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Tanioka M, Yamamoto Y, Kato M, Miyachi Y. Camouflage for patients with vitiligo vulgaris improved their quality of life. J Cosmet Dermatol 2010; 9:72-5. [DOI: 10.1111/j.1473-2165.2010.00479.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
Skin diseases are among the most common health problems worldwide and are associated with a considerable burden. The burden of skin disease is a multidimensional concept that encompasses psychological, social and financial consequences of the skin disease on the patients, their families and on society. Chronic and incurable skin diseases, such as psoriasis and eczema, are associated with significant morbidity in the form of physical discomfort and impairment of patients' quality of life; whereas malignant diseases, such as malignant melanoma, carry substantial mortality. With the availability of a wide range of health status and quality-of-life measures, the effects of most skin diseases on patients' lives can be measured efficiently. The aim of this review is to present some of the published data in order to highlight the magnitude of the burden associated with some common skin diseases and also to suggest ways to quantify this burden of skin disease.
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Affiliation(s)
- Mohammad K A Basra
- Department of Dermatology, Cardiff University School of Medicine, Heath Park, Cardiff, CF14 4XN, UK.
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Linthorst Homan MW, Spuls PI, de Korte J, Bos JD, Sprangers MA, van der Veen JPW. The burden of vitiligo: patient characteristics associated with quality of life. J Am Acad Dermatol 2009; 61:411-20. [PMID: 19577331 DOI: 10.1016/j.jaad.2009.03.022] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2007] [Revised: 03/03/2009] [Accepted: 03/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Vitiligo is commonly regarded as a harmless cosmetic skin problem in Western societies, and the importance of treating patients with vitiligo is often underestimated. OBJECTIVE We sought to determine the clinical and sociodemographic variables that adversely affect the quality of life in adult patients with generalized vitiligo so that these variables can be considered in the treatment and care. METHODS A total of 245 adult patients with generalized vitiligo completed two quality-of-life questionnaires (the Medical Outcomes Study 36-Item Short-form General Health Survey and the Skindex-29). Physicians assessed sociodemographic and clinical characteristics of these patients. RESULTS Dark skin type, vitiligo located on the chest, and treatment in the past appeared to have an adverse impact on the psychosocial domains of quality of life. Moreover, itch was reported by 20% of the patients in this study. LIMITATIONS Psychiatric comorbidity was not evaluated in the analyses. CONCLUSION Generalized vitiligo is a serious skin disorder with an adverse impact on the emotional state, comparable with that of other major skin diseases.
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Affiliation(s)
- May W Linthorst Homan
- Netherlands Institute for Pigment Disorders, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Radtke M, Schäfer I, Gajur A, Langenbruch A, Augustin M. Willingness-to-pay and quality of life in patients with vitiligo. Br J Dermatol 2009; 161:134-9. [DOI: 10.1111/j.1365-2133.2009.09091.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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KIM DY, LEE JW, WHANG SH, PARK YK, HANN SK, SHIN YJ. Quality of life for Korean patients with vitiligo: Skindex-29 and its correlation with clinical profiles. J Dermatol 2009; 36:317-22. [DOI: 10.1111/j.1346-8138.2009.00646.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Kostopoulou P, Jouary T, Quintard B, Ezzedine K, Marques S, Boutchnei S, Taieb A. Objective vs. subjective factors in the psychological impact of vitiligo: the experience from a French referral centre. Br J Dermatol 2009; 161:128-33. [PMID: 19298280 DOI: 10.1111/j.1365-2133.2009.09077.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Vitiligo affects around 0.5% of the population. The burden of disease perceived by patients seems to be underestimated by the medical community. OBJECTIVES To analyse the impact of objective and psychological factors on the quality of life (QoL) and self-body image of patients with vitiligo. METHODS Demographic data, medical information and psychological factors (perceived severity, trait anxiety, trait depression, trait self-esteem, body image and QoL) were prospectively collected for all patients. RESULTS Forty-eight patients with a mean age of 43.9 years were included in the study. Vitiligo caused overall a moderate effect on patients' QoL with a 7.17 Dermatology Life Quality Index (DLQI) mean score (out of 30) without correlation with gender. According to distribution, no or minimal (DLQI 0-1), mild (2-5), moderate (6-11) and severe (12-20) impairment of QoL was found in five (10%), 14 (29%), 18 (38%) and 11 (23%) patients, respectively. The mean perceived severity evaluated by the patients was 4.91 based on visual analogue scale from 0 to 10. The self-body image was influenced by gender, perceived severity and disease characteristics. Perceived severity and patient personality were predictors of QoL impairment. Perceived severity of vitiligo was explained mainly by the patients' personality and less significantly by objective criteria. CONCLUSIONS Subjective as well as objective factors should be included in the assessment of disease severity and follow-up of patients with vitiligo. A simple perceived severity scale is useful in clinical practice.
