on the body image of an individual, and vitiligo has been linked to decreased self-esteem and poor socialization of the affected people. In Indian society, vitiligo is labeled as Shweta-Kushta (i.e., white-colored leprosy) and is compared to leprosy—a more stigmatizing skin condition. Aim: This study aims to study gender-related differences in the quality of life of Indian vitiligo patients. Methodology: In this hospital-based cross-sectional study, a total of 55 vitiligo patients (females 25 and males 30) were enrolled using the purposive sampling technique. The sample was assessed on Dermatology Life Quality Index (DLQI) questionnaire, Rosenberg Self-Esteem Scale (RSS), and General Health Questionnaire-12 (GHQ-12) to assess their quality of life, self-esteem, and psychological well-being, respectively. The gender differences in sociodemographic and clinical details as well as their relationship with the quality of life of the patients were sought with the help of appropriate statistical measures. Results: The patients of both genders were comparable in terms of all sociodemographic and clinical variables except the females being less educated and employed than the males. There was a statistically significant trend of higher mean DLQI total score in females than males (6.6 ± 3.55 vs 4.8 ± 2.71, Mann–Whitney U = 263.5, P =0.058). Significantly, the average DLQI score in female vitiligo patients was negatively related to family income (r s = -.659, P &lt;.001) and it was significantly higher for the patients from a rural background than those from an urban background (8.55 ± 3.30 vs 5.07 ± 3.03, Mann–Whitney U = 33.5, P &lt;.05). The average DLQI score was negatively correlated to RSS score but positively correlated to GHQ-12 score in patients of both genders. Conclusion: The quality of life of female patients with vitiligo is poorer than the same in male patients. The poor financial condition of families and rural living are two factors related to the poorer quality of life of female patients. A poorer quality of life in vitiligo patients of both genders is linked with decreased self-esteem and decreased psychological well-being. Gender-related issues in the quality of life and the overall well-being of such patients are important in their management and policy-making.

Quality of life and stigmatization in people with skin diseases in Europe: A large survey from the 'burden of skin diseases' EADV project.

Several large studies on the burden of skin diseases have been performed in patients recruited in hospitals or clinical centres, thus missing people with skin diseases who do not undergo a clinical consultation. To evaluate the burden of the most common dermatological diseases in adult patients across Europe, in terms of quality of life, work life, and stigmatization. Population-based survey on a representative sample of the European general population aged 18 years or older. Participants who declared to have had one or more skin problem or disease during the previous 12 months completed the Dermatology Life Quality Index questionnaire, and answered questions regarding the impact of their skin disease on daily and work life, anxiety/depression, and stigmatization. The study population included 19,915 individuals, 44.7% of whom were men. Quality of life was particularly impaired in people with hidradenitis suppurativa (HS), and sexually transmitted diseases. About a half of participants with acne, alopecia, or chronic urticaria, and about 40% of those with atopic dermatitis (AD), skin cancers, or psoriasis reported a modest to extremely large effect of the disease on their quality of life. Overall, 88.1% of participants considered their skin disease as embarrassing in personal life and 83% in work life. About half of the respondents reported sleeping difficulty, feeling tired, and impact of the disease on taking care of themselves. Concerning stigmatization, 14.5% felt to have been rejected by others because of the skin disease, and 19.2% to have been looked at with disgust. Anxiety and depression were frequently reported by patients with all the diseases. Skin diseases may heavily affect patients' daily and work life, and cause feelings of stigmatization. An early intervention is needed to avoid consequences on the patients' life course.

Dermatology Life Quality Index in Thai Patients with Facial Port-Wine Stains.

Port-wine stains (PWS) are congenital capillary abnormalities caused by immature, venule-like vasculature that progressively dilates due to poor endothelial cell differentiation. PWS affects between 0.3% and 0.9% of newborns, with 90% of cases occurring on the face. Individuals with facial PWS and their parents had a significant negative impairment on their quality of life (QoL) and also suffered from psychological disabilities. This was a cross-sectional questionnaire-based survey study in Thailand from July 2021 to April 2022. The questionnaires included demographic data, subjective evaluation (SE), and the Dermatology Life Quality Index (DLQI). The questionnaire was performed with a full scale and adjusted scale of validity and reliability test of DLQI using factor analysis and Cronbach's alpha. The study outcome was a subjective evaluation and DLQI in patients who received pulsed dye laser (PDL) treatment. Of the 54 patients, 35.2% (19) are male, and 64.8% (35) are female. Regarding age groups, 64.8% (35) are below 5years old, and 35.2% (19) are older than 5years. SE results showed that males evaluated an improvement of the facial PWS lesion significantly better than females (P < 0.05). The older age group graded the percentage of improvement better than the younger age group (P < 0.01). The result of the DLQI showed no difference in DLQI between gender. Older age result resulted in a significantly different DLQI compared with younger age (P < 0.01). Parent-reported DLQI improvement was less than self-reported DLQI improvement in patientswith PWS treated with PDL (P < 0.05). Concerning the instrument of the study, the validity and reliability analysis of the DLQI questionnaire using factor analysis and Cronbach's alpha have been performed. The adjusted scale with the 5-item DLQI questionnaire is more appropriate in terms validity and reliability. This study demonstrates that facial PWS reduces the QoL as measured by DLQI. We discovered that the QoL of patients and parents with PWS was significantly impaired. The main influencing factors were older age, the improved perception between gender, and PDL treatments. In addition, we found only five questions that are reliable for PWS. The adjusted five-item DLQI questionnaires are more appropriate regarding validity and reliability. TCTR20230210001, COA no. si 1059/2020.

