Mean Dermatology Life Quality Index Research Articles

Effect of Melasma on Quality of Life of Patients using Dermatology Life Quality Index

Objective: To assess the effect of melasma on the Quality of Life (QoL) of patients using the Dermatology Life Quality Index (DLQI).
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of dermatology PAF Hospital, Jacobabad Pakistan, from Jun 2019 to 2020.
 Methodology: A total of 103 patients with melasma were enrolled in the study from the dermatology outpatient department after written informed consent. Patients of either gender aged 15 years and above were included in the study. Melasma Area and Severity Index assessed melasma severity. In addition, the impact on Quality of Life was assessed using the Dermatology Life Quality Index questionnaire.
 Results: Among the 103 patients, 67 (65%) were females, and 36 (35%) were male. The mean age of patients was 29.50±7.94 years and included 78 (75.7%) married and 25 (24.3%) unmarried individuals. Mean Melasma Area and Severity Index was 22.04±11.23, including 36 (35%) patients with mild, 43 (41.7%) moderate and 24 (23.3%) patients with severe disease, respectively. Overall mean Dermatology Life Quality Index of the sample was 11.25±7.78, while mean scores for the mild, moderate and severe diseases were 5.89±.58, 10.33±5.75 and 20.96±6.62, respectively (p=0.001), indicating that Quality of Life is significantly more impaired with increased disease severity.
 Conclusion: Melasma significantly affects the Quality of Life of the patients as measured by Dermatology Life Quality Index. The impact on Quality of Life is directly proportional to the severity of melasma assessed by the Melasma Area Severity Index.

Real-world clinical outcomes of treatment with brodalumab in patients with moderate-to-severe psoriasis: a retrospective, 24-month experience from four academic dermatology centers in Greece

Objective To assess the real-world clinical treatment outcomes with brodalumab in patients with moderate-to-severe plaque psoriasis in Greece. Materials and methods This was a longitudinal, retrospective, real-world analysis of data from medical records of 106 patients with moderate-to-severe plaque psoriasis, treated with brodalumab for up to 24 months at four University Dermatology Centers in Greece. Efficacy assessments of psoriasis severity [Psoriasis Area and Severity Index (PASI) and Body Surface Area affected (BSA) scores] and its impact on patients’ quality of life (QoL) [Dermatology Life Quality Index (DLQI) score] were evaluated at different timepoints up to 24 months. Results Treatment with brodalumab reduced both mean PASI (14.0–1.5, p < .001) and BSA scores (21.6–2.5, p < .001) across all visits. This effect was accompanied by reduction in mean DLQI score (12.8–2.1, p < .001) across all visits compared with baseline. Moreover, therapeutic efficacy was affected by prior biologic treatment exposure, as biologic naïve patients had greater reductions in all scores from baseline following treatment with brodalumab (numerical for mean PASI, significant for mean BSA and DLQI scores). Conclusion Brodalumab is effective long term, improving disease severity and health-related QoL in patients with moderate-to-severe plaque psoriasis in a real-world setting.

Clinicohistological and immunopathological features of patients with cutaneous lupus erythematosus at tertiary dermatology centre in Malaysia

Cutaneous lupus erythematosus (CLE) is a chronic, autoimmune skin disease with a wide spectrum of clinical presentations in different populations. To study the clinicohistological and immunological features of CLE in a multiethnic population and to identify the predictive factors of disease severity based on the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). This was a cross-sectional study of CLE conducted from March 2019 to February 2020. In total, 111 patients were recruited with a female/male ratio of 4.9 : 1. Acute CLE contributed 47.7%, followed by chronic CLE at 46.9% and subacute CLE at 5.4%. A large majority (84%) of patients had systemic lupus erythematosus. Of patients with chronic CLE, about 67.3% developed systemic involvement. Antinuclear antibody (ANA) was detected in 90.0%. Skin biopsy was taken from 42 patients and showed perivascular lymphocytic infiltration (95.2%), epidermal atrophy (47.6%) and hydropic degeneration of the basal layer (47.6%). Immunoglobulin deposition at the dermoepidermal junction was seen in > 40% of patients, predominantly in a granular pattern. Mean CLASI Total was 6.44 ± 7.70, while CLASI Activity (CLASI-A) was 2.75 ± 4.10 and CLASI Damage (CLASI-D) was 3.71 ± 4.76. Involved body surface area (BSA) was found to be an independent predictive factor for CLASI-A (OR = 1.34, P < 0.02). For CLASI-D, positive predictive factors were involved BSA (OR = 4.14, P < 0.001), discoid lupus erythematosus subtype (OR = 13.10, P = 0.001), cutaneous vascular disease (OR = 26.59; P = 0.014), scalp involvement (OR = 8.7, P < 0.01) and hypocomplementaemia (OR = 5.71, P < 0.5). Mean Dermatology Life Quality Index was 5.91 ± 5.34 and correlated significantly with disease severity. We observed a high percentage of patients with CLE with systemic manifestations and positive ANA result. More aggressive treatment of patients with positive predictive factors for severe disease combined with significant clinical activity may be warranted.