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Affiliation(s)
- P Kostopoulou
- Centre de Référence des Maladies Rares de la Peau, Service de Dermatologie, Hôpital Saint André, Bordeaux 33075, France
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Gawkrodger D, Ormerod A, Shaw L, Mauri-Sole I, Whitton M, Watts M, Anstey A, Ingham J, Young K. Guideline for the diagnosis and management of vitiligo. Br J Dermatol 2008; 159:1051-76. [DOI: 10.1111/j.1365-2133.2008.08881.x] [Citation(s) in RCA: 225] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Basra MKA, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol 2008; 159:997-1035. [PMID: 18795920 DOI: 10.1111/j.1365-2133.2008.08832.x] [Citation(s) in RCA: 254] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The Dermatology Life Quality Index (DLQI) is one of the most widely used dermatology-specific quality of life instruments. Over the last 5 years there has been great interest in its use. OBJECTIVES To collect and present all information regarding the technical properties and the clinical use of the DLQI from the date it was published to the end of 2007 for use as a single source of reference. METHODS A detailed literature search was conducted using electronic reference databases and the DLQI library in the Department of Dermatology, Cardiff University. All publications mentioning any aspect of the DLQI, from the time of its development to the end of 2007, were identified and the data concerning the DLQI in terms of its psychometric analysis, and use in clinical trials, epidemiological studies and health services research, were extracted and tabulated with all the relevant references. RESULTS In total, 272 full articles which have included the DLQI were reviewed. Studies described in these articles were divided into five main categories: psychometric studies, descriptive/epidemiological studies, drug (topical and systemic) trials, clinical practice research, and therapeutic interventions. The DLQI has been used in 33 different skin conditions in 32 countries and is available in 55 languages. Psychometric aspects of the DLQI such as validity, reliability, responsiveness to change, factor structure, and minimal important difference were described in 115 studies. The DLQI has been used in 33 studies assessing the effectiveness of 14 different types of therapeutic interventions and in 37 studies evaluating nine types of clinical practice research. Sixty studies have used it alone or in parallel with other instruments as an outcome measure in clinical trials of 18 systemic drugs while 22 studies have used it in 14 different topical drug trials. The DLQI has also been used in 27 multinational studies. CONCLUSIONS During the last 14 years there has been a gradual increase in the international use of the DLQI. The brevity and simplicity of use of the DLQI has resulted in its popularity both in clinical practice and in research. However, there are various issues in particular regarding its unidimensionality, differential item functioning, and minimal clinically important difference, which require further research. This article should facilitate the work of potential users of the DLQI by providing a readily available source of references for different aspects of the DLQI.
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Affiliation(s)
- M K A Basra
- Department of Dermatology, School of Medicine, Cardiff University, Heath Park, Cardiff CF14 4XN, U.K.
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Sampogna F, Raskovic D, Guerra L, Pedicelli C, Tabolli S, Leoni L, Alessandroni L, Abeni D. Identification of categories at risk for high quality of life impairment in patients with vitiligo. Br J Dermatol 2008; 159:351-9. [DOI: 10.1111/j.1365-2133.2008.08678.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Schmid-Ott G, Schallmayer S, Calliess IT. Quality of life in patients with psoriasis and psoriasis arthritis with a special focus on stigmatization experience. Clin Dermatol 2008; 25:547-54. [PMID: 18021891 DOI: 10.1016/j.clindermatol.2007.08.008] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Negative impact of psoriasis and psoriasis arthritis on quality of life is a central consequence of these diseases. Feelings of stigmatization might, for example, already emerge with only small patches of skin being affected. Empirical data indicate that treating dermatologists should address possible negative effects elicited by problematic encounters with the public and in sexual relationships even if the severity of the disease is low, because lesions on invisible parts of the body can already cause serious adverse impairment. Such psychosocial consequences can be reduced by attending a self-help organization and by taking part in an interdisciplinary patient education program led by dermatologists.
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Affiliation(s)
- Gerhard Schmid-Ott
- Department of Psychosomatic Medicine, Hanover Medical School, D-30625 Hanover, Germany.
