Median Dermatology Life Quality Index Score Research Articles

Efficacy of Topical Dapsone 5% Gel for the Treatment of Erythematotelangiectatic Rosacea: New Treatment Option With Old Drug.

Many topical drugs are used in the treatment of erythematotelangiectatic rosacea (ETR). However, dapsone 5% gel has never been used in ETR to date. To evaluate the efficacy of dapsone 5% gel as a new treatment option for ETR. Thirty-five patients with ETR were included in the study. Diagnosis was made with National Rosacea Society criteria. Dapsone 5% gel was used topically twice a day for 12 weeks. Investigator Global Assessment (IGA) 4-point scale ( 0 → Clean, 1 → mild, 2 → moderate, 3 → severe, 4 → very severe), Visual Analogue Scale (VAS) and Dermatology Life Quality Index (DLQI) were used for evaluation (at baseline, 2nd, 6th, and 12th weeks). IGA scores among baseline (2 → 62.9%, 3 → 34.3%, 4 → 2.9%) and 2nd (1 → 14.3%, 2 → 77, 1%, 3 → 8.6%), 6th (1 → 45, 7%, 2 → 54.3%) and 12th weeks (1 → 62.9%, 2 → 37.1%) were found to be statistically significant (P < 0.001). Median VAS scores among baseline (median = 7 [5-9]) and 2nd (median=5 [3-8]), 6th (median=5 [3-6]) and 12th weeks (median = 4 [2-6]) were statistically significant (P < 0.001). Median DLQI scores among baseline (median = 8 [6-14]) and 2nd (median = 5 [3-11]), 6th (median = 5 [3-11]) and 12th weeks (median = 4 [2-9]) were statistically significant (p<0.001). Concurrent systemic disease was a risk factor for poor treatment response (P = 0.034). Mild irritation was observed in 3 patients (8.5%) during treatment. Dapsone 5% gel was effective and well tolerated in ETR treatment.

Health-related quality of life of adults with cutaneous leishmaniasis at ALERT Hospital, Addis Ababa, Ethiopia.

Cutaneous leishmaniasis (CL) is a growing public health threat in Ethiopia. Leishmania aethiopica is the predominant causative organism. Affected individuals develop chronic skin lesions on exposed parts of the body, mostly on the face, which are disfiguring and cause scarring. The effects of CL on the health-related quality of life (HRQoL) of affected individuals has not been assessed in Ethiopia. To assess HRQoL in adults with active CL at ALERT Hospital, Addis Ababa, Ethiopia. A cross-sectional study was done using the Amharic version of the Dermatology Life Quality Index (DLQI). Trained health staff administered the DLQI. Three hundred and two adults with active CL participated and all of them exhibited a reduced HRQoL. The median DLQI score was 10 (IQR 8). Almost half of the participants reported very poor HRQoL, 36.4% and 11.3% fell within the very large and extremely large effect categories respectively. DLQI scores were higher (median 18) in patients diagnosed with diffuse cutaneous leishmaniasis (DCL) compared to those with localized cutaneous leishmaniasis (LCL). The DLQI domain of 'work and school' was the most affected, scoring 73.3% and 66.6% of total possible score for female and male respectively, followed by that of 'symptom and feeling' (at 50.0% and 56.6% for female and male respectively). Men were more affected than women in the domains of 'leisure' (P = 0.002) and 'personal relationships' (P = 0.001). In the multivariate ordinal logistic regression site of lesion, clinical phenotype and age of participant remained associated with significantly poor HRQoL. The HRQoL impairment associated with CL is significant. Thus, patient-reported outcome measure should be used to assess the efficacy of treatments along with clinical outcome measures.

Cutaneous Manifestations in Adult Thalassemia Patients

Background: A wide range of cutaneous manifestations have been described in thalassemia patients. No studies have been conducted in Southeast Asia where there is a high prevalence of hemoglobin E (Hb E) thalassemia. Objective: The primary objectives of the present study were to determine the prevalence of cutaneous manifestations among adult thalassemia patients and assess how cutaneous findings differ between patients with and without β-thalassemia (β-thal)/Hb E. Secondary objectives were to determine any associations between cutaneous manifestations and clinical or laboratory findings and to evaluate quality of life (QoL). Materials and Methods: The present study was a cross-sectional descriptive study conducted between April 2021 and December 2022 in Thailand. Adults aged 18 years and older with any type of thalassemia were eligible. The authors collected relevant demographic data, cutaneous and laboratory findings, as well as responses to a validated Thai version of the Dermatology Life Quality Index (DLQI). Results: One hundred patients (37% male) were included, with a median age of 33 (IQR of 24, 41) years. Of these, 76% had β-thal/Hb E. Xerosis was the most common cutaneous manifestation at 69%. Hyperpigmentation was more common in patients with β-thal/Hb E than those without at 41% versus 17% (p=0.031). Extramedullary erythropoiesis, xerosis, and serum ferritin were significantly associated with hyperpigmentation. The overall median DLQI score was 0 (IQR 0, 2). Conclusion: Xerosis was the most common cutaneous findings in adult thalassemia patients, and hyperpigmentation was more common in patients with β-thal/Hb E. However, cutaneous changes had low impact on patients’ QoL. Keywords: Thalassemia; Cutaneous manifestations; Hemoglobin E thalassemia