Burden of Moderate to Severe Atopic Dermatitis in Adults from France, Italy, and the UK: Patient-Reported Outcomes and Treatment Patterns

IntroductionModerate to severe atopic dermatitis (AD) is associated with a significant disease burden, impacting sleep, quality of life, and treatment needs. The aim of this study was to characterize disease burden and treatment patterns for adults with moderate to severe AD in three European countries: France, Italy, and the UK.MethodsThis retrospective analysis of adult patients with moderate to severe AD in Europe used medical records and physician/patient survey data collected in August 2019 to April 2020. Demographic and baseline disease characteristics, information on current comorbidities, disease flares, and current and previous treatments were collected by the physician. Patient-perceived burden was assessed using patient-reported outcome (PRO) questionnaires, which were completed on a voluntary basis and included the following instruments: Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), EuroQol five-dimensional (EQ-5D), and Work Productivity and Activity Impairment (WPAI). Disease severity was subjectively assessed by physicians and was based on their own definition of the terms mild, moderate, and severe. Data were analyzed descriptively.ResultsThe physician-reported sample included 912 patients with moderate to severe disease from France (n = 314), Italy (n = 309), and the UK (n = 289); approximately 30% of patients provided PRO data. Across these countries, 22–41% of patients reported current flares; mean POEM and DLQI scores were 10.6–13.1 and 9.5–11.1, respectively, indicating a high disease burden. However, systemic therapy use was low (e.g., conventional systemics were used by 18–24% of patients). Physician-assessed disease severity did not fully align with EASI scores, indicating that factors in addition to skin signs are impacting AD severity.ConclusionPatients with moderate to severe AD report significant disease burden, highlighting unmet treatment needs, particularly with respect to the underuse of systemic treatments despite AD being a systemic disease and the associated disease burden.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-022-00777-z.

Impact of Hirsutism on the Quality of Life: A Cross-sectional Pilot Study Using Dermatology Life Quality Index from Western India

Background: Hirsutism is defined as excess terminal hair growth over androgen-dependent areas in women. It may cause significant social and psychological stigma with a negative impact on the quality of life. However, there is a dearth of data regarding this important parameter from the Indian sub-continent. Objectives: A cross-sectional study was performed to elucidate the quality of life of women with hirsutism using the dermatology life quality index (DLQI). Methods: The severity of hirsutism was graded by modified Ferriman-Gallwey Score (F-G score) and correlated with quality of life by employing self-administered questionnaires of DLQI. Results: Of 40 women with hirsutism (mean DLQI score 5.55 ± 1.501), 3% demonstrated no effect, 52% small effect, and 45% moderate effect. Among domains, “symptoms and feelings” had the highest mean DLQI. Moreover, F-G score and DLQI had a weak positive but insignificant correlation. There was no significant correlation between DLQI and variables like age, marital status, occupation, and polycystic ovarian syndrome (PCOS). Conclusions: Hirsutism had a small to moderate impact on the quality of life, with symptoms and feelings as the most affected domain.