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63
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Critical Review of Generic and Dermatology-Specific Health-Related Quality of Life Instruments. J Invest Dermatol 2007; 127:2726-39. [DOI: 10.1038/sj.jid.5701142] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Wittkowski A, Richards HL, Williams J, Fortune DG, Griffiths CEM, Main CJ. An Examination of the Psychometric Properties and Factor Structure of the Feelings of Stigmatization Questionnaire. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9074-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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65
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Evren B, Evren C. Relationship Between Alexithymia and Social Anxiety in Female Outpatients with Dermatological Disorder Presenting for Psychiatric Consultation. J Clin Psychol Med Settings 2007. [DOI: 10.1007/s10880-007-9072-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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66
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Schmid-Ott G, Künsebeck HW, Jecht E, Shimshoni R, Lazaroff I, Schallmayer S, Calliess IT, Malewski P, Lamprecht F, Götz A. Stigmatization experience, coping and sense of coherence in vitiligo patients. J Eur Acad Dermatol Venereol 2007; 21:456-61. [PMID: 17373970 DOI: 10.1111/j.1468-3083.2006.01897.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study examines the extent of stigmatization experienced by vitiligo patients considering the visibility of the lesions. METHODS 363 vitiligo patients were assessed using the Experience with Skin Complaints (QES), Adjustment to Chronic Skin Disorders (ASC), and Sense of Coherence (SOC) questionnaires. Out of the total patients group two representative samples with 52 patients each were identified comparable for age, gender, and the duration of the skin disease, the first with visible and the second with invisible lesions. RESULTS Data indicate a significant negative correlation between the QES dimensions, except for 'Composure', and between coping scales with sense of coherence withstanding. The 'visible lesions' group scored higher compared to the 'invisible lesions' group on the two QES scales 'Self-Esteem' and 'Refusal', i.e., patients with visible lesions experienced a higher level of stigmatization. CONCLUSION This study provides new information which supports the notion that the stigmatization experience of vitiligo patients is psychologically relevant.
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Affiliation(s)
- G Schmid-Ott
- Department of Psychosomatic Medicine, Hannover Medical School, Hannover, Germany.
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67
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Abstract
BACKGROUND There is a clear need for a useable measure of health-related quality-of-life (HRQoL) for dermatology patients. Most of the existing dermatology-specific measures were developed for the English language, and these measures should be adapted for use in other cultures. OBJECTIVE To adapt Skindex-29 (one of the most widely recognized dermatology-specific quality-of-life indices) for the Turkish cultural setting. PATIENTS AND METHODS Forward and backward translations were carried out, and for doubtful items the process was repeated until a satisfactory agreement with the original version of Skindex-29 was achieved. The intermediate Turkish version was administered to a group of 20 randomly selected Turkish adults with and without skin conditions. The final Turkish version of the Skindex-29 was administered to 456 patients attending Osmangazi University Dermatology outpatient clinics. Reliability, construct and content validity were assessed. RESULTS The instrument was internally consistent, with Cronbach's alpha-coefficients of 0.94, 0.76, 0.88, and 0.92 for entire questionnaire, symptom, emotional, and functional scales, respectively. The Turkish Skindex-29 demonstrated construct and content validity. CONCLUSION Our evaluation of the Skindex-29 indicates that the instrument is a comprehensible, useable, reliable and valid measure of quality-of-life for Turkish dermatologic patients.
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Affiliation(s)
- Ayse Esra Koku Aksu
- Department of Dermatology, Osmangazi University Medical School, Eskisehir, Turkey.
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68
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Belhadjali H, Amri M, Mecheri A, Doarika A, Khorchani H, Youssef M, Gaha L, Zili J. Vitiligo et qualité de vie : étude cas-témoins. Ann Dermatol Venereol 2007; 134:233-6. [PMID: 17389846 DOI: 10.1016/s0151-9638(07)91814-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Vitiligo is a common and visible form of leukoderma that can adversely affect the quality of life of patients. The aim of this study was to assess the impact of vitiligo on the quality of life of patients. PATIENTS AND METHODS This was a cross-sectional case-control study performed between 1 September 2000 and 31 December 2001. Sixty patients with vitiligo and 60 controls paired for age and gender were collated. Quality of life was assessed using the Dermatology Life Quality Index (DLQI). RESULTS Mean patient age was 38.9 years. The sex-ratio M/F was 1.1. Vitiligo was generalized in 80% of cases. Quality of life was significantly impaired in patients and to a greater extent in women and in cases affecting more than 10% of the body surface. All aspects of quality of life were affected. CONCLUSION Because of its visible nature, vitiligo can impair patients' quality of life and have marked psychological impact.
