Total Dermatology Life Quality Index Research Articles

Quality of life assessment in patients with alopecia areata and androgenetic alopecia in the People's Republic of China.

IntroductionIn medical terms, alopecia is considered a relatively mild dermatological condition that nevertheless is a serious condition, but it causes major depression in many sufferers. Alopecia areata (AA) and androgenetic alopecia (AGA) are the main types of hair loss. This study assessed the quality of life (QoL) of Chinese patients with AA and AGA using the Dermatology Life Quality Index (DLQI) questionnaire.MethodsA total of 178 AA and AGA patients were enrolled in this study, and DLQI was used to evaluate the QoL of the patients. The DLQI used 10 items regarding symptoms and feelings, daily activities, leisure, work and school, personal relationships, and treatment as dimensions of life. Each was scored on a 0–3 scale. The total DLQI score equaled 0–30; higher scores showed greater impact on QoL.ResultsThe DLQI scores of the 178 patients ranged from 0 to 28, with a mean score of 6.3. Higher DLQI scores were reported by younger patients (P<0.05) and by those who had hair loss for a duration of >12 months (P<0.05). The DLQI score of AA patients was significantly higher than that of AGA patients (P<0.05). QoL was not affected by gender, marital status, educational level, past history of alopecia, family history of alopecia, or severity of alopecia.ConclusionAA and AGA moderately affected the QoL of the patients. A higher DLQI score was significantly associated with younger age, hair loss for a duration of >12 months, and AA. Both AA and AGA moderately affected the QoL of the patients not only in physiological aspects but also in their emotional and social aspects. The bio-psycho-social aspects of disease need to be addressed in patients with AA and AGA, even though these conditions are not life-threatening.

Quality of Life Impairment in Children and Adults with Vitiligo: A Cross-Sectional Study Based on Dermatology-Specific and Disease-Specific Quality of Life Instruments

Background: Vitiligo can negatively affect a patient's quality of life (QoL). A specific questionnaire has been developed and validated in the English language: the vitiligo-specific quality-of-life instrument (VitiQoL). The instrument was translated, culturally adapted and validated into Brazilian Portuguese (VitiQoL-PB). Objective: The aim of this study was to assess the QoL in adult patients through the VitiQoL and Dermatology Life Quality Index (DLQI) and in pediatric patients through the Children's Dermatology Life Quality Index (CDLQI) in a sample of patients with vitiligo. Methods: Subjects were selected from a dermatological outpatient clinic and from a private practice in Porto Alegre. The QoL of pediatric patients was evaluated using the CDLQI questionnaire. In adult patients we used the VitiQoL-PB and the DLQI. Results: A strong correlation between the scores of the total VitiQoL and DLQI was observed (r = 0.81; p < 0.001). The factor that most contributed to the final score of VitiQoL was stigma. In our sample, women had higher scores than men (p < 0.05). Psychiatric problems were associated with lower QoL. In the pediatric population, the median score of the CDLQI was 3 (interquartile range 1.3-7.3). There was a statistically significant correlation between the child's age and the CDLQI score (r_s = 0.41, p = 0.044). Conclusion: This study confirms that the VitiQoL is easy to administer and adds important information about the impact of vitiligo on a South American population. Stigmatization is very present in the disease. There are groups of patients that are more vulnerable, like women, patients with psychiatric diseases and adolescents.

Discrepancies between the Dermatology Life Quality Index and utility scores.

In many jurisdictions, deterioration in quality of life assessed with Dermatology Life Quality Index (DLQI) is used for medical and reimbursement decisions in various dermatological conditions such as psoriasis. However, utility values for health states defined by the DLQI have not yet been evaluated. Therefore, we aim to estimate utilities for different health states described by the ten items of the DLQI. A cross-sectional survey was performed in a convenience sample of the general population. Seven DLQI health states with total scores of 6, 11 and 16 (3-3 and 1 states, respectively) were developed. All of them were different from each other in the number of affected items and severity levels of impairment. The 10-year time trade-off method was used to value health states. Mean utilities elicited by the respondents (n=308) for the three 6-, three 11- and one 16-point DLQI health states were 0.62-0.75, 0.59-0.66, and 0.56, respectively. In half of the six pairwise comparisons, where health states with the same total DLQI score were compared, significant difference between utilities was found. In eight out of the 15 comparisons between health states with different DLQI scores, utilities were not significantly different. Utility values for health states with identical DLQI total score may significantly vary. This result might be generalisable to various patient populations, in which the DLQI is used; nevertheless, further research is needed. The discrepancies between DLQI scores and utilities might have an impact on medical and reimbursement decisions as they make the utility gain from treatment uncertain.