229 Pityriaris rubra pilaris has a significant psychiatric burden and impact on quality of life

Pityriasis rubra pilaris (PRP) is an inflammatory condition that has debilitating complications and is frequently refractory to treatment. Despite this, the psychiatric burden of PRP remains largely uninvestigated. Our aim was to quantify comorbid psychiatric disorders and identify disease factors associated with worsened quality of life in this condition. We conducted an online Qualtrics survey study of PRP patients. We recruited participants through a mailing list from the PRP Alliance. Inclusion criteria were diagnosis of PRP by a dermatologist and age >18 years at survey completion. Univariate analyses comparing mean Dermatology Life Quality Index (DLQI) scores were performed using Kruskal-Wallis tests. In total, 307 patients met inclusion criteria. The mean DLQI score for PRP patients was 11.5 ± 8.4. Overall, 61.9% of patients reported depression, 23.1% anxiety, 69.4% mobility issues, and 58.6% significant impact on their ability to work or attend school. Most (60.9%) patients had a >50% reduction in sleep. Factors associated with a higher DLQI included alopecia, joint pain, photosensitivity, and history of hospitalization (p<0.001). Only 9.1% reported that their dermatologist referred to a psychologist or psychiatrist. Patients referred to psychiatrists or psychologists had mean DLQI scores of 16.4, compared to 11.0 in those without a referral (p=0.0012). Our findings reveal that psychiatric comorbidities and impaired daily living are highly prevalent in PRP patients. Despite this, only a small proportion of patients are referred to psychiatry or psychology, with those who are referred exhibiting higher DLQI scores.

Secukinumab treatment demonstrated high drug survival and sustained effectiveness in patients with severe chronic plaque psoriasis: 21-month analysis in Australian routine clinical practice (SUSTAIN study).

BackgroundDrug survival measures the rate and duration of adherence to a given therapeutic agent and evaluates its long‐term effectiveness, safety, and real‐world utility. The SUSTAIN study sought to establish the drug survival and effectiveness of secukinumab for patients with severe chronic plaque psoriasis (CPP) in the Australian clinical setting.MethodsData of all patients (aged ≥18 years) from Australasian Psoriasis Registry (APR) treated with secukinumab were analysed. The primary objective was to describe the drug survival of secukinumab at 9 months. Key secondary objectives included drug survival of secukinumab at 3, 6, 15, and 21 months, stratified by biologic‐naïve vs biologic‐experienced patients; proportion of patients achieving Psoriasis Area and Severity Index (PASI) 75/90/100 responses; and changes in health‐related quality of life over time utilising the Dermatology Life Quality Index (DLQI).ResultsOf 294 patients included in this analysis, 110 (37.4%) were biologic‐naïve and 184 (62.6%) biologic‐experienced. Kaplan–Meїer drug survival rates in biologic‐naïve vs biologic‐experienced patients were 0.92 vs. 0.86 (9 months) and 0.82 vs. 0.68 (21 months), respectively. The proportion of patients with PASI 75/90/100 responses for biologic‐naïve vs. biologic‐experienced was 100/87.7/38.4 vs 98.5/61.5/27.2 (9 months) and 100/81.0/41.7 vs. 98.4/62.0/24.2 (21 months), respectively. The mean (standard deviation [SD]) DLQI in biologic‐naïve vs. experienced patients was 2.2 (4.1) vs. 3.1 (5.2) (9 months) and 1.4 (2.5) vs. 3.1 (5.3) (21 months). No new safety signals were observed.ConclusionsSecukinumab demonstrated high drug survival and sustained effectiveness in Australian real‐world setting, in biologic‐naïve and biologic‐experienced patients with severe CPP.

Fast and sustained improvement of patient-reported outcomes in psoriatic patients treated with secukinumab in a daily practice setting.

Psoriasis is a chronic dermatological disease with great impact on patients' quality of life (QoL). The main objective of this study was to assess the impact of secukinumab treatment on different patient-reported outcomes (PROs) during a long-term follow-up in Spanish patients with moderate-to-severe psoriasis under real-world conditions. Retrospective, observational, open-label, nationwide multicenter cohort study that included patients who initiated treatment with secukinumab in daily clinical practice conditions. PROs assessing disease impact and QoL included Dermatology Life Quality Index (DLQI), Patient's Global Psoriasis Assessment, Itch Numerical Rating Scale and EuroQoL Thermometer Visual Analogue Scale. Outcomes, including PROs and Psoriasis Area and Severity Index (PASI), were assessed at months 3, 6, 12, 18, and 24 during treatment. A total of 238 patients were enrolled in the study. Patients had a mean DLQI score of 14.9 at baseline; 78.3%, 73.7%, and 71.7% of them achieved a DLQI 0/1 response at months 6, 12, and 24, respectively. DLQI score was lower in the long term for naïve patients. A sharp decrease in mean DLQI was observed during the first 3 months, reaching a plateau that was maintained until the end of follow-up. Similar findings were observed for the rest of QoL assessments. There was a close association between improvement in QoL and skin clearance (PASI), which progressively increased during follow-up. In this study, secukinumab sustainably improved patient's QoL during a 24-month follow-up, with strongest effects in patients naïve to biological therapies and with a direct correlation with PASI improvement.

