What do dermatology patients believe?

Is a worker's understanding of their diagnosis an important determinant of outcome in occupational contact dermatitis?

The possible effect of an individual's knowledge of their diagnosis on their disease outcome was examined in a group of 230 workers with occupational contact dermatitis. The workers were surveyed with an interviewer-administered questionnaire for an average of 5 years following a diagnosis of occupational contact dermatitis. 48% had allergic contact dermatitis and 52% had irritant contact dermatitis. There was a poor correlation between the workers' recalled diagnosis and the actual diagnosis, but better concordance with their recollection of patch test results. Only 33% correctly identified their diagnosis. Those who could not were approximately 2 x as likely to still have active dermatitis, to have more severe dermatitis and to note that their skin problem interfered with their work and home activities. Those who had no idea of their diagnosis were 3 x as likely to have these problems. These results raise the possibility that further efforts directed at the patient's education with respect to their condition might improve the outcome of their occupational skin disease.

Consequences of having hand eczema

Consequences of hand eczema were studied in 1238 patients who had the diagnosis confirmed in a prevalence study of hand eczema in the population of Gothenburg. It was found that 2/3 of the patients had consulted a doctor on some occasion and 1/5 had been on sick leave for their hand eczema. The mean total time on sick leave was 18.9 weeks, the median 8 weeks. Patients in service occupations reported more periods of sick leave than other occupational groups. Local steroid preparations were used by 1/2 the patients, emollients by 85%. Change of work was reported by 8% and was most common in service occupations. Hairdressers had the highest rate of change. 80% of the patients experienced some kind of disturbance to their social and emotional lives, considered to be caused by the hand eczema. Frequent itching was reported by 1/2 the patients, occasional itching by another 1/3. Comparing different types of hand eczema, allergic contact dermatitis seemed throughout to cause more serious consequences. It is concluded that good care of a hand eczema patient includes attention to the impact of the disease on the patient's total situation.

Skin disease and handicap: an analysis of the impact of skin conditions

This research sought to quantify the handicapping effect of skin conditions in a far more rigorous way than had previously been attempted. One hundred people who had attended a hospital outpatient clinic during a specified period for treatment of their acne, psoriasis or eczema were interviewed in their homes. A comprehensive and structured interview schedule was used and interviewees were encouraged to talk at length about the impact that their skin conditions had had on their lives. Detailed data were collected that show the serious effect that these diseases can have in several domains. The findings record not only the physical discomfort and inconvenience sufferers may meet but also the consequences for their personal and social life and daily functioning. There is evidence from interviewees' employment experiences of limited opportunities, and functional and interpersonal difficulties in the workplace. 64% of people said that their skin disease affected their socio-economic activity. The extent to which sufferers experienced embarrassment, anxiety, a lack of confidence and depression is documented. 40% of people felt that their social life was affected and there was evidence of particular stresses and demands in personal relationships. The social impact of skin disease is discussed.

Evaluation of a history questionnaire in dermatologic practice

A history questionnaire completed by 1,236 new dermatology patients yielded at least one item relevant to the presenting complaint in two thirds of the patients. The questionnaire saved physician time, frequently elicited clinically useful information, and provided insights as to the patients' general medical state and attitudes toward their illness. Dermatologists are urges to evaluate a history questionnaire in their practices.

Dermatological games

Doctor/patient relationships may not be optimal in medicine in general and in dermatology in particular. The study of the dermatological consultation has been entirely neglected and game analysis may form a useful basis for further study. It is not possible to know whether better communication with patients leads to better responses to treatment, but there is no doubt that better communication leads to better patient compliance with regard to therapy. There are many dermatological games. An insight into these games may not only improve doctor/patient communication, but also make the consultation a much more interesting event for the dermatologist. Once the processes involved in the consultation are understood, the way is open for improvements. The dermatologist should become as interested in the art of practice as he is knowledgeable in the science and clinical features of dermatology.

A history questionnaire for dermatology out-patients

A questionnaire has been devised to be completed by new patients at home before attending the dermatology clinic. We report our experience with this questionnaire and discuss the potential advantages of this system; these include increased detail and accuracy of history, standardization of information and easier availability of information at patients' follow-up. Previously used questionnaires and other similar methods of obtaining a self administered history are discussed.