Efficacy of Intralesional Botulinum Toxin A for Treatment of Painful Cutaneous Leiomyomas: A Randomized Clinical Trial.

Cutaneous leiomyomas can be associated with severe paroxysmal pain in which nerve conduction may have a key role. Medical management of painful cutaneous leiomyomas is generally unsatisfactory. To assess the efficacy of intralesional botulinum toxin A in the management of pain associated with cutaneous leiomyomas. Randomized, double-blind, placebo-controlled pilot study conducted from January 5, 2009, to March 27, 2014. The setting was a single-center study at the National Institutes of Health among participants 18 years or older with cutaneous leiomyomas characterized by pain at least once weekly and pain of at least 4 on a pain scale ranging from 0 to 10. Eighteen participants were randomized to receive intralesional botulinum toxin A (5 U per 1 cm2) or equivalent volumes of intralesional saline placebo. The primary outcomes were the differences in average lesional pain assessed by the Brief Pain Inventory and visual analog scale before and after ice provocation over a 4-week period. No significant difference in average lesional pain was observed between the study arms. Decreased pain was reported in the botulinum toxin vs placebo arms by visual analog scale scores before ice provocation (median, 0.00; range, -3.30 to 0.70 for botulinum toxin and median, 0.40; range, -1.30 to 1.50 for placebo; P = .06); however, this finding was nonsignificant. No significant difference was observed in change in pain after ice provocation. A significant difference was seen between the arms in skin-related quality of life by total Dermatology Life Quality Index (median, -4.00; range, -8.00 to 2.00 for botulinum toxin and median, 0.00; range, -1.00 to 4.00 for placebo; P = .007) and with the specific skin pain-related question on the Dermatology Life Quality Index (median, -1.00; range, -2.00 to 1.00 for botulinum toxin and median, 0.00; range, -1.00 to 0.00 for placebo; P = .048). No significant difference was found in pain as ascertained by Patient Global Impression of Change at week 4. No serious adverse events related to botulinum toxin use were observed. The use of botulinum toxin to treat painful cutaneous leiomyomas was associated with improved quality of life and with a trend toward improved pain at rest. clinicaltrials.gov Identifier: NCT00971620.

Prevalence of scars and "mini-scars", and their impact on quality of life in Japanese patients with acne.

There have been very few studies on the prevalence and severity of acne scars in Japanese patients. The aim of the present study was to investigate the prevalence of acne scars and their impact on the quality of life (QOL) in Japanese acne patients. Acne scars were classified as mini-scars (atrophic scars of ≥0.5 and <2mm in diameter) atrophic scars (≥2 mm in diameter), and hypertrophic scars. The severity of acne and acne scars were evaluated. The background of patients and their QOL in relation to acne were assessed. Of 240 subjects, 218 (90.8%) had scars. All patients with scars had mini-scars; 61.2% and 14.2% of 240 had atrophic scars and hypertrophic scars, respectively. Severe scarring was found in patients who had experienced severe acne symptoms, although 15.0% of patients with scars had experienced only mild acne symptoms. The total Dermatology Life Quality Index score was significantly higher in patients with scars than in patients without scars (5.9±4.4 vs 4.2±4.1). Almost all the patients had small atrophic scars with a diameter of 0.5 or more and less than 2mm, which we have termed "mini-scars". Acne scars had a negative impact on patient QOL. Early initiation of treatment is recommended to avoid acne scars.

Clinical Characteristics and Quality of Life of Seborrheic Dermatitis Patients in a Tropical Country.

Background:Seborrheic dermatitis is a common chronic inflammatory skin condition that can have a negative impact on a patient's quality of life. Few studies have been conducted to assess the clinical characteristics of the disease and quality of life of the patients, especially in tropical countries.Aims and Objectives:The aim of this study was to demonstrate the clinical characteristics and quality of life of patients with seborrheic dermatitis in Thailand.Materials and Methods:A cross-sectional study was performed at a university-based hospital and tertiary referral center in Bangkok, Thailand. The validated Thai version of the dermatology life quality index (DLQI) was used to evaluate patients’ quality of life.Results:A total of 166 participants were included. One hundred and forty-seven patients (88.6%) experienced multiple episodes of the eruption. The mean of outbreaks was 7.8 times per years, ranging from once every 4 years to weekly eruption. The most common factor reported to aggravate seborrheic dermatitis was seasonality (34.9%), especially hot climate. The mean (SD) of the total DLQI score was 8.1 (6.0) with a range of 0 to 27. There was no statistically significant difference between the two DLQI categories regarding duration of disease, extent of involvement, symptoms or course of the disease.Conclusion:Although mild and asymptomatic, seborrheic dermatitis can have a great impact on the quality of life. Youth, female gender, and scalp lesions were significantly associated with higher DLQI scores.