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Affiliation(s)
- H Belhadjali
- Service de Dermatologie, Hôpital CHU de Monastir, Tunisie.
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69
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Oztürkcan S, Ermertcan AT, Eser E, Sahin MT. Cross validation of the Turkish version of dermatology life quality index. Int J Dermatol 2006; 45:1300-7. [PMID: 17076710 DOI: 10.1111/j.1365-4632.2006.02881.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND The aim of this study was to test the linguistic validation of the Turkish version of the Dermatology Life Quality Index (DLQI) for Turkish speaking dermatology patients. METHODS The DLQI is a 10-item dermatology specific index developed originally in English. The methodology of this study consists of four consecutive sections: Translation, cognitive debriefing, field testing and statistical analysis. Translation steps: (a) Two forward independent translations into Turkish, (b) reconciliation of these translations by a dermatologist, (c) backward translation of the consensus Turkish version by a bilingual person into its original language (English), (d) and comparing the original questionnaire with the backward translated one. Cognitive debriefing: Sessions were performed on five patients from each of the seven different dermatological diagnosis groups. Field testing: The final Turkish version on which the face validity was approved by specialists on a total of 79 inpatients/outpatients with various dermatological diagnoses treated at Celal Bayar University Hospital. STATISTICAL ANALYSIS Internal consistency (using Cronbach a) and item-total score correlations (Pearson correlation) were used for reliability analysis. Validity analysis was carried out by construct testing (principal components factor analysis), convergent (Pearson correlation) and (discriminate Student's t-test and Mann-Whitney U-test) validity, and SF-36 was used in parallel with DLQI in order to test convergent validity. The data were analyzed by the SPSS version 10.0 (SPSS Inc., Chicago, IL, USA) statistical package. RESULTS The mean age of the patients in the study was 30.77+/-15.91 years; the mean score of DLQI was 7.61+/-6.12. The median of item-total correlation coefficient was found to be 0.66, within a range of 0.48-0.81. The internal consistency of the index was found to be highly sufficient (alpha=0.85). The DLQI was found to be highly related to the physical domain of SF-36. Life quality score was found to be significantly low for the inpatients compared with outpatients (differential validity). CONCLUSION It was found that the Turkish version of the DLQI was an acceptable index for dermatologists and dermatology patients and, moreover, to be valid and reliable in a cross-sectional level. The responsiveness of the Turkish version of the DLQI needs to be tested further on a variety of dermatological conditions with different severities.
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Affiliation(s)
- Serap Oztürkcan
- Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey.
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Borimnejad L, Parsa Yekta Z, Nikbakht-Nasrabadi A, Firooz A. Quality of life with vitiligo: Comparison of male and female muslim patients in Iran. ACTA ACUST UNITED AC 2006; 3:124-30. [PMID: 16860271 DOI: 10.1016/s1550-8579(06)80201-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND Vitiligo is a chronic pigmentary disorder of the skin that, although not life threatening, may considerably influence the psychological well-being of patients. It has been suggested that vitiligo patients suffer from low self-esteem, poor body image, and poor quality of life (QOL). OBJECTIVE The aim of this study was to explore and compare QOL in male and female patients with vitiligo in Iran. METHODS To obtain the patients' self-assessment of QOL, we used a 17-item multiple-choice questionnaire based on the Dermatology Life Quality Index (DLQI). All statistics used 2-way analysis of variance comparisons with an (alpha-risk of 5%. DLQI scores were assessed using nonparametric comparisons, and qualitative variables were compared with xi(2) testing. Categorical regression analyses were also used as an exploratory aim. RESULTS A total of 77 Muslim patients with vitiligo (53 females, 24 males; mean age, 29.3 years) were included in this survey. The mean (SD) DLQI score of 42.9 (11.4) for females was lower than that of 51.6 (8.8) for males (P = 0.002). Female patients experienced significantly more impairment of general and psychological health (P < 0.003), social relationships (P < 0.02), and sexual activity (P < 0.001) than did male patients. CONCLUSIONS This study indicates the specific areas of patients' lives that are most affected by vitiligo. Gender and location of disease independently affect QOL in Muslim patients in Iran. Women with vitiligo experience greater QOL impairment than their male counterparts.