Psychological Burden and Willingness to Pay Among Korean Rosacea Patients and Their Association With Rosacea Phenotype and Severity: A Multi-Center Cross-Sectional Study.

Rosacea is a chronic inflammatory disorder that can adversely affect the patient's quality of life (QOL). However, few studies have examined the association between the psychological burden and willingness to pay (WTP) with rosacea features and severity. The study aimed to determine the overall psychological burden and WTP among Korean rosacea patients and identify factors that may contribute, such as patient demographics, clinical features, and rosacea severity. This prospective cross-sectional study recruited Koreans with rosacea. All were asked to complete a questionnaire on their demographics, rosacea-related symptoms, self-rated severity, dermatology life quality index (DLQI), and WTP. The clinical features were assessed by a board-certified dermatologist. The investigator's global assessment and global flushing severity score (GFSS) were used to determine the clinical severity of rosacea. Multiple regression analysis was conducted to identify factors contributing to the psychological burden and WTP. Out of 201 rosacea patients, 147 (73.1%) were female, and 54 (26.9%) males, with a median age of 50.1 years. Their median DLQI score was 8 (interquartile range [IQR]): 4.0-13.0). The median WTP per month for the control of rosacea was $100, with relative WTP (WTP/household income per month x 100) being 3.3%. According to the multiple regression model, phymatous change (β = .153, p = .030), DLQI score (β = .152, P = .045), and GFSS (β = .154, P = .041) contributed most to the WTP. Rosacea patients experience substantial psychological and economic burdens. More vigorous treatment should be performed for those with phyma and severe flushing whose QOL is most severely affected.

An Unexpected Finding: Treatment History Associated with the Quality of Life in Chinese Patients with Port-Wine Stains.

Port-wine stains (PWS) are predominantly located on the face and neck. Hence, PWS affect not only aesthetic appearance but may also cause psychological distress. However, very few studies have researched on the quality of life (QoL) in Chinese patients with PWS. To evaluate QoL in patients with PWS. Skindex-29 and Dermatology Life Quality Index (DLQI) were used to investigate the QoL of the patients with PWS and healthy controls. In total, 198 adults with PWS and 200 healthy controls were included. The scores of symptomatic, emotional and functional dimensions of Skindex-29 in the observational group were significantly higher as compared with the control group (P<0.05). Female gender, lesion location and the treatment history (such as pulsed dye laser or photodynamic therapy) had a negative impact on the scores (emotional and functional dimensions) of the patients with PWS. The median DLQI score was 3 points in the observational group and 0 points in the control group (P<0.05), and QoL of patients who had a history of previous treatments was diminished. The QoL of patients with PWS is impaired. Patients' QoL is negatively influenced by female gender, lesion location and treatment history. The Skindex-29 scale seems to be more applicable to the study of QoL of patients with PWS.

P107 Clinical priorities when treating psoriasis: insights from a real-world data study of tildrakizumab