Disease‐ and treatment‐related expectations, attitudes, and beliefs among adult patients initiating or switching biological therapies for psoriasis

AbstractBackgroundThe treatment expectations of patients with psoriasis are essential for clinical outcomes.ObjectivesTo examine disease‐ and treatment related intra‐ and interpersonal factors and their relation to treatment expectations among patients with psoriasis who initiate or switch biological therapy.MethodsConsecutive adult patients with moderate to severe psoriasis who initiated or switched biological therapy completed a questionnaire regarding their disease‐ and treatment‐related expectations. Additionally, they filled out Patients' Attitudes and Beliefs Scale (PABS), Trust in Physician Scale (TPS) and Dermatology Life Quality Index (DLQI) questionnaires. Psoriasis Area Severity Index (PASI) was scored before and 3 months after treatment initiation.ResultsA total of 65 patients participated; 28% expected &lt;90% clearance of psoriasis following treatment, whereas 72% expected 90%–100% clearance. No differences were found between bionaïve and non‐naïve patients. Mutually adjusted analysis showed that female gender (p = 0.026), higher PASI score (p = 0.004) and lower TPS score (p = 0.006) were associated with high overall expectations towards biological therapy. PABS scores were not significantly associated with high expectations. The proportion of patients having low expectations was greatest when asked about work/education, partner interaction and socializing. Additionally, high expectations towards these subjects were associated with higher DLQI (p = 0.047, p = 0.014 and p = 0.056, respectively). Patients with high overall expectations towards biological therapy had a significantly greater reduction in absolute PASI score following treatment (4.7 vs. 2.75), p = 0.048.ConclusionsTechniques aimed at maximizing patients' expectation‐effect (placebo response) should be implemented in daily clinical practice. Knowledge about gender, disease severity, impact on life quality and patients' trust in physician should be taken into consideration.

Chronic Spontaneous Urticaria in Belgium: Deciphering the Clinical Profile and Treatment of Patients Visiting an Urban City Immunology Department

Background: Chronic urticaria (CSU) is a chronic inflammatory mast cell-driven disorder of which reliable clinical data in Belgium are lacking. This study focusses on clinical characteristics of CSU patients presenting at an urban Immunology-Allergology department. Methods: Outpatients with CSU were included from 2018 to 2021. Clinical characteristics, Dermatology Life Quality Index (DLQI) and Urticaria activity score (UAS7) were collected by thorough anamnesis and questionnaires. Furthermore, patients underwent provocational testing, an autologous serum skin test (ASST) and a blood analysis. Results: The study included 49 CSU patients and 20 non-CSU subjects. CSU was distributed differently with age and sex, showing higher numbers in female patients below the age of 46 years. 67% of CSU patients had accompanying angioedema of which 9% were reported genital. CSU patients scored a mean 8/30 on their DLQI questionnaire. There was no significant difference in immunoglobulin E (IgE), C-reactive protein, and tryptase levels between CSU patients and controls. Oral glucocorticosteroids were prescribed in 23% of CSU patients during their disease course though only half of these patients had a severity grade 4 CSU. In 82% of the included CSU patients, Urticaria Control Test (UCT) scores were below 12. When we hypothetically considered low IgE levels and high IgG anti-thyroid peroxidase levels as differentiation marker for autoimmune (ai)CSU and non-aiCSU, we found that 4% of all included CSU patients could be considered aiCSU. Conclusion: Generally, the inner-city population displayed the same clinical characteristics, as previous cohorts from Northern Europe. The relatively high rate of CSU patients receiving oral glucocorticosteroid treatment for their disease though not always classified as severe, underlines the need to train doctors of various specialties in the treatment algorithms of CSU. Furthermore, by looking at potential autoimmune characteristics, our findings open perspectives on the identification of new routinely used clinical parameters for the detection of aiCSU, a relatively small immunological subtype of CSU.