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Affiliation(s)
- Leili Borimnejad
- School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Hundley JL, Carroll CL, Lang W, Snively B, Yosipovitch G, Feldman SR, Jorizzo JL. Cutaneous symptoms of dermatomyositis significantly impact patients' quality of life. J Am Acad Dermatol 2006; 54:217-20. [PMID: 16443050 DOI: 10.1016/j.jaad.2004.12.015] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2004] [Revised: 11/24/2004] [Accepted: 12/07/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dermatomyositis affects visible skin and causes disease symptoms that can affect patients' quality of life (QOL). METHODS In all, 71 patients with dermatomyositis or dermatomyositis sine myositis completed two QOL measures (the Skindex-16 and the Dermatology Life Quality Index) and a visual analog scale for pruritus. Disease severity was assessed by Physician's Global Assessment. RESULTS The mean Dermatology Life Quality Index score was 10.7 and the mean Skindex-16 score was 51.1. Itching contributed to impact on both the Dermatology Life Quality Index and Skindex-16. Females reported worse QOL. LIMITATIONS The effect of treatment on quality of life was not assessed in these analyses. CONCLUSION QOL impairment in dermatomyositis is greater than in other skin conditions including psoriasis and atopic dermatitis. Pruritus is an important treatable factor that significantly impacts QOL for patients with dermatomyositis.
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Affiliation(s)
- Jennifer L Hundley
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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72
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Affiliation(s)
- Victoria Lewis
- Department of Dermatology, University of Wales College of Medicine, Cardiff, UK.
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73
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Aghaei S, Sodaifi M, Jafari P, Mazharinia N, Finlay AY. DLQI scores in vitiligo: reliability and validity of the Persian version. BMC DERMATOLOGY 2004; 4:8. [PMID: 15294022 PMCID: PMC514558 DOI: 10.1186/1471-5945-4-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2004] [Accepted: 08/04/2004] [Indexed: 11/24/2022]
Abstract
Background The objective of this study was to translate and to test the reliability and validity of the 10-item Dermatology Life Quality Index (DLQI) questionnaire in Iranian patients with vitiligo. Methods Using a standard "forward-backward" translation procedure, the English language version of the questionnaire was translated into Persian (the Iranian official language) by two bilinguals. Seventy patients with vitiligo attending the Department of Dermatology, Saadi Hospital, Shiraz, Iran, were enrolled in this study. The reliability and internal consistency of the questionnaire were assessed by Cronbach's alpha coefficient and Spearman's correlation, respectively. Validity was performed using convergent validity. Results In all, seventy people entered into the study. The mean age of respondents was 28.3 (SD = 11.09) years. Scores on the DLQI ranged from 0 to 24 (mean ± SD, 7.05 ± 5.13). Reliability analysis showed satisfactory result (Cronbach's α coefficient = 0.77). There were no statistically significant differences between daily activity (DA) and personal relationship (PR) scale mean scores in generalized versus focal-segmental involvement in sufferers (P = 0.056, P = 0.053, respectively). There were also strong differences between the mean scores of the PR (personal relationship) scale with the involvement of covered only and covered/uncovered areas (P= 0.016) that was statistically significant in the second group. Conclusions The study findings showed that the Persian version of the DLQI questionnaire has a good structural characteristic and is a reliable and valid instrument that can be used for measuring the effects of vitiligo on quality of life.
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Affiliation(s)
- Shahin Aghaei
- Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Manouchehr Sodaifi
- Department of Dermatology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peyman Jafari
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Andrew Y Finlay
- Department of Dermatology, University of Wales College of Medicine, Cardiff CF4 4XN, UK
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Wittkowski A, Richards HL, Griffiths CEM, Main CJ. The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis. J Psychosom Res 2004; 57:195-200. [PMID: 15465076 DOI: 10.1016/s0022-3999(03)00572-5] [Citation(s) in RCA: 103] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2002] [Accepted: 08/12/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of the study was to assess the influence of general and dermatitis-specific psychological and clinical factors on quality of life in adults with atopic dermatitis (AD). METHOD A total of 125 adults recruited through the National Eczema Society of U.K. (NES) completed a number of psychological and dermatological questionnaires, including the Dermatology Life Quality Index (DLQI), the Stigmatisation and Eczema Questionnaire (SEQ), the Hospital Anxiety and Depression Scale (HADS), the Fear of Negative Evaluation Scale (FNE) and the Rosenberg Self-Esteem Scale (RSE). RESULTS Pearson's correlational analyses suggested that perceptions of stigma were significantly associated with psychological factors as well as quality of life (Ps<.01). An association was also found between perceived stigma and disease severity (-.28, P<.01). Almost 46% of participants were identified as having probable mood disorder. Regression analysis indicated that perceptions of stigma and depression accounted for 44.5% of the variance in quality of life in this sample [F(3,121)=34.18, P<.001], when disease severity was controlled for. CONCLUSION Psychological factors and disease severity were strong predictors of quality of life in adults with AD. AD-related perceptions of stigma were of particular importance in predicting AD-related quality of life over and above more general psychological factors, such as depression. These findings have important implications for the psychological and clinical management of AD.