Abstract Achieving clear skin when treating psoriasis is the clinical priority for some clinicians, but it may not be the priority for all patients; wellbeing may be more important. To gain insights into the relative importance of clear skin for wellbeing, we retrospectively reviewed real-world data from four specialist dermatology departments in England and Scotland. We assessed the evolution in absolute Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores in 122 adults treated with tildrakizumab for plaque psoriasis, to determine whether a reduction in PASI scores to &amp;lt; 3 or &amp;lt; 1 was needed to achieve a DLQI of 1 or 0. Mean age was 49 years (range 17–82). Median time since diagnosis was 18 years (range 4–67). Median time on treatment with tildrakizumab was 9 months (range 1–21). At baseline, the median PASI score was 12 (range 0–40) and median DLQI was 20 (range 0–30). The proportion of patients with PASI &amp;lt; 3 increased from 6% at baseline to 60% at final visit, and with PASI &amp;lt; 1 from 3% to 48%. The proportion of patients with PASI &amp;lt; 1 was greater for patients having &amp;gt; 52 weeks of data (61%) than for patients having &amp;gt; 28 weeks of data (52%). The median DLQI score at baseline was 20 (range 0–30) and that at final visit was 1 (range 0–22). The proportion of patients with a DLQI of 0 or 1 increased from 4% at baseline to 54% at final visit. The proportion of patients with a DLQI of 0 or 1 was no different for patients having &amp;gt; 52 weeks of data (52%) than for patients having &amp;gt; 28 weeks of data (56%). An improvement in the PASI score to &amp;lt; 1 or &amp;lt; 3 was accompanied by a reduction in DLQI to 1 or 0, but it was not a requirement. Tildrakizumab demonstrated substantial improvement in psoriasis signs and in patient quality of life comparable with other interleukin (IL)-23 inhibitors in UK clinical practice. The PASI score decreased and was maintained in line with the thinking that IL-23p19 antagonists such as tildrakizumab have good survival. An improvement in the PASI score to &amp;lt; 1 or &amp;lt; 3 may not be necessary for a patient to feel that their life is unaffected by their psoriasis. It may be prudent for clinicians to prioritize patient wellness and durability of treatment rather than aim for clear skin in every patient. Funding sources: Almirall.

Frequency and Effect of Cutaneous Manifestations on Quality of Life in Patients with End-Stage Renal Disease Undergoing Hemodialysis.

To determine the frequency of skin manifestations found in end-stage renal disease (ESRD) patients undergoing dialysis, while assessing their effect on the quality of lives of the same patients. Descriptive cross-sectional study. Place and Duration of the Study: Benazir Bhutto Hospital, Holy Family Hospital, and Hussain Lakhani Hospital, from 12th December 2021 to 13th October 2022. Seventy-three Patients undergoing hemodialysis were enrolled in the study. Skin manifestations were defined as "cutaneous signs and symptoms related to ESRD unrelated to the symptoms resulting from any primary dermatological disorder or other systemic diseases". Data on the skin manifestations of their disease and their effect on patients' quality of life were collected by using a 2-part questionnaire. The first part consisted of demographic details along with the type of skin disorders faced by the patient and the second part of the questionnaire comprised of the dermatology life quality index (DLQI). The data were entered and analysed using the statistical package for social sciences (SPSS) version 23.0. Xerosis and pruritus were most commonly reported (83.7%), followed by nail changes (18.6%) and skin discolouration (16.3%). The median duration of dialysis was 36 (1-180) months and there was no significant increase in skin symptoms with the increase in the duration of dialysis (p=0.082). The median DLQI score was 3 (range:0-10) A significantly higher number of females (n=14) reported associated mental discomfort with their skin symptoms of pruritis as compared to males (n=5, p=0.008). Cutaneous manifestations have variable effects on the quality of life of ESRD patients. Adopting a multidisciplinary approach early in the management may help to minimise the mental discomfort of these patients and bring an improvement in their quality of life. End-stage renal disease (ESRD), Hemodialysis, Skin manifestations, Pruritus, Quality of life.

The Impact of Disease Severity and Treatment on Quality of Life in Patients of Psoriasis

Background: Psoriasis is a common inflammatory dermatosis with significantly challenging clinical needs in patient management. Given its chronicity and social stigmatization, the burden on health-related life quality is substantial. The objective of this study was to assess psychosocial and financial impact of disease severity and treatment modalities on patients’ life quality.&#x0D; Methodology: A total of 93 clinically diagnosed patients with Psoriasis were included in this cross-sectional study. Quality of life was assessed through Dermatology Life Quality Index (DLQI) scoring system and disease severity by Psoriasis area severity index (PASI) respectively. Treatment modalities were evaluated by filling out a brief questionnaire. Descriptive analyses were presented as mean ± SD for symmetrically distributed variables while median with interquartile range (IQR) were reported for non-symmetrically distributed variables. Association was determined by Chi-square test considering p-value ≤0.05 as significant.&#x0D; Results: There were 47.3% male and 52.7% female patients. The Median DLQI score was 6.00 with an IQR of 7. Topical treatment was used in the majority of patients currently (60%). Quality of life ( QOL) for 41.9% of cases was mildly affected. Rest of the cases were affected more severely, consisting of 47.3% with moderate and 10.8% with severe impact on quality of life. Significant association of DLQI scores was found with disease severity and current treatment modalities.&#x0D; Conclusion: Different therapies along with disease severity, remarkably affect QoL among psoriasis patients.&#x0D; KEYWORDS&#x0D; Disease Severity ,Impact, Psoriasis , Quality of Life, Treatment

Health-related quality of life impact of scabies in the Solomon Islands.