Clinical Profile and Quality of Life in Patients with Resistant to Treatment Vitiligo Lesions in Iran: Vitiligo Patients need Medico-psycho-social Assistance

Background: Vitiligo is a common chronic disease associated with physical effects, psychological impacts, and impaired quality of life (QoL). Lesions in acral areas are resistant to treatments. Since these areas are exposed and visible, they have a profound effect on patients' self-confidence. Despite the high prevalence of these conditions, information in this field, especially for Iranian patients, is scarce. Objectives: To study the clinical profile of patients with vitiligo lesions in the acral areas, assess the burden of QoL impairment, and investigate the association between patient's characteristics and their QoL outcomes Methods: A total of 84 patients with non-segmental vitiligo who had involvement in resistant treatment areas were recruited in this study. Clinical characteristics and disease outcomes, with a special emphasis on the quality of life (QoL), were investigated using the Dermatology Life Quality Index (DLQI) questionnaire. Furthermore, the extent of the disease was calculated by utilizing the Vitiligo Area Scoring Index (VASI). Descriptive and comparative analyses were conducted using SPSS software (version 29). Results: The most common comorbidity observed among the patients was various types of immune diseases. The mean total score of DLQI was 8.1, indicating a moderate effect of the disease on the patient's life since the score falls within the range of 6-10. The Kruskal-Wallis non-parametric test illustrated a significant difference in QoL among different age groups (P=0.020). The results indicated a positive, direct, and significant relationship between the extent of the disease and DLQI (r=0.269,;P=0.013). Nonetheless, the relationship between the engagement of the genital area in married patients and difficulties in sexual relations was not found to be statistically significant at α=0.05. Conclusion: The involvement of end-extremities based on existing studies is a frequent occurrence in vitiligo. These affected areas hold considerable significance in terms of the patient's quality of life (QoL) due to their prominent visibility and resistance to available treatments. Considering the high prevalence of psychological consequences, diversity in skin phototypes, and social acceptance, regional studies are necessary for more efficient and responsive medical management integrated with psychosocial assistance.

Female Pattern Hair Loss and Negative Psychological Impact: Possible Role of Brain-derived Neurotrophic Factor (BDNF).

Female Pattern Hair Loss (FPHL) is considered the most common type of hair loss in females. Women with FPHL may suffer from psychological distress and defective social functioning. Patients with psychiatric and neurodegenerative disorders almost have a deficient brain and blood brain-derived neurotrophic factor levels (BDNF). This serum BDNF level may act as a diagnostic marker for negative psychological impact in FPHL patients. Evaluate the levels of serum BDNF in patients with FPHL and correlate its level to the severity of alopecia and the degree of psychological impact. Forty-six female patients with FPHL and 41 healthy age-matched female volunteers as a control were included in the study. Patients filled out a Dermatology Life Quality Index questionnaire. Both patients and controls filled Beck Depression Inventory, Beck Anxiety Inventory, and Perceived Stress Scale (PSS) questionnaires. Serum levels of BDNF were measured for all the participants using the ELISA technique. Patients with FPHL had significantly lower levels of BDNF and significantly higher Beck depression inventory score and PSS questionnaire scores. There is a significant negative correlation between serum levels of BDNF and Beck Depression Inventory, Beck Anxiety Inventory, and PSS questionnaire scores. Patients with FPHL are at a high risk to develop chronic stress and depression. The serum level of BDNF is a good predictor for the assessment of chronic stress and depression in FPHL patients.

Patient-reported burden of skin disorders in coeliac disease

Objectives The current knowledge on the associations between coeliac disease and different skin diseases is contradictory and the patient’s perspective on the burden of these is lacking. This study aimed to investigate patient-reported frequency, severity and quality of life effects of skin disorders in coeliac disease patients compared to controls and moreover to study the impacts of gluten-free diet on these skin diseases. Materials and methods A study questionnaire designed for the purposes of this study and a validated Dermatology Life Quality Index (DLQI) questionnaire were posted to 600 adult members of the Finnish Coeliac Society and 1173 matched controls. Responses from 327 coeliac disease patients and 382 non-coeliac controls were compared. Results Coeliac disease patients were shown to be at no increased risk of atopic dermatitis, acne, rosacea, psoriasis, alopecia areata, vitiligo or chronic urticaria. The severity of these skin diseases did not differ between study groups, but the risk for at least moderate effects on quality of life caused by dermatological diseases was increased among those with coeliac disease. Positive response from gluten-free diet was most commonly experienced by coeliac disease patients with atopic dermatitis. Conclusions Even though the risk for skin diseases was shown not to be increased among coeliac disease patients, there is still an increased burden related to experienced skin symptoms among these patients, which non-dermatologists treating coeliac disease patients should acknowledge.