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Affiliation(s)
- Anja Wittkowski
- Academic Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, 2nd Floor Education and Research Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.
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Wallenhammar LM, Nyfjäll M, Lindberg M, Meding B. Health-Related Quality of Life and Hand Eczema—A Comparison of Two Instruments, Including Factor Analysis. J Invest Dermatol 2004; 122:1381-9. [PMID: 15175027 DOI: 10.1111/j.0022-202x.2004.22604.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hand eczema is a disease of long duration, affecting the individual and society. The purpose of this study of 100 patients (51 females and 49 males) at an occupational dermatology clinic was to investigate whether the generic questionnaire Short Form-36 (SF-36), and the dermatology-specific Dermatology Life Quality Index (DLQI) are appropriate for assessing health-related quality of life (HRQL) in patients with hand eczema, and whether gender differences in HRQL could be detected. HRQL was affected by hand eczema, measured with both SF-36 and DLQI. The SF-36 showed more impaired HRQL for females than for males, in the mental health dimension, whereas no gender-related differences were detected with the DLQI. To compare the instruments we used factor analysis, with a polychoric correlation matrix as input, thus taking the ordinal aspect of the data into account. There was a high correlation between the instruments for physical health, but lower for mental health. In this context our interpretation of the factor analysis is that the SF-36 measures mental health better than the DLQI. The SF-36 therefore appears suitable for use in future studies for measuring HRQL, and gender differences in HRQL, in persons with reported hand eczema.
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Affiliation(s)
- Lena-Marie Wallenhammar
- Occupational and Environmental Dermatology, Stockholm County Council and Karolinska Institutet, Stockholm, Sweden
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76
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Chuh AAT, Zawar V. Demonstration of residual perifollicular pigmentation in localized vitiligo—a reverse and novel application of digital epiluminescence dermoscopy. Comput Med Imaging Graph 2004; 28:213-7. [PMID: 15121210 DOI: 10.1016/j.compmedimag.2004.03.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2003] [Revised: 02/06/2004] [Indexed: 01/30/2023]
Abstract
Digital epiluminescence dermoscopy (microscopy) is usually employed to examine melanomas and other pigmented lesions. We report its reverse application in assisting the early diagnosis of a depigmentation condition-localized vitiligo. A pattern of depigmentation with residual reservoirs of perifollicular pigments is clearly visualized. This pattern is not seen in other disorders of depigmentation. Such pattern signifies focally active or repigmenting vitiligo and thus, clearly serves as a useful guide for the cases wherein there exists a doubt about the possible diagnosis. Further studies are warranted to affirm the specificity and applicability of our observations.
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Affiliation(s)
- Antonio A T Chuh
- Department of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong, SAR, China.
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77
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Ayyalaraju RS, Finlay AY, Dykes PJ, Trent JT, Kirsner RS, Kerdel FA. Hospitalization for severe skin disease improves quality of life in the United Kingdom and the United States: a comparative study. J Am Acad Dermatol 2003; 49:249-54. [PMID: 12894073 DOI: 10.1067/s0190-9622(03)00897-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Financial and managerial constraints have resulted in the rationalization of dermatology inpatient services in the United Kingdom and the United States. Therapeutic regimes may vary locally, regionally, and internationally but the clinical outcome of treatment remains the same. OBJECTIVE We studied 2 inpatient units: the University of Wales College of Medicine, Cardiff, United Kingdom, and the University of Miami School of Medicine, Miami, Florida, to compare the use and effectiveness of the service provided. METHODS Data were collected prospectively from inpatients during a 12-month period. The Dermatology Life Quality Index was administered on admission and after discharge. Data were recorded about the diagnosis, duration of admission, and referring dermatologist. RESULTS In all, 295 patients (Cardiff, UK) and 366 patients (Miami, Fla) participated. The average duration of admission in Miami was 6.7 days compared with 14.2 (P <.0001) in Cardiff. In Miami, the most common reasons necessitating admission were extensive disease (54%), the patient being unwell (18%), photophoresis (14%), outpatient treatment failure (8%), and acute deterioration of disease (4%). In Cardiff, the common reasons were acute deterioration (35%), extensive disease (28%), outpatient treatment failure (22%), and liver biopsy (4%). The most common diagnoses in Cardiff were psoriasis (31%) and eczema (26%). In contrast, the most common diagnoses in Miami, were psoriasis (19%), leg ulcers (17%), and mycosis fungoides (14%). The mean Dermatology Life Quality Index value for all patients decreased after admission in Cardiff (14.9-8.2, P <.0001) and Miami (12.0-8.5, P <.0001). CONCLUSION Despite the differences in the 2 health care systems, inpatient therapy remains an important and effective therapeutic option in the United States and the United Kingdom.
