Quality of life instrument for Turkish people with skin diseases

Quality of life of dermatology outpatients and its associated factors in Halibet National Referral Hospital in Asmara, Eritrea

Skin diseases are prevalent globally and can have detrimental effects on the individual's health-related quality of life (HRQoL). The treatment of dermatological patients typically focuses on clinical signs and symptoms and a subjective view of the impact of the disease on the patient's life. Assessing quality of life can help provide patients with better service, by acknowledging their real needs and interfering with treatment decisions. The aim of the study was therefore to assess quality of life of dermatology outpatients and its associated factors. An analytical cross-sectional study was conducted in the dermatology clinic of Halibet National Referral Hospital in Asmara, Eritrea. HRQoL data were collected between May 6 and August 18, 2022 using a validated standard tool (Skindex-29). Descriptive statistics, logistic regression and paired t-test were employed using Statistical Package for Social Sciences (Version-26.0). A total of 375 dermatology clinic out-patients with a median age of 29 (Interquartile range: 25) were included in the study. The most commonly seen skin diseases were eczema, seborrhoeic dermatitis and tinea pedis. Emotion, symptom, and functioning domains of HRQoL were severely impaired in 75.7%, 50.4% and 57.6% of all dermatology outpatients, respectively. More than half of the respondents (57.9%) had a severely impaired overall HRQoL. In the overall HRQoL, being a rural resident [Adjusted Odds Ratio (AOR) 1.98, 95% CI 1.18, 3.33] and presence of chronic illness (AOR 2.16, 95% CI 1.22, 3.82) were significantly associated with severely impaired overall quality of life. A significantly higher mean score (p < 0.001) was observed in emotion [Mean (M) = 55.60, Standard Deviation (SD) = 21.0] as compared to functioning (M = 46.89, SD = 21.2). On the other hand, significantly higher mean score (p < 0.001) was observed on symptom (M = 54.08, SD = 20.5) as compared to functioning (M = 46.89, SD = 21.2). Skin diseases severely affected the emotion, functioning, and symptom domains of health-related quality of life. This highlights the importance of providing physical and psychosocial support to patients with dermatologic problems.

Quality of life measurement in urticaria: Position statement of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient-Oriented Outcomes and Urticaria and Angioedema

The European Academy of Dermatology and Venereology (EADV) Task Forces on quality of life (QoL) and patient-oriented outcomes and on urticaria and angioedema recommendations for the assessment of Health-related (HR) QoL in all patients with urticaria in research and practice are as follows: to use the DLQI for adults and the CDLQI for children as dermatology-specific and the CU-Q2oL as a disease-specific HRQoL instruments in urticaria; to use generic instruments to provide comparison of data on urticaria with non-dermatologic diseases, or to compare with healthy volunteers or the general population; to select validated HRQoL instruments with appropriate age limits; to present exact numeric data for HRQoL results; correct title of any HRQoL instrument should be used, along with its correct abbreviation and the reference to its original publication, where possible. The EADV TFs discourage the use of non-validated HRQoL instruments and modified HRQoL instruments that have not undergone standard validation.

Evaluation of the Quality of Life and the Demographic and Clinical Characteristics of Patients With Pemphigus With Oral Mucosal İnvolvement: A Multicenter Observational Study

INTRODUCTION

Pemphigus vulgaris (PV) is an autoimmune disease primarily affecting the oral mucosa.

OBJECTIVES

This study aimed to determine the demographic, clinical and treatment characteristics of PV patients with oral mucosal involvement and to assess the impact on their quality of life.

METHODS

We conducted a prospective observational study among 106 patients diagnosed with PV and presenting oral mucosal involvement. Demographic data, clinical and treatment characteristics, and quality of life questionnaires were recorded.

RESULTS

The study included 106 patients, 55 (51.89%) were male and there was a predominance of the mucocutaneous subtype in 83 individuals (78.38%). Oral mucosa was the initial site of manifestation in 44 patients (41.51%). Bilateral buccal mucosa was the most frequently affected site. The predominant symptom reported was a burning sensation, noted in 91 patients (85.85%). Oral mucosal examination revealed erosions in 85.85% of the patients. Systemic steroids were the most commonly administered treatment, and rituximab was used in 18 patients (16.98%). A positive and significant correlation was found between pemphigus severity and Oral Health Impact Profile-14, Dermatology Life Quality Index and Dermatological Quality of Life Scale scores (P < 0.05). The presence of superficial ulcers, flaccid bullae, lesion diameter ≥1 cm, and >10 lesions were factors that markedly diminished quality of life. Complete response to treatment was noted in all patients administered rituximab.