To What Extent Is Quality of Life Impaired in Vitiligo? A Multicenter Study on Italian Patients Using the Dermatology Life Quality Index

Background: It is believed that vitiligo has an impact on the overall patient quality of life (QoL). Objective: To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire. Methods: One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire. Results: The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset. Conclusions: The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.

Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients.

BackgroundSurgical scars are crucial cosmetic problem, especially when in exposed areas such as the anterior neck following thyroidectomy.ObjectiveTo evaluate the impact of post-thyroidectomy scars on quality of life (QoL) of thyroid cancer patients and identify the relationship between scar characteristics and QoL.MethodsPatients with post-thyroidectomy scars on the neck were recruited. QoL was measured using the Dermatology Life Quality Index (DLQI). Scar characteristics were graded according to Vancouver scar scale (VSS) score.ResultsNinety-seven patients completed a battery of questions at the time of enrollment. Post-thyroidectomy scars were classified according to morphology as linear flat scars, linear bulging scars, hypertrophic scars or adhesive scars. There were 32 patients (33.0%), 9 patients (9.3%), 41 patients (42.3%) and 15 patients (15.5%), respectively, in each group. The mean total DLQI score was 9.02. Domain 2 (daily activities, 2.87 points), which includes questions about clothing, was the most greatly impacted among patients. The total DLQI scores of patients who have experienced scar-related symptoms were significantly higher than those of patients without symptoms (p<0.05). The VSS scores were 3.09 for linear flat scars, 6.89 for linear bulging scars, 6.29 for hypertrophic scars and 5.60 for adhesive scars. However, the DLQI scores did not significantly differ among scar types or VSS scores.ConclusionPost-thyroidectomy scars on the neck affect the QoL of thyroid cancer patients regardless of scar type. Therefore, clinicians should pay attention to the psychological effects of scars on patients and take care to minimize post-thyroidectomy scar.

Disease characteristics in patients with and without psoriatic arthritis treated with etanercept

Patients with psoriasis (PsO) and psoriatic arthritis (PsA) have functional disability, pain and emotional problems, and experience lower quality of life (QoL) than patients with PsO alone. Examine effectiveness of etanercept (ETN) in patients with PsO alone, and with PsA, and determine whether PsA patients on ETN experience rapid QoL improvement. Data from three phase III trials using ETN in adults with moderate-to-severe PsO were pooled. Patients with (n = 523) and without (n = 1330) PsA received ETN 25 mg once weekly to 50 mg twice weekly or placebo for 12-24 weeks. Assessments included Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), EuroQoL-5D (EQ-5D), Study 36-item Short Form Health Survey (SF-36) and Hamilton Depression Rating Scale (HAM-D). Baseline PASI, EQ-5D and SF-36 physical component summary scores were worse for PsA patients. With ETN, PASI for PsA and non-PsA groups improved as early as week 2. Scores for both groups converged by week 12. EQ-5D and SF-36 physical component improved faster in PsA patients, with EQ-5D scores converged by week 2. For total DLQI and most components, both groups had similar baseline scores and improved over 24 weeks on ETN. While the PsA group had more depressed patients at baseline, after 24 weeks on ETN it showed a greater reduction in the number of depressed patients than the non-PsA group. In patients with PsO involving ≥10% of body surface area, skin disease and QoL are worse in PsA patients. With ETN, QoL improved rapidly in PsA patients.