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Affiliation(s)
- R Sowjanya Ayyalaraju
- Department of Dermatology at University of Wales College of Medicine, Heath Park, United Kingdom
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78
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Menchini G, Tsoureli-Nikita E, Hercogova J. Narrow-band UV-B micro-phototherapy: a new treatment for vitiligo. J Eur Acad Dermatol Venereol 2003; 17:171-7. [PMID: 12705746 DOI: 10.1046/j.1468-3083.2003.00743.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Vitiligo is a common, acquired, often familial, melanocytopenic disorder with focal depigmentation of the skin. There are several new treatments, that appear to have higher success rates than previous therapies for the treatment of vitiligo. Among these, the most promising one appears to be narrow-band UV-B therapy. OBJECTIVE The aim of this open study is to evaluate the efficacy of the BIOSKIN micro-phototherapy in the treatment of vitiligo in 734 patients. SUBJECTS AND METHODS Seven hundred and thirty-four individuals affected by vitiligo (segmental and non-segmental) were treated for 12 months with a new device called BIOSKIN that can produce a focused beam of narrow UV-B (microphoto-therapy) on vitiligo patches only. Photographs of the subjects were taken at the beginning of the therapy and every month thereafter for 12 months. The response to treatment was estimated in two comparable photographs using planimetry. The duration of the clinical study was of 2 years and 8 months. At the end of this period 734 patients had received each a mean of 24 sessions of treatment during a period of 12 months. RESULTS Five hundred and ten subjects (69.48%) of the 734 achieved normal pigmentation on more than 75% of the treated areas. In particular, 112 of these were totally repigmented. One hundred and fifty-five (21.12%) individuals achieved 50-75% pigmentation of the treated areas, and 69 (9.40%) showed less than 50% repigmentation. No patients showed acute or chronic relevant adverse effects. CONCLUSION BIOSKIN UV-B microphototherapy seems highly effective in restoring pigmentation in patients affected by vitiligo. As no side-effects have been observed, this could represent the treatment of choice for vitiligo limited to less than 30% of the skin surface.
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Affiliation(s)
- G Menchini
- Department of Dermosciences, University of Florence, Florence, Italy.
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79
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80
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Peñas PF, Jones-Caballero M. Calidad de vida (II). Calidad de vida en Dermatología. ACTAS DERMO-SIFILIOGRAFICAS 2002. [DOI: 10.1016/s0001-7310(02)76619-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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81
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Mattoo SK, Handa S, Kaur I, Gupta N, Malhotra R. Psychiatric morbidity in vitiligo and psoriasis: a comparative study from India. J Dermatol 2001; 28:424-32. [PMID: 11560159 DOI: 10.1111/j.1346-8138.2001.tb00004.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In a tertiary-care teaching hospital in India, dermatology outpatients with vitiligo (N=113) and psoriasis (N=103) were studied for psychiatric morbidity. The two groups were similar with regard to education, locality, religion, and attitude to appearance (ATT). Psoriasis cases were older, more often male, and more often married. The General Health Questionnaire (GHQ) assessed psychiatric morbidity rates at 33.63% and 24.7% for vitiligo and psoriasis, respectively. The ICD-10 psychiatric diagnoses in GHQ positive cases were: adjustment disorder (56% vs 62%), depressive episode (22% vs 29%) and dysthymia (9% vs 4%) in vitiligo and psoriasis, respectively. The Comprehensive Psychopathological Rating Scale (CPRS) assessed that depression, anxiety, and total psychopathology levels were similar in the two GHQ positive subgroups. Significant correlations were noted between psychopathology (GHQ CRPS), dysfunction as per Dysfunction Analysis Questionnaire (DAQ), and behavior change as per Impact of Skin Disease Scale (IMPACT), and all were more prominent in vitiligo.