Real-world outcomes in patients with moderate-to-severe plaque psoriasis treated with guselkumab for up to 1 year

ABSTRACT Background Real-world data on guselkumab, especially at times >6 months, are limited. Research design and methods We performed a longitudinal, retrospective analysis on 307 patients with moderate–severe chronic plaque psoriasis (Psoriasis Area Severity Index [PASI] >10) treated with guselkumab for up to 12 months. Main outcome measures PASI 75, PASI 90, and PASI 100 were assessed at baseline and at 4, 12, 20, 28, 36, 44, and 52 weeks. Results At 12 weeks, PASI 75, PASI 90, and PASI 100 were achieved in 56.4%, 33.6%, and 24.1% of patients, respectively. At 52 weeks, PASI 75, PASI 90, and PASI 100 were achieved in 82.7%, 68.7%, and 51.1% of patients, respectively. Patients without comorbidities and those naïve to previous biological therapy had better responses. The mean Dermatology Life Quality Index score decreased from 14.0 at baseline to 3.1 at 12 weeks and 1.6 at 6 months, which was maintained at later times. Similar improvements were seen in pruritus visual analog scale. Conclusions Guselkumab maintains its efficacy for up to 12 months among responders in a real-world cohort of patients with moderate–severe plaque psoriasis, confirming data from prior real-world studies with smaller cohorts and shorter duration of follow-up.

IMPACT OF VITILIGO ON QUALITY OF LIFE

Introduction and objective: Vitiligo is a chronic depigmenting disorder with profound psychological effects. This study aimed to assess the quality of life (QoL) of Vietnamese patients with vitiligo. Material and method: We conducted a cross-sectional study at the National Hospital of Dermatology and Venereology in Hanoi, Vietnam. 164 patients with vitiligo older than 6 years of age who attended the hospital from July 2018 to March 2019 were recruited. Data were collected using a structured questionnaire, 39 pediatric patients aged from 6 to 15 years were administered the Children’s Dermatology Life Quality Index (CDLQI), 125 patients from 16 years old and older used the Dermatology Life Quality Index (DLQI) and Vitiligo Quality of Life index (VitiQoL). Results: In the pediatric group, the mean score on the CDLQI was 7.0 ± 5.0, indicating a moderate effect on patients’ quality of life. Most affected aspects included embarrassment, decreased self-esteem, social activities, schoolwork or vacation time, and treatment discomfort. In the older group (from 16 years old and older): The mean VitiQoL score was 55.7 ± 17.5 and the mean DLQI score was 9.7 ± 5.1. Most affected items were embarrassment, daily activities, personal relationships, leisure, and discomfort of treatment. Females were more affected than males. Patients with lesions in visible skin had greater impairment on QoL than those without lesions in these areas. Patients from urban areas tended to be more affected on the quality of life than the rural group but the difference was not statistically significant. Conclusion: Vitiligo has a moderate impact on the QoL of our patients in both pediatric and adult groups. QoL impairment was worse in female patients and patients with lesions in the visible area.

Real-world evidence from the non-interventional, prospective, German multicentre PERSIST study of patients with psoriasis after 1 year of treatment with guselkumab.

PERSIST was a prospective, non-interventional, long-term, German multicentre study of patients with moderate-to-severe psoriasis receiving guselkumab, an approved monoclonal antibody that binds to the p19 subunit of interleukin (IL)-23, in a real-world setting. Evaluation of the efficacy and safety of guselkumab, and its effect on health-related quality of life (HRQoL), in patients with moderate-to-severe psoriasis who have received 52 weeks of treatment. Patients (≥18 years old) were prescribed guselkumab as per routine clinical practice. End points assessed include Psoriasis Area and Severity Index (PASI), Physician's Global Assessment (PGA), target Nail Psoriasis Severity Index (NAPSI), and the Dermatology Life Quality Index (DLQI). Overall, 303 patients were enrolled and treated with guselkumab. Mean disease duration was 21.0 years, and 77.2% and 51.2% of patients had received ≥1 prior conventional systemic or ≥1 prior biologic therapy, respectively. Mean PASI score decreased from 16.4 at baseline to 3.0 by Week (W) 28, and further decreased to 2.4 by W52, while the proportion of patients achieving an absolute PASI score of ≤1 increased from 1.3% at baseline, to 50.8% at W28 and to 58.4% by W52. PASI90 and PASI100 responses also showed marked improvements between W28 and W52, regardless of biologic treatment history. Clearance of psoriatic skin was observed in difficult-to-treat areas, with the percentage of patients achieving a PGA score ≤1 increasing between W28 and W52. Guselkumab improved HRQoL; mean DLQI score decreased from 13.7 at baseline to 2.8 by W28, and further decreased to 2.4 by W52. At W52, 64.6% of patients achieved a DLQI score ≤1. The cumulative probability of drug survival was 92.4% at W52. Guselkumab is efficacious and well tolerated regardless of previous biologic therapies, comorbidities or psoriasis manifestation in difficult-to-treat areas. No new safety signals were observed.