BackgroundScabies causes intense itching and skin lesions. A small number of studies have shown that scabies impacts health-related quality of life (HRQoL), but no studies have been conducted in the Pacific region. We assessed the impact of scabies on HRQoL in a high-prevalence setting using the Children's Dermatology Life Quality Index (CDLQI) and Dermatology Life Quality Index (DLQI). We also assessed the validity of these tools in a Pacific Island population.MethodsThe study was conducted in the Solomon Islands. Participants with and without skin disease were randomly selected. HRQoL indices were scored on a scale of 0–30.ResultsWe surveyed 1051 adults (91 with scabies) and 604 children (103 with scabies). Scabies had a small impact on HRQoL, with a median DLQI score of 2 (interquartile range [IQR] 0–6) and a CDLQI score of 2 (IQR 0–4). Scores increased linearly with severity. The greatest impact on QoL was due to itch, sleep disturbance and impacts on education and employment.ConclusionsScabies has a small but measurable impact on HRQoL. The DLQI and CDLQI scores were discriminated between the skin-related QoL of patients with scabies and the control group, indicating that these tools are appropriate to measure skin-related QoL in the Solomon Islands.

Quality of life in vitiligo patients in central Saudi Arabia.

Objectives:To assess the quality of life (QoL) in patients with vitiligo in central Saudi Arabia using the dermatology life quality index (DLQI).Methods:A cross-sectional study spanning over 6 months was conducted on 253 adult patients with vitiligo at the outpatient dermatology clinics of the National Center of Vitiligo (Light Clinics) and King Khalid University Hospital, Riyadh, Saudi Arabia. The patients were asked to complete a self-administered questionnaire using an Arabic version of the DLQI to measure the impact of vitiligo on their QoL. The association between the demographic and diseases characteristic to the median DLQI scores was investigated using binary logistic regression.Results:The median DLQI score was 4, the range 25, min 0 - max 25 and percentiles 2-8. The unadjusted odds ratio (95%CI) showed the median DLQI score was significantly higher in married subjects 2.29 (1.33-3.94) (p<0.01), non-segmental vitiligo 2.10 (1.16-3.79) (p<0.01), and the progressive vitiligo 1.87 (1.09-3.18) (p<0.02) than their counterparts. However, after adjustment only married status predicted the high DLQI score 2.08 (1.11-3.61) (p<0.01).Conclusion:The QoL in vitiligo patients in Saudi Arabia is adverse than those with lighter skin, in other countries. Therefore, in Saudi Arabia, better management modalities to improve patients’ QoL and prevent subsequent mental distress are needed.

The Study of Quality of Life in Patient with Vitiligo

Introduction: Vitiligo is an acquired, idiopathic and common de-pigmentation disorder of skin. Strong stigma associated with the disease, its chronic nature, and cosmetic disfigurement often cause distress to patients and may affect the quality of life.&#x0D; Objective:  To assess the quality of life in patient with vitiligo, using Dermatology life quality index(DLQI) questionnaire.&#x0D; Methodology:Total of 212 patients with vitiligo participated in this cross- sectional study done at Dermatology and Venereology OPD of Universal College of Medical Science, Bhairahawa, Nepal.. The participants were given DLQI questionnaire consisting of 10 questions to fill up.&#x0D; Result:The median DLQI score was 4(6), which showed small effect in quality of life. There was positive association with duration of disease and DLQI score (p˂ 0.05). The highest average score was seen in heading item “symptom and feeling”.There was no difference in DLQI score, when compared among gender and among various types of vitiligo.&#x0D; Conclusion: Psychological assessment should be done in vitiligo cases, especially in those with long duration of disease.