CONCLUSIONS

The most common area of involvement was bilateral buccal mucosa, and the severity of PV closely correlated with a decline in quality of life measures. These results highlight the need for careful clinical oversight of PV, taking into account its effects on patients quality of life.

Investigating Hand Dermatitis and Related Dermatologic Quality of Life Among Nursing Students During the COVID-19 Pandemic

OBJECTIVE

To investigate hand dermatitis and related dermatologic quality of life among nursing students during the COVID-19 pandemic period.

METHODS

In total, 241 nursing students participated in this cross-sectional descriptive study. The data were collected using a sociodemographic data collection form, Hand Dermatitis Self-assessment form, and the Dermatological Quality-of-Life Scale.

RESULTS

During their clinical practice during the COVID-19 pandemic period, 41.9% of participants experienced hand dermatitis. Participants with a history of allergies experienced hand dermatitis at higher rates than those with no history of allergies ( P < .01). The most frequently reported symptom associated with hand dermatitis was "irritation and itching in the hands" (53.9%). Dermatological Quality-of-Life Scale scores differed significantly among participants who did and did not have hand dermatitis: those who experienced hand dermatitis or symptoms of hand dermatitis reported lower quality of life ( P < .01 and P < .05, respectively). Participants' most frequently reported cause of hand dermatitis was the use of antiseptic agents (44.8%), and their most frequently reported preventive measure was the use of moisturizers (61.8%).

CONCLUSIONS

Nursing students in the COVID-19 pandemic period experienced a high rate of hand dermatitis. Both the presence and symptoms of hand dermatitis were associated with lower dermatologic quality-of-life levels for the nursing students.

Evaluation of the effect of COVID ‐19 pandemic on dermatological diseases with dermatological quality life index

Disease‐related skin lesions have been reported in 8% to 20% of COVID‐19 patients. In the literature, cutaneous symptoms associated with the disease are generally emphasized. However, there are very few studies on the effect of this new SARS‐CoV‐2 virus entering our lives on dermatological diseases, and none of them have used the dermatological quality of life index (DLQI). In our study, we aimed to evaluate the difficulties faced by the patients who applied to the dermatology outpatient clinic during the pandemic period and the course of their diseases with the dermatological quality of life index. The study was carried out prospectively by including dermatology patients who will apply to the outpatient clinic in June‐July 2020. 282 patients were evaluated in the study. DLQI was significantly lower in the group using regular emollients (P < .001). When DLQI was compared between disease groups, it was found to be significantly different (P: .017). DLQI was found to worsen significantly compared to prepandemic studies. It was found that using moisturizer in this period helps to maintain the dermatological quality of life.

Validation of an Egyptian Arabic Version of Skindex-16 and Quality of Life Measurement in Egyptian Patients with Skin Disease

PURPOSE

To translate and cross-culturally adapt the Skindex-16, a brief skin-disease-specific QoL questionnaire, into Arabic for Egyptians and to evaluate its measurement properties in Egyptian patients with skin disease.

METHOD

Translation and cultural adaption were performed following guidelines for cross-cultural adaption of health-related quality of life measures. Subsequently, Skindex-16 was administered to 500 consecutive dermatological patients and 500 healthy persons for verification of its reliability and validity. Next, we examined the effect of skin disorders on QoL as well as influences of age, sex, socioeconomic level, education, and use of medication on skin disease-related QoL.

RESULTS

The instrument showed high internal consistency reliability and good construct and content validity. The quality of life was most deteriorated in the emotional domain followed by symptoms domain (mean percentage score 55.5 ± 23.1 and 31.7 ± 26.8 respectively), while functioning was the least affected domain (mean percentage score 29.1 ± 26.8). Higher total Skindex-16 scores were observed for patients with psoriasis, urticaria, acne, and atopic dermatitis than those with vitiligo and alopecia areata. Educational level, social class, medication use, and family history influenced the impact of skin disease on overall QoL.

CONCLUSION

The adapted Egyptian Arabic version of Skindex-16 is valid and reliable; it showed that skin problems had a clinically significant impact on QoL in Egyptian patients.