Unmet clinical needs and burden of disease in hidradenitis suppurativa: real-world experience from EU5 and US.

BackgroundHidradenitis suppurativa (HS) is a chronic, inflammatory, debilitating skin disease characterized by painful deep lesions and associated with substantial disease burden.ObjectivesThe objective of this study was to describe physician‐ and patient‐reported clinical unmet needs from a real‐world perspective.MethodsThis study used data from the Adelphi HS Disease Specific Programme, a point‐in‐time survey of dermatologists and their patients with HS in Europe and the United States. Dermatologists completed patient record forms (PRFs) for 5–7 consecutively consulting patients with HS; patients or carers of patients also optionally completed a patient/carer self‐completion questionnaire (PSC/CSC). Data collection included demographics, symptomatology and impact on quality of life (QoL).ResultsDermatologists (N = 312) completed PRFs for 1787 patients with HS; patient‐ and carer‐reported questionnaires (PSC/CSC) were completed for 33.1% (591/1787) of patients. The mean age was 34.4 ± 12.2 years and 57.6% of patients were female (1029/1787). Physician‐judged disease severity at sampling was categorized as mild in 66.0% (1179/1787), moderate in 29.3% (523/1787) and severe in 4.7% (85/1787) of patients. Deterioration or unstable condition over the previous 12 months was described by 17.1% [235/1372] and 12.6% [41/325] of physician‐ and patient/carer‐reported cases, respectively. Despite receiving treatment, high proportions of patients still experienced symptoms at sampling (general pain/discomfort [49.5%, 885/1787]; inflammation/redness of lesions/abscesses [46.1%, 823/1787] and itching [29.9%, 535/1787]); these symptoms were more frequent in patients with moderate or severe disease. Patients reported a mean Dermatology Life Quality Index score of 5.9 ± 5.4 (555/591; mild, 4.1 ± 4.3; moderate, 9.4 ± 5.4; severe, 13.3 ± 5.5) and a mean Hidradenitis Suppurativa Quality of Life score of 11.0 ± 10.6 (518/591; mild, 7.6 ± 8.3; moderate, 17.7 ± 10.0; severe, 31.0 ± 15.4) indicating a substantial impact on QoL.ConclusionsPatients with HS experienced a high disease burden despite being actively treated by a dermatologist. This study demonstrates that the burden of HS disease is generally poorly managed with a considerable impact observed on patients' QoL.