Beyond quality of life: A call for patients' own willingness to pay in chronic skin disease to assess psychosocial burden—A multicenter, cross-sectional, prospective survey

To the Editor: Willingness to pay (WTP) is a preference-based method that can be assessed by directly asking patients what amount they would be willing to pay to cure or improve their health condition.1Seidler A.M. Kini S.P. DeLong L.K. Veledar E. Chen S.C. Preference-based measures in dermatology: an overview of utilities and willingness to pay.Dermatol Clin. 2012; 30: 223-229Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar,2Okhovat J.P. Grogan T. Duan L. Goh C. Willingness to pay and quality of life in alopecia areata.J Am Acad Dermatol. 2017; 77: 1183-1184Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar This intuitive method directly reflects the impact of the disease on a patient's life, including the psychological aspect, whereas the Dermatology Life Quality Index (DLQI) has some drawbacks in that it does not measure a patient's preference or desire for a cure of skin disease.3Poor A.K. Brodszky V. Pentek M. et al.Is the DLQI appropriate for medical decision-making in psoriasis patients?.Arch Dermatol Res. 2018; 310: 47-55Crossref PubMed Scopus (20) Google Scholar There are limited studies on investigating and comparing the WTP and DLQI across a variety of chronic skin diseases. We conducted a multicenter survey involving adult patients who were diagnosed with 7 chronic skin diseases, including atopic dermatitis (AD), psoriasis, vitiligo, alopecia areata, rosacea, chronic urticaria (CU), and seborrheic dermatitis in Korea from September 2018 to October 2019 (Table I). To examine WTP, we used a standardized questionnaire validated in previous studies.4Radtke M.A. Schafer I. Gajur A. Langenbruch A. Augustin M. Willingness-to-pay and quality of life in patients with vitiligo.Br J Dermatol. 2009; 161: 134-139Crossref PubMed Scopus (103) Google Scholar It consists of 2 items: WTP control (how much they would be willing to pay on a monthly basis to control their skin condition) and WTP cure (how much they would be willing to pay as a 1-time cost for an imaginary cure for their skin condition). This study was approved by the ethics committees of the Catholic institutional review boards (XC20RADI0016). Continuous variables were expressed as median and interquartile range. Kruskal-Wallis tests and post hoc Mann-Whitney tests after the Bonferroni correction were used to assess differences in median WTP control and cure between disease groups.Table IClinical characteristics of patients, n (%)CharacteristicsTotalADPsoriasisVitiligoAARosaceaCUSDTotal530 (100)86 (100)60 (100)93 (100)64 (100)72 (100)88 (100)67 (100)Age, y, median (IQR)45 (32-56)30.5 (24-41)45 (34-55)48 (36-61)39.5 (29-51)49.5 (44-58)44.5 (35-56)57 (40-65) 20-39208 (39.3)60 (69.8)23 (38.3)30 (33.3)32 (50.0)12 (16.7)35 (39.8)16 (23.9) 40-59219 (41.3)23 (26.7)29 (48.3)37 (39.8)29 (45.3)45 (62.5)35 (39.8)21 (31.3) ≥60103 (19.4)3 (3.5)8 (13.3)26 (28.0)3 (4.7)15 (20.8)18 (20.5)30 (44.8)Sex Male245 (46.2)37 (43.0)33 (55)36 (38.7)34 (53.1)22 (30.6)38 (43.2)45 (67.2) Female285 (53.8)49 (57.0)27 (45)57 (61.3)30 (46.9)50 (69.4)50 (56.8)22 (32.8)Educational background Elementary school graduate43 (8.1)4 (4.7)4 (6.7)9 (9.7)4 (6.3)8 (11.1)7 (8.0)7 (10.5) Middle school graduate164 (30.9)24 (27.9)24 (40.0)34 (36.6)16 (25.0)20 (27.8)25 (28.4)21 (31.3) High school graduate271 (51.1)49 (57.0)30 (50.0)40 (43.0)35 (54.7)36 (50.0)53 (60.2)28 (41.8) College graduate52 (9.8)9 (10.5)2 (3.3)10 (10.8)9 (14.1)8 (11.1)3 (3.4)11 (16.4)Fitzpatrick skin type II21 (4.0)3 (3.5)4 (6.7)7 (7.5)2 (3.1)1 (1.4)3 (3.4)1 (1.5) III272 (51.3)54 (62.8)32 (53.3)39 (41.9)26 (40.6)33 (45.8)54 (61.4)34 (50.8) IV237 (44.7)29 (33.7)24 (40)47 (50.5)36 (56.3)38 (52.8)31 (35.2)32 (42.8)Disease duration, months, median (IQR)22 (4.3-60)60 (12-129)36 (12-120)24 (4-60)5 (2-12.2)24 (7.8-48)9.5 (3-24)24 (8-60)BSA, % 0.266 (12.5)03 (5.0)19 (20.4)27 (42.2)3 (4.2)3 (3.4)11 (16.4) 0.549 (9.2)01 (1.7)14 (15.1)15 (23.4)11 (15.3)4 (4.6)4 (6.0) 161 (11.5)2 (2.3)3 (5.0)13 (14.0)8 (12.5)18 (25)6 (6.8)11 (16.4) 2106 (20.0)9 (10.5)6 (10.0)19 (20.4)7 (10.9)26 (36.1)7 (8.0)32 (47.8) 577 (14.5)16 (18.6)9 (15.0)11 (11.8)7 (10.9)14 (19.4)14 (15.9)9 (13.4) 1059 (11.1)19 (22.1)16 (26.7)11 (11.8)0011 (12.5)0 2038 (7.2)18 (20.9)8 (13.3)3 (3.2)009 (10.2)0 ≥2074 (14.0)22 (25.6)14 (23.3)3 (3.2)0034 (38.6)0AA, Alopecia areata; AD, atopic dermatitis; BSA, body surface area; CU, chronic urticaria; IQR, interquartile range; SD, seborrheic dermatitis. Open table in a new tab AA, Alopecia areata; AD, atopic dermatitis; BSA, body surface area; CU, chronic urticaria; IQR, interquartile range; SD, seborrheic dermatitis. In total, 617 patients were recruited from 7 hospitals, of whom 530 (85.9%) responded to both the WTP and DLQI questionnaires. The median WTP cure was highest in vitiligo ($2000 for vitiligo, $1000 for psoriasis and atopic dermatitis), and the median WTP control was also highest in vitiligo ($140 for vitiligo and $110 for psoriasis) (Supplemental Table I, available via Mendeley at http://doi.org/10.17632/bhwn5rnybr.1). However, the median DLQI score was highest in patients with AD, followed by psoriasis, CU, rosacea, and vitiligo (Fig 1). Substantial discrepancies between the WTP and DLQI score were seen, reflecting the obvious pitfall of the DLQI questionnaire as a tool to measure the impact of certain skin diseases on a patient's health-related quality of life.5Rencz F. Baji P. Gulacsi L. et al.Discrepancies between the Dermatology Life Quality Index and utility scores.Qual Life Res. 2016; 25: 1687-1696Crossref PubMed Scopus (14) Google Scholar Although patients with vitiligo showed the highest WTP cure and control values, their DLQI scores were lower than those of patients with AD, psoriasis, CU, and rosacea. This is possibly because the DLQI is based on questions asking about physical symptoms, such as itch and pain, plus daily activities and personal relationships, but certain diseases, including vitiligo and AA, are rarely associated with skin symptoms.5Rencz F. Baji P. Gulacsi L. et al.Discrepancies between the Dermatology Life Quality Index and utility scores.Qual Life Res. 2016; 25: 1687-1696Crossref PubMed Scopus (14) Google Scholar Possibly, the DLQI would have been more elaborately designed for patients with AD and psoriasis than those with vitiligo and others. Indeed, the DLQI cannot fully evaluate the psychological burden of stigmatization, isolation, and low self-esteem experienced by patients with vitiligo in particular.4Radtke M.A. Schafer I. Gajur A. Langenbruch A. Augustin M. Willingness-to-pay and quality of life in patients with vitiligo.Br J Dermatol. 2009; 161: 134-139Crossref PubMed Scopus (103) Google Scholar Limitation of our study include sampling bias, small sample size, self-administered questionnaire survey, and an inability to compare severity between diseases. In conclusion, WTP would be more appropriate than DLQI in assessing the psychosocial burden of disease, particularly in patients with vitiligo, which is otherwise asymptomatic.