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Affiliation(s)
- S K Mattoo
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigrah, India
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82
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Hutchings CV, Shum KW, Gawkrodger DJ. Occupational contact dermatitis has an appreciable impact on quality of life. Contact Dermatitis 2001; 45:17-20. [PMID: 11422262 DOI: 10.1034/j.1600-0536.2001.045001017.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In this study, we examined the impact of occupational contact dermatitis on quality of life. 181 patients, diagnosed with occupational contact dermatitis over a period of 3 years (1996-1999 inclusive), were sent a questionnaire based on the Dermatology Life Quality Index (DLQI) and the Short Form-36 (SF-36). 60 (32%) patients were in industrial occupations and 27 (14%) in health care. An overall response rate of 39% (n=70) was obtained. The median DLQI score was 5, with a mean score 6.6 (SD 6.4), which is similar to that seen in Behçet's syndrome and urticaria. There was no statistically-significant difference between male and female median scores (p=0.98) and no significant correlation between age and DLQI score nor between DLQI score and time from diagnosis. The most problematic quality of life areas were symptoms and feelings. Males scored highest in problems associated with work, relationships and treatment, whereas females scored highest in problems associated with symptoms and feelings, daily activities and leisure. The SF-36 scores showed an association between physical problems and emotional problems affecting work. From this study, it can be seen that occupational contact dermatitis has an appreciable impact on quality of life.
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Affiliation(s)
- C V Hutchings
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
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83
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Abstract
Skin disease is common in the United States and accounts for a considerable fraction of all outpatient visits. Dermatologists care for more skin disease visits than any other single specialty, while still accounting for a minority of visits overall. The data presented in this introduction, from 1997, do not show a drastic drop in the number of visits to dermatologists as might be feared to occur with the growth in managed care. These visits for skin disease represent a considerable disease burden in the United States. Skin disease is not simply a cosmetic problem. As the data on psoriasis show, skin disease has a tremendous impact on HRQL. The magnitude of this impact on the individual patient is comparable to the impact of other medical disorders.
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Affiliation(s)
- A B Fleischer
- Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1071, USA.
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84
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Poon E, Seed PT, Greaves MW, Kobza-Black A. The extent and nature of disability in different urticarial conditions. Br J Dermatol 1999; 140:667-71. [PMID: 10233318 DOI: 10.1046/j.1365-2133.1999.02767.x] [Citation(s) in RCA: 156] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Chronic forms of urticaria are common, often adversely impacting on quality of life. No formal studies have assessed the extent and nature of disability in different types of urticaria. The Dermatology Life Quality Index (DLQI) is a simple and validated 10-item questionnaire designed to measure and compare disability in different skin conditions. In this study, we aimed to assess the disability in different urticarial groups using the DLQI, allowing comparison with previously published DLQI scores in common skin diseases. The DLQI was administered to 170 consecutive patients attending a specialist urticaria clinic over a 4-month period. Consistent with previous studies using the DLQI, mean scores were not influenced by gender or age. Patients with chronic idiopathic urticaria without a concurrent physical urticaria (n = 47) suffered moderate quality of life impairment (mean +/- SD DLQI 25 +/- 24%). In comparison, patients with chronic idiopathic urticaria with concurrent delayed pressure urticaria (DPU) (n = 26) suffered significantly higher quality of life impairment (mean +/- SD DLQI 43 +/- 23%, 95% confidence interval for difference 7-29%). Disability in this group was greatest in the dimensions of work/study, symptoms/feelings and leisure. Subjects with another form of physical urticaria, cholinergic urticaria, also endured high levels of disability (n = 9, mean +/- SD DLQI 50 +/- 34%). From our urticaria study group, we have shown that subjects with DPU and cholinergic urticaria endure the most quality of life impairment. The mean DLQI scores demonstrated in these groups are comparable with those previously seen in severe atopic dermatitis out-patients (60%) and higher than those seen in out-patients with psoriasis (29.7%), acne (24.3%) and vitiligo (16.1%).
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Affiliation(s)
- E Poon
- St John's Institute of Dermatology, Department of Public Health Medicine, Guy's Kings and St. Thomas School of Medicine, London, UK
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