Impact of Alcohol Consumption, Smoking, and Diet on the Severity of Plaque Psoriasis: A Comprehensive Assessment using Clinical Scales and Quality of Life Measures.

BACKGROUND This study aimed to evaluate the effects of alcohol intake, assessed using the Alcohol Use Disorder Identification Test (AUDIT) questionnaire, on the severity of plaque psoriasis using the Body Surface Area (BSA) and Psoriasis Area and Severity Index (PASI) scales, and quality of life using the Dermatology Life Quality Index (DLQI) questionnaire. MATERIAL AND METHODS The diagnosis of psoriasis was made based on the clinical picture. We enrolled 24 patients with psoriasis vulgaris, and the AUDIT test conducted at the time of follow-up indicated a possible risky/harmful pattern of alcohol consumption or alcohol dependence syndrome among the patients (>8 points). The comparison group consisted of 20 psoriatic patients and AUDIT <8 points. The BSA and PASI scales were used to determine the severity of psoriasis, and the DLQI questionnaire assessed patients' quality of life and how they felt during the week preceding the survey. RESULTS As the amount and frequency of alcohol consumed increased, the exacerbation of lesions measured according to the PASI and BSA scales was significantly higher (P<0.05), and the quality of life decreased (P<0.05). We noted that inadequate and excessive dietary intake of total protein, total fat, and assimilable carbohydrates were associated with statistically significantly higher values of BSA and PASI scores and, thus, more severe psoriatic lesions (P<0.05). CONCLUSIONS An unbalanced diet, alcohol abuse, and smoking negatively affect the course of psoriasis vulgaris, hence the importance of patient education.

A study on the quality of life of patients with leprosy: A cross-sectional study

Background: Leprosy is a chronic infectious disease caused by Mycobacterium leprae. If not detected early and treated adequately, it leads to disabilities and deformities, in turn leading to social stigma and discrimination. Hence, leprosy has an impact on the Quality of Life (QoL) of the affected. Materials and Methods: This study was conducted at the Dermatology Department and Leprosorium Hospital. A total of 164 leprosy patients were assessed for QoL with the Dermatology Life Quality Index (DLQI) questionnaire. Results: Among the total of 164 patients, leprosy had no effect on the QoL of 14 (8.54%) patients, a small effect on the QoL of 34 (20.73%) patients, a moderate effect on the QoL of 47 (28.66%) patients, a large effect on the QoL of 64 (39.02%) patients, and an extremely large effect on the QoL of 5 (3.05%) patients. Among the demographic variables, age, occupation, and socioeconomic status had an impact on the QoL of patients with leprosy. Conclusion: Leprosy is an ancient disease and continues to be the most feared due to deformities and the social stigma associated with it. The clinical spectrum, reactions, deformities, and disability have a profound impact on the QoL of patients with leprosy. Key words: Leprosy; DLQI questionnaire; Quality of life

Comparing the Clinical Efficacy of Topical Application of Virgin Coconut Oil and 1% Clotrimazole Cream as an Adjuvant to Systemic Antifungal in Chronic Dermatophytoses: A Randomized Controlled Trial

Introduction: Dermatophyte infections have become a common entity with a prevalence ranging from 36.6-78.4%. Majority of the patients are from low socioeconomic background who favour topical treatment. High treatment costs of antifungal medication and consequent poor compliance have given rise to the need of an effective and economical topical preparation. Objectives: To compare efficacy of topical 1% clotrimazole versus virgin coconut oil application as an adjuvant to systemic antifungals in dermatophytosis. Materials and Methods: A total of 100 patients presenting to the dermatology outpatient department and diagnosed with tinea infection clinically and by potassium hydroxide mount were taken up for the study. The patients were randomized into two groups with 50 patients in each group. One group received virgin coconut oil while the other group received 1% clotrimazole cream twice daily application as the topical preparation. Mycological cure was assessed by potassium hydroxide mount and clinical improvement was assessed objectively by severity score for itch, changes in clinical signs and symptoms and subjectively by Dermatology Life Quality Index questionnaire. Statistical analysis was analyzed using SPSS software version 17. Results: Virgin coconut oil and 1% Clotrimazole had equivocal response after 12 weeks of treatment with respect to potassium hydroxide mount positivity, itch severity, clinical improvement and changes in Dermatology Life Quality Index scores when used along with systemic antifungal. Conclusion: Virgin coconut oil can be easily used as a topical emollient and antifungal preparation along with systemic antifungals in the treatment of dermatophytosis.