Pictorial Representation of Illness and Self-Measure to assess the perceived burden in patients with chronic inflammatory vulvar diseases: an observational study.

Chronic inflammatory vulvar diseases can have a huge detrimental impact on patient welfare. A few studies have addressed this issue so far, mainly measuring patients' quality of life or sexual dysfunction. To assess the burden of suffering in patients with chronic inflammatory vulvar diseases using the Pictorial Representation of Illness and Self-Measure (PRISM), a visual, non-verbal instrument. We also assessed (i) the concordance between PRISM and the Dermatology Life Quality Index (DLQI), (ii) whether some variables, both patient-related and disease-related, affect the patient's suffering and quality-of-life impairment. We evaluated for inclusion in this cross-sectional study all patients who attended our Vulva Unit over a 9-month period with histologically proven lichen sclerosus (LS), lichen planus (LP), lichen simplex chronicus (LSC), eczema, plasma cell vulvitis and psoriasis (at least five for each disease). Demographics and disease-related subjective and objective scores were recorded. The PRISM and DLQI were administered. We included 87 patients affected with LS, 13 with LSC and seven with LP. Median PRISM values (0-273mm) ranged from 95 to 120mm, depending on the disease, and median DLQI scores (0-30) were five for all three groups. Neither PRISM nor DLQI scores differed significantly among the three groups. Moderate coherence was found between PRISM and DLQI (ρ=0.5455, P<0.001). Global subjective score was the only variable significantly associated with the degree of suffering and quality-of-life impairment. Pictorial Representation of Illness and Self-Measure proved to be a valuable, highly reliable tool for measuring the perceived burden in these patients. In spite of a moderate correlation, PRISM resulted more sensitive in capturing patient distress than DLQI.