Quality of Life and Emotional State in Vitiligo in an Estonian Sample: Comparison with Psoriasis and Healthy Controls

The impact of vitiligo on quality of life is controversial. The aim of this study was to observe the impairment of quality of life and emotional state in adults with vitiligo compared with subjects with psoriasis and unaffected controls. The study group comprised 54 subjects with vitiligo, 57 with psoriasis and 57 unaffected controls. All subjects were examined and interviewed using the Dermatology Life Quality Index (DLQI) and Emotional State questionnaires. The total mean DLQI score in vitiligo was 4.7, compared with 0.6 in healthy controls (p<0.001) and 13.1 in psoriasis (p<0.001). In vitiligo, females experienced a greater impact on feelings and men experienced a greater impact on relationships. Lower quality of life in vitiligo was associated with active stage of the disease, extension of pigment loss, depigmentation on the hands, and earlier onset of disease. The results demonstrate that vitiligo has less impact on quality of life than psoriasis.

Measuring melasma patients' quality of life using willingness to pay and time trade-off methods in thai population

BackgroundMelasma is a common hyperpigmentation disorder that has a significant effect on an individual's quality of life. However, there is no preference-based measurement that reflects quality of life in patients with melasma. The objective of this study was to assess the impact of melasma on quality of life by using a health status measurement - the Dermatology Life Quality Index (DLQI) - and a preference-based measurement - Willingness to Pay (WTP) and Time Trade-Off (TTO).MethodsA cross-sectional descriptive study was conducted. Seventy-eight patients with melasma who attended the melasma clinic at Siriraj Hospital from February to March 2009 were recruited in this study. The Thai version of the DLQI, questionnaires about WTP, standard TTO, and daily TTO were used to assess patients' quality of life.ResultsSeventy-seven (98.7%) patients were female with a mean age of 47.8 ± 7.9 years. The mean health utility based on standard TTO was 0.96. The utility obtained by the daily TTO method was 0.92 and was significantly correlated with an economically inactive occupation (p < 0.05). The mean monthly WTP for the most effective treatment was 1,157 baht (7.2% of monthly income), ranging from 100 to 5,000 baht (1 USD ~ 35.1 baht). The WTP was significantly correlated with monthly personal income and the total DLQI score.ConclusionThe WTP method could be a useful tool with which to measure the quality of life of patients with melasma.

Sexual Dysfunction in Female Patients With Neurodermatitis

Neurodermatitis is a chronic disease affecting the patient's psychosocial status and quality of life. It is associated with a variety of psychologic problems, including demoralization, depression, anxiety, obsessive-compulsive disorder, and sleep disturbances. Coexistence of sexual dysfunction, especially in women, with several systemic diseases has gained interest in recent years. In this study, we evaluated sexual function in female patients with neurodermatitis. We enrolled 89 women (43 patients, 46 controls) in the study. Quality of life was assessed with the Dermatology Life Quality Index (DLQI), and the Female Sexual Function Index (FSFI) was used to determine sexual function. Individuals with psychiatric disorders and/or those using antidepressants were excluded. The total DLQI score was 11.95 ± 5.65 in patients with neurodermatitis. The total FSFI score was significantly lower in patients compared with healthy controls (22.76 ± 5.31 and 28.83 ± 3.50, respectively; P = .001). Domain scores of FSFI (desire, arousal, lubrication, orgasm, and satisfaction) except pain were significantly lower in patients with neurodermatitis (P = .001). The pain score was also lower in patients than controls, but the difference was not statistically significant (P = .073). Neurodermatitis may be associated with sexual dysfunction, and patients with neurodermatitis should be evaluated with regard to sexual function to provide a better quality of life.

DLQI scores in patients with keloids and hypertrophic scars: a prospective case control study

Keloids and hypertrophic scars (HTS) can cause functional impairment and psychosocial burdens, both of which affects quality of life (QoL). Our aim was to compare Dermatology Life Quality Index (DLQI) scores in patients with keloids and HTS to those of psoriasis patients and normal controls. Forty-eight consecutive patients with keloids and HTS and 48 with psoriasis vulgaris attending our dermatology outpatient clinic, as well as 48 sex- and age-matched healthy controls completed the DLQI. Total DLQI scores of patients with keloids and HTS (7.79 +/- 5.10) and psoriasis (8.73 +/- 5.63) were comparable and significantly higher than that of healthy controls (0.58 +/- 0.77). No significant difference were found between patients with psoriasis and patients with keloids and HTS in terms of the total DLQI scores and the subscale scores (p > 0.05) except "treatment" (p < 0.05) sub-scale scores which were higher in psoriasis. The QoL of patients with keloids and HTS is impaired as much as that of those with psoriasis. The DLQI questionnaire is a reliable and valid instrument for assessing the QoL in patients with keloids and HTS.