Evaluation of Nomacopan for Treatment of Bullous Pemphigoid

Bullous pemphigoid is a difficult-to-treat autoimmune blistering skin disease that predominantly affects older adults and is associated with an increased mortality rate. To examine the safety and therapeutic potential of nomacopan, an inhibitor of leukotriene B4 and complement C5, in patients with bullous pemphigoid. This multicenter, single-group, phase 2a nonrandomized controlled trial was conducted in the dermatology departments of universities in the Netherlands and Germany. Participants were enrolled between September 2018 and April 2020. Older adult patients (aged ≥55 years) with mild to moderate, new-onset or relapsing bullous pemphigoid were recruited into the study. Patients received nomacopan, 90 mg, subcutaneously on day 1 and 30 mg subcutaneously daily until day 42. The primary end point was the proportion of patients with grade 3 to 5 (severe) adverse events associated or possibly associated with nomacopan. Secondary end points included mean absolute and percentage changes in the Bullous Pemphigoid Disease Area Index (BPDAI) activity score, the BPDAI pruritus score, and the patient-reported outcome measures Dermatology Life Quality Index (DLQI) and Treatment of Autoimmune Bullous Disease Quality of Life (TABQOL). A total of 9 patients (median [range] age, 75 [55-85] years) with bullous pemphigoid were included in the trial, of whom 5 were women (55.6%). No serious adverse events associated with nomacopan were found. The mean (90% CI) BPDAI activity score decreased from 32.0 (8.7) points on day 1 to 19.6 (9.0) points on day 42. Seven of 9 patients (77.8%) responded to nomacopan with a reduction in the BPDAI activity score of at least 8 points between days 1 and 42; in 3 responders, the reduction was 80% or greater. On day 42, the mean (90% CI) BPDAI pruritus score had decreased by 6.8 (4.6) points from 17.6 (4.0) points on day 1. The mean (90% CI) DLQI score decreased from 11.3 (4.2) points at baseline to 6.4 (3.8) points by day 42, and the mean (90% CI) TABQOL score decreased from 14.6 (5.4) points at baseline to 10.3 (5.0) points on day 42. Results of this nonrandomized controlled trial suggest that nomacopan can be well tolerated in older patients with bullous pemphigoid and may have therapeutic benefits for suppressing acute flares of this disease. A larger, placebo-controlled randomized clinical trial is warranted to confirm this safety profile and to establish nomacopan as a new therapeutic option for bullous pemphigoid. ClinicalTrials.gov Identifier: NCT04035733.

Clinical Characteristics, Quality of Life, and Risk Factors of Amputation Stump Skin Disease and Stump Fungal Infection in Adult Amputees in Shanghai, China.

IntroductionThe stump site of amputees is clinically vulnerable and prone to various skin diseases. Data regarding the impact on quality of life (QoL) of amputees with amputation stump skin disease (ASSD) and risk factors of ASSD and stump fungal infection in the Shanghai area are yet unknown.ObjectiveThis study aims to evaluate the QoL of amputees with ASSD and explore the risk factors of ASSD and stump fungal infection in the Shanghai area.MethodologyA total of 104 amputees from Shanghai Hebin Rehabilitation Hospital, Otto Bock (China) Industries Co., Ltd., Shanghai Tongji Hospital, and Shanghai Rehabilitation and Vocational Training Center for the Disabled were enrolled in this study. We collected demographic, clinical, and skin fungal examination data from these amputees from April 2015 to May 2021. Dermatology life quality index (DLQI) questionnaire was used to evaluate the QoL. The risk factors for ASSD and fungal skin infection were analyzed by the univariate analyses.ResultsThe median age of the 104 amputees was 57.9 ± 11.9 years with an average amputation time of 17.7 ± 15.1 years, and 73% of cases were men. The mean DLQI score of amputees with ASSD was13.6, suggesting the severe impairment of QoL. Among amputees, 41 (39.4%) had confirmed ASSD, of whom 24 (58.5%) suffered from fungal skin infection and the remaining were subjected to intertriginous dermatitis and eczema (22%), cutaneous keratosis (12.2%), and others (7.3%). Aspergillus (50.0%) was the most common species. The other fungal organisms included Trichophyton rubrum (33.3%), Candida krusei (8.3%), T. mentagrophytes (4.2%), and C. albicans (4.2%). ASSD rather than non-ASSD was more common in men (80.4%) and summer (46.3%). Summer (OR = 3.31, 95% CI = 1.19–9.17) was an established risk factor for ASSD compared to spring. The daily artificial limb wearing time > 8 h was associated with stump fungal infection.ConclusionThe QoL of amputees with ASSD was severely affected and the ASSD was characterized by fungal infection (tinea), intertriginous dermatitis, eczema, and skin keratosis. Summer and daily prosthesis wearing > 8 h was a risk factor for ASSD. Aspergillus was the most common fungal species, especially when the stump was exposed in summer.