Does transcutaneous electrical nerve stimulation have an antipruritic effect in lichen planus? A randomized clinical trial.

Lichen planus (LP) is a moderately prevalent inflammatory disorder that affects the skin and the oral mucosa, leading to a characteristic appearance and causing severe itching. To assess the potency of transcutaneous electrical nerve stimulation (TENS) as an antipruritic line of treatment in patients with LP. We enrolled 30 patients with LP who had a history of recurrent relapses of confined pruritus forcing them to scratch or rub the affected area intensively. Patients were treated with TENS three times per week for 4weeks. Severity of itching was estimated by visual analogue scale (VAS) and Dermatology Life Quality Index (DLQI). There was a statistically significant decline in mean VAS score at weeks 2 and 4 of treatment compared with baseline (P<0.05, with 74% of participants having an improvement of >50%. Significant improvement in itching intensity also resulted in better quality of life, as there was also a significant reduction in median DLQI at weeks 2 and 4 of therapy compared with baseline (P<0.05), with 65% of patients having an improvement of >50% in median DLQI score. TENS may be an alternative safe treatment for LP-induced itching.

PSS24 - Real-World, Non-Interventional, Observational, Patient Reported Outcome Study for Evaluating Effectiveness of Intensive Moisturizing Cream with Plant Based Butters (Venusia Max) in Management of Indian Patients with Psoriasis

Real-world, observational study to assess effectiveness, patient reported outcomes(PROs) and safety of intensive moisturizing cream with plant-based butters (Venusia® Max) in Indian patients with psoriasis A 4-week study conducted in 400 psoriatic patients receiving intensive moisturizing cream with plant-based butters (Venusia® Max) in routine clinical practice. PROs in form of Dermatology Life Quality Index (DLQI) questionnaire and Dry Skin/Ichthyosis Area and Severity Index (DASI) score were recorded at week 4 to measure the improvement in quality of life and severity of dryness. Safety and compliance assessment were recorded. Mean age of enrolled patients was 43.9 years, 50.8% were males and 49.2% females. Most patients had pre-existing chronic psoriasis, with 49 patients having severe disease at baseline and all were on topical therapy. Reduction in mean DLQI score was 66.7 % at week 4 from baseline (4.2 vs. 10.5, p<0.001) in overall population and 54.4% at week 4 from baseline (7.9 vs. 17.7) for severe psoriatic subgroup. Reduction of mean DASI score was 84.6 % at week 4 from baseline (149.7 vs. 430.5, p<0.001) in overall population and 80.9% at week 4 from baseline (300.4 vs. 734.3) for severe psoriatic subgroup. Similar reduction trend was seen in median DLQI score at week 4 from baseline (2 vs. 9 p<0.001) and median DASI score at week 4 from baseline (100 vs. 420 p<0.001) for overall population. Adverse events, mild to moderate in severity were reported in <3% patients and commonly included itching, fever. More than 90% patients used the cream as instructed by the physician during the study. Use of intensive moisturizing cream with plant-based butters (Venusia® Max) in Indian patients with posriasis was found to be effective, demonstrating a significant reduction in DASI score and significant improvement in quality of life (DLQI) with favorable tolerability profile.

Body dysmorphic disorder in female Swedish dermatology patients.

Individuals with body dysmorphic disorder (BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients. The occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire (BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI). The prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety (HADS A≥11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression (HADS D≥11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) (P<0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non-BDD group (P<0.001). Our results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life.

Health-related quality of life in adult dermatitis patients stratified by filaggrin genotype.