Effect on quality of life in patients with pityriasis rosea: Is it associated with rash severity?

It is unknown how the quality of life (QOL) is affected in patients with pityriasis rosea (PR), and whether it is related to rash severity. We constructed a valid and reliable Cantonese version of the Dermatology Life Quality Index (DLQI). We recruited patients with PR, with atopic dermatitis and with acne vulgaris, and controls of the same sex and comparable age. We applied the DLQI and the Pityriasis Rosea Severity Score (PRSS) to the patients with PR, the DLQI and the SCORing Atopic Dermatitis Index (SCORAD) to the controls with atopic dermatitis, and the DLQI and the Leeds Acne Grading System (LAGS) to the controls with acne vulgaris. Total DLQI scores of the 22 patients with PR (mean: 6.36, SD: 5.79) were significantly lower than those of the 22 controls with atopic dermatitis (mean: 12.00, SD: 5.38) (P = 0.021), but were insignificantly different from those of the 22 controls with acne vulgaris (mean: 6.86, SD: 4.53) (P = 0.57). Correlation between the total DLQI and PRSS scores was weak (gamma(s) = +0.19) and insignificant (P = 0.40). All six DLQI parameters were insignificantly correlated with the PRSS scores. In contrast, the total DLQI scores and most of the DLQI parameters were strongly correlated with the rash severity scores for the control subjects. Significantly more patients with PR have concerns regarding disease etiology and infectivity. The QOL of the patients with PR was significantly less affected than that for the patients with atopic dermatitis, but was insignificantly different from the patients with acne vulgaris. Unlike atopic dermatitis and acne vulgaris, the effects on the QOL in PR are insignificantly correlated with rash severity. These results bear important implications on clinical management.

Validation of the Dermatology Life Quality Index as an outcome measure for urticaria-related quality of life

Chronic idiopathic urticaria (CIU) is a debilitating skin disease that affects patients' quality of life (QOL). The Dermatology Life Quality Index (DLQI) assesses QOL parameters across several types of dermatologic conditions. However, an evaluation of the validity of the DLQI for use in CIU patients has not been undertaken, because CIU, unlike other chronic skin conditions, is subject to daily or weekly symptom fluctuations. To test the reliability and validity of the DLQI in 2 samples of CIU patients treated with fexofenadine hydrochloride (20, 60, 120, or 240 mg twice daily). Data were obtained from 2 similar multicenter, double-blind, randomized, placebo-controlled, parallel-group studies of CIU patients (n = 418 and n = 439). Patients completed the 10-item DLQI during 3 clinic visits (approximately 2 weeks apart). Clinic personnel also recorded patients' symptoms. The results of the DLQI items were similar to those obtained with other skin disease populations, indicating the presence of relatively symmetrical distributions. Reliability was high, demonstrating the lack of excessive random measurement error (alpha coefficient = .89 and .87 for samples 1 and 2). Factor analysis resulted in a unidimensional pattern, supporting the use of a total DLQI score. Most DLQI items distinguished patients with varying degrees of QOL impairment, highlighting the sensitivity of this instrument. Construct validity was moderate, providing evidence that the DLQI was responsive to changes in patients' clinical status. The DLQI is a valid, reliable, and clinically useful outcome measure for assessing QOL in CIU patients.

Skin cancer and quality of life: assessment with the Dermatology Life Quality Index.

Quality of life (QOL) has been identified as an important outcome in cancer research, yet the most common malignancy among humans, nonmelanoma skin cancer (NMSC), has been poorly studied in this regard. To determine whether change occurred in the QOL of NMSC patients after surgery using a general, validated dermatology QOL instrument: the Dermatology Life Quality Index (DLQI). A prospective study was conducted on 121 consecutive patients referred to a dermatologic Mohs surgery clinic with NMSC of the head and neck. QOL assessment was performed using the DLQI before (n=121) and after surgical treatment at 4 months (n=101). QOL scores demonstrated little handicap at initial diagnosis. The total DLQI scores showed little change over time, but an item analysis revealed that 2 of the 10 items demonstrated statistically significant change over time, with QOL improving after treatment-decreased painfulness/itchiness/soreness and less necessity to use concealing clothing. General dermatology QOL instruments demonstrated minimal handicap at initial diagnosis and little change after treatment of NMSC. Although the associations were modest, improvement in some aspects of well-being after treatment of NMSC was demonstrated. A more disease-specific instrument may be necessary to study this disease process further.