Quality Of Life in Patients with Non-Genital Warts: A Cross-Sectional Study using Dermatology Life Quality Index (DLQI) Questionnaire

Introduction: Warts are one of the commonest causes for the dermatology outpatient department visits. These are caused by the Human Papilloma Viruses (HPV). Sometime warts can cause significant embarrassment and consequently impair the quality of life. Materials and Methods: All consenting patients with non-genital warts presenting to the clinic from September 2020 to February 2021 were enrolled in this observational study. Clinical evaluation for non-genital warts, sites involved and patient demographics was recorded. All participants were asked to complete the Nepali Dermatology Life Quality Index (DLQI) questionnaire. Results: Out of total 80 patients, 55 (68.8%) were males. The mean age of the study population was 23.86±7.42 years, mean duration was 21.98±26.69 months and the mean DLQI score was 8.0±5.15. The embarrassment or self- consciousness was the most prominent psychological aspect in the patients with the warts, followed closely by the difficulty in carrying out daily household activities. All items measured in DLQI were more impaired in women than in men. Clothing habits and sexual functions were affected based on the site of involvement with the warts. Shorter duration of disease had higher negative impact in the quality of life. Conclusion: Patients with warts had moderate impact in their quality of life. Females seem to be affected more due to their warts. Shorter duration of disease had higher negative impact in cases of warts.

Evaluation of the benefit of thermal spa therapy in plaque psoriasis: the PSOTHERMES randomized clinical trial

Spa therapy is considered an add-on treatment for psoriasis, but without any objective evaluation in the absence of randomized trials. This multicenter, open-label, randomized trial compared immediate spa therapy versus a control group having usual treatments until study assessments at 4.5 months. Spa therapy was proposed in five French spa resorts with standardized programs. Inclusion criteria were adults with plaque psoriasis, Dermatology Life Quality Index (DLQI) > 10, and stable medical treatment in the last 6 months. The main objective was DLQI ≤ 10 at 4.5 months after inclusion. VQ-Dermato and EQ5D-3L also assessed quality of life (QoL), Perceived Stress Scale (PSS) stress, and visual analogue scales (VAS) pain and pruritus. Between January 2015 and November 2018, 128 patients were randomized to either immediate spa therapy (64) (within 34 days, median) or usual treatments (61) until assessment at 4.5 months. Most were first-time spa users (71.2%). Mean DLQI and Psoriasis Area and Severity Index at inclusion were 16.7 and 10.5, respectively. Immediate spa therapy patients achieved the primary objective for 66.1% [95% CI 52.6% > 77.9%] vs 41.4% [95% CI 28.6% > 55.1%] control group patients (p = 0.007). VQ-Dermato scores and pruritus VAS significantly improved. Outcomes at 12-month follow-up of the immediate spa therapy group showed persistent improvement of DLQI, VQ-Dermato, and pruritus. This randomized controlled trial demonstrated that a cure of spa therapy improves QoL and alleviates certain symptoms of psoriasis, in short and long terms. This justifies its integration in the therapeutic strategies for psoriasis. Trial registration number: ClinicalTrials.gov Identifier: NCT02098213.

Long‐term, durable, absolute Psoriasis Area and Severity Index and health‐related quality of life improvements with risankizumab treatment: a post hoc integrated analysis of patients with moderate‐to‐severe plaque psoriasis

BackgroundRisankizumab has demonstrated durable, high rates of efficacy in patients with moderate‐to‐severe plaque psoriasis as assessed by the achievement of relative Psoriasis Area and Severity Index (PASI) improvement and Dermatology Life Quality Index (DLQI) 0/1.ObjectivesThe aim of this post hoc analysis is to assess the achievement of absolute PASI thresholds and related improvements in health‐related quality of life (HRQoL) in patients with moderate‐to‐severe plaque psoriasis treated with (i) risankizumab compared with ustekinumab, and (ii) long‐term (>52 weeks to 172 weeks) risankizumab.MethodsData from patients randomised to 150 mg risankizumab or 45 or 90 mg ustekinumab in replicate randomised controlled trials UltIMMa‐1 and UltIMMa‐2 were analysed for the achievement of absolute PASI thresholds PASI ≤ 3, PASI ≤ 1, and PASI = 0, time to achieve these thresholds, and combined PASI and DLQI endpoints. Data from pat ients initially randomised to risankizumab who continued on risankizumab in the open‐label extension study LIMMitless were analysed for the achievement of absolute PASI levels, mean DLQI scores, and DLQI 0/1.ResultsSignificantly greater proportions of patients treated with risankizumab compared with ustekinumab achieved PASI ≤ 3, PASI ≤ 1, and PASI = 0, as well as combined endpoints for absolute PASI and DLQI [(PASI ≤ 3 and DLQI ≤ 5) or (PASI ≤ 1 and DLQI 0/1)]. The median time to first achieve PASI ≤ 3, PASI ≤ 1, and PASI = 0 was significantly lower for risankizumab‐treated patients compared with ustekinumab‐treated patients. Among patients treated with long‐term risankizumab, more than 90% achieved PASI ≤ 3 though week 172 and more than 80% achieved DLQI 0/1. Low absolute PASI scores corresponded with low mean absolute DLQI scores through week 172 of continuous risankizumab treatment.ConclusionsRisankizumab treatment demonstrated high rates of rapid and durable efficacy as measured by absolute PASI thresholds and improvements in patient HRQoL.