Information concerning health-related quality of life (HRQoL) and comorbidities of adult dermatitis patients stratified by loss-of-function mutations in the filaggrin gene (FLG) is limited. To investigate HRQoL, skin symptoms and comorbidities in adult FLG mutation carriers. This cross-sectional study included patients diagnosed with atopic dermatitis and/or hand eczema (n = 520). Patients completed questionnaires about dermatitis, skin symptoms, HRQoL, and comorbidities, including actinic keratosis, and atopic and mental disorders. FLG mutations (R501X, 2282del4, and R2447X) were identified in 16.9% of patients, and were significantly associated not only with atopic dermatitis, but also independently with skin fissures on the fingers and heels, and self-reported actinic keratosis. Although FLG mutations were significantly associated with reduced HRQoL, as measured by use of the Dermatology Life Quality Index (DLQI), no association with self-reported anxiety or depression was identified. Notably, the highest median DLQI score, reflecting greater impairment, was reported by patients with both FLG mutations and atopic dermatitis. Overall, 19.7% of patients with both atopic dermatitis and FLG mutations reported a 'large or extremely large' impact on their lives; this represents twice the prevalence seen in patients with atopic dermatitis and wild-type FLG (9.6%). Patients with both atopic dermatitis and common FLG mutations are more frequently affected by reduced HRQoL.

Quality of life in patients with seborrhoeic dermatitis in KwaZulu-Natal, South Africa

428 May 2016, Vol. 106, No. 5 Quality of life in patients with seborrhoeic dermatitis in KwaZuluNatal, South Africa To the Editor: Skin diseases may have a severe effect on the quality of life (QOL) of affected individuals,[1,2] but their impact has rarely been investigated in the developing world. In South Africa, there have been no studies conducted on patients with sebor­ rhoeic dermatitis (SD). A cross­sectional study was undertaken in the ILembe District, KwaZulu­Natal Province, assessing the QOL of patients presenting with SD, correlating clinical severity and demographic parameters. Forty­five consenting participants, with a clinical diagnosis of SD, were invited to participate. QOL was assessed using the Dermatology Life Quality Index (DLQI).[3] The severity of the condition was assessed by a dermatologist and graded at individual sites for erythema, thickness, scaling and pruritus on a three­point scale. Body surface area involvement was calculated using the rule of nines and the sites of involvement were recorded. A detailed demographic profile was completed for each patient (Table 1). The median severity score was 24 and the median DLQI score was 17, which equates to a very large effect on the QOL.[3] The QOL varied depending on sex, educational level, ethnic origin, home language, marital status, residence, HIV status and site of involvement. Female patients were more negatively influenced by the disease, confirming the findings in three other studies.[4­6] Patients with no formal schooling were more adversely affected. The way the questions were interpreted and the perception of disability may explain the differences in DLQI between the groups. Visible body areas and groin involvement had a greater impact on a patient’s QOL. As appearance plays an important role in our society, patients felt more embarrassed and self­conscious. In addition groin involvement may affect intimacy with a partner. SD has a higher prevalence in patients with HIV and has been found in up to 40% of seropositive patients,[7] notably, HIV­ positive patients (n=37, 82.2%), with a CD4 count 1 year (n=13, 46.6%) had higher DLQI and severity scores. Although the introduction of ARVs has reduced the number of opportunistic dermatological conditions seen, there has been no change in the prevalence of primary HIV­related inflammatory diseases.[7] This is illustrated by a lack of significant associations between HIV­positive patients on ARVs v. those who were not on ARVS and QOL (on ARVs n=29, median 18; not on ARVs n=8, median 17). This study highlights that QOL tools are valuable in understanding the impact of skin disorders and will help in providing holistic, comprehensive management, offering a patient’s own perspective of their debilitating skin condition.

DI-057 Biological treatment and psoriasis: the correlation between clinical efficacy and therapeutic adherence

BackgroundPsoriasis is a chronic disease that significantly affects patients’ quality of life (QoL). Biological drugs interfere in the immunological processes that trigger and support psoriasis and, therefore, prove effective in...

Determinants of Health-Related Quality of Life in Psoriasis Patients in Malaysia

Psoriasis is a chronic dermatological disorder that has a negative impact on quality of life (QoL). This hospital-based cross-sectional study determined factors associated with health-related QoL (HRQoL) impairment in adult psoriasis patients. HRQoL was assessed using the Dermatology Life Quality Index (DLQI). Disease severity was assessed using the Psoriasis Area and Severity Index (PASI). A total of 223 patients, aged 18 to 83 years, were recruited. For 67 (30%) patients, psoriasis had very large to extremely large effect on their life (DLQI score = 11-30). The median DLQI score was 7 (interquartile range = 7). Factors significantly associated with severe impact on HRQoL (DLQI ≥ 10) were disease severity, single status, working status, sports activities, nail dystrophy, exposed area involvement, itch, disturbed sleep, stress, and infection. The factor predictive of severe impact of psoriasis on HRQoL was disease severity. A holistic approach in the management, including psychosocial issues, is absolutely crucial for the optimal care of psoriasis patients.