Comparison of quality of life in patients with androgenetic alopecia and alopecia areata

BACKGROUND

Androgenetic alopecia is one of the most common forms of hair loss. Alopecia areata is a common autoimmune disorder which causes hair loss. It has been previously reported that both alopecia disorders can have negative effects on quality of life. However, only a few studies have compared the effects of the two disorders.

OBJECTIVE

The aim is to show the impact of alopecia on patients' quality of life and compare patients with androgenetic alopecia and alopecia areata.

METHODS

82 androgenetic alopecia and 56 alopecia areata patients were recruited. All patients were evaluated with the Hairdex scale and dermatology quality of life instrument in Turkish (TQL), and the scores were statistically compared according to age, sex, employment and education status, and severity of illness in the two groups. Also, female patients were statistically evaluated according to whether they wore headscarves.

RESULTS

Androgenetic alopecia patients had significantly higher total Hairdex scores in terms of emotions, functioning, and symptoms, while self-confidence was significantly higher in the alopecia areata patients. No significant differences were found in stigmatization or TQL scores between groups. The Hairdex scale and TQL scores did not show differences between the groups in terms of wearing headscarves.

STUDY LIMITATIONS

The validity and reliability of the Hairdex index have not been established in Turkey.

CONCLUSIONS

Based on the Hairdex scale, our findings revealed that androgenetic alopecia patients are more affected by their disorder than alopecia areata patients. Although androgenetic alopecia is common and neither life-threatening nor painful, it is a stressful disorder with increased need for improvement in the patient's quality of life.

Development and initial validation of a cutaneous leishmaniasis impact questionnaire

Background

The impact of cutaneous leishmaniasis (CL) on the quality of life of patients has been neglected in research studies worldwide. The few reported studies have used non-specific questionnaires for the disease, which represents a limitation since generic instruments may not address specific aspects of the disease, compromising the evaluation of its real impact. The aim of this paper is to describe the development and the initial validation of an instrument for evaluating the impact of CL, named the Cutaneous Leishmaniasis Impact Questionnaire.

Methodology

The formulation and validation of the instrument consisted of the following steps: (1) literature review; (2) conceptual framework construction and initial item generation; (3) tool analysis by health professionals (experts); (4) tool evaluation performed by the patients; and (5) a pilot study with 100 patients with localized CL, evaluated at a reference ambulatory facility in Belo Horizonte, in the state of Minas Gerais, Brazil. The structure of the proposed instrument was analyzed using hierarchical cluster analysis (ICLUST).

Results

Twenty-seven items were initially proposed by the researchers to compose the questionnaire. Content validity (evaluates if the instrument fully assesses the construct of interest) was evaluated by the panel of experts, while face validity (evaluates how potential participants interpret the items) was evaluated by the target population. In this step, some items were excluded, reformulated and/or included. After evaluating a factorial structure of the items in accordance with the cluster analysis, we assembled a questionnaire with 25 items (alpha = 0.86), with high reliability and homogeneity, which address the following: 1) the general impact of the disease (alpha = 0.91, beta = 0.67) and 2) the evaluation of the perception about the treatment and health services (alpha = 0.72, beta = 0.51).

Conclusions

The Cutaneous Leishmaniasis Impact Questionnaire, developed with contributions from patients and experts, was confirmed, in this first validation, as a useful and reliable instrument.

Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health-related QoL assessment in acne and because of the high impact of acne on patients' lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations.

Efficacy of azole therapy for tegumentary leishmaniasis: A systematic review and meta-analysis

Background

Several controlled and uncontrolled studies addressing azole antifungal drugs for cutaneous and mucosal leishmaniasis have been published with inconclusive results. We conducted a systematic literature review of studies evaluating the efficacy and toxicity associated with azole therapy for tegumentary leishmaniasis.

Methodology

PRISMA guidelines for systematic reviews and the Cochrane manual were followed, and the review methodology was registered (PROSPERO; CRD42016048668). Sources included the EMBASE, Web of Science, MEDLINE, LILACS, and IBECS databases along with a manual search of references from evaluated studies. Additional resources such as Google Scholar and clinicaltrials.gov were also searched. We included all studies reporting cure rate after cutaneous or mucosal leishmaniasis treatment with systemic azole drugs, regardless of