Quality of Life of Melasma Patients in Pakistan

Objective: To assess the quality of life in Pakistani melasma patients.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Dermatology, Combined Military Hospital Lahore, from Oct 2020 to May 2021.&#x0D; Methodology: The study was conducted on 126 adult patients of both genders by non-probability, consecutive sampling technique. Melasma severity was assessed by 'melasma area severity index (MASI) and quality of life impairment by 'dermatology life quality index (DLQI).&#x0D; Results: A total of 126 patients participated in the study, out of which 85.7% were females, and 14.3% were males. Mean MASI score was 12.21 ± 6.87, and mean DLQI score was 8.22 ± 7.46. Male patients had higher MASI scores and statistically signifycant DLQI than female patients (p=0.016). Employed people and those from the higher socio-economic group showed a more significant impairment of their quality of life.&#x0D; Conclusion: There was moderate impairment of quality of life in melasma patients. Healthcare givers need to recognize the effect of melasma on mental health while counselling patients and devising management strategies.

Health Related Quality of Life of Rosacea Patients in China Assessed by Dermatology Life Quality Index and Willingness to Pay.

PurposeRosacea is a chronic inflammatory dermatosis mainly involving facial skin, leading to physical and emotional problems, which greatly affect the quality of life (QoL) of patients. Dermatology Life Quality Index (DLQI) and willingness to pay (WTP) are well-established instruments assessing the health-related quality of life (HRQoL), while very few studies have been focused on this topic about rosacea in China. The present study investigated HRQoL in Chinese rosacea patients.Patients and MethodsThis cross-sectional study was conducted on 973 patients with rosacea. Sociodemographic data, clinical features and DLQI were collected, and WTP was assessed by three standardized items. Multivariable logistic analysis was performed to investigate independent factors influencing QoL.ResultsA total of 921 questionnaires were accomplished by participants. The mean DLQI score was 11.6 (median 11). Patients were willing to pay an average of € 896.2 (median € 368.1) for complete cure. 33.3% would like to pay more than 20% of their monthly income to achieve sustainable control. There were positive correlations between WTP with DLQI (P < 0.05). DLQI could be independently impacted by age (21–30 and 31–40 relative to > 50, OR = 3.242 and 3.617, respectively), the occupational requirement of appearance (high, OR = 4.410), disease duration (< 2 years, OR = 1.582), edema (OR = 1.844) and severity of flushing, burning, stinging and pruritus (severe, OR = 2.003, 1.981, 2.491, 2.249, respectively). There were no significant associations between WTP and most of the clinical factors.ConclusionThe QoL was greatly impaired and should not be ignored among rosacea patients in China. Patients aged 21–40y, having occupational requirement of appearance, with the disease duration less than 2 years, and suffering severe flushing and related sensitive symptoms were more likely to have severe or very severe limitation of QoL.

Does omalizumab use in chronic spontaneous urticaria results in improvement in sexual functions?

Chronic spontaneous urticaria (CSU) is a disease that can affect the patient's quality of life (QoL), sexual functions, and mood. We planned a retrospective study to investigate the effects of omalizumab use in CSU patients on sexual function. We also aimed to evaluate the sexual function, quality of life (QoL), and mood of CSU patients compared to the control group consisting of idiopathic pruritus patients. A review of patients' records with CSU attending the dermatology outpatient clinic from January 2020 to June 2020 was done. Urticaria activation score (UAS7), Beck depression inventory (BDI), Dermatology life quality index (DLQI), female sexual function index (FSFI) to female participants, and the international index of erectile function (IIEF) to male participants were used to assess the impact of the disease on patients' life. The obtained data were analyzed by using SPSS software. Each one of the mean UAS, BDI, and DLQI score values decreased significantly in weeks in omalizumab group patients. IIEF score in male patients and FSFI score in female patients also increased in weeks in omalizumab group patients. Omalizumab can play an effective role in enhancing the sexual function of CSU patients in addition to improving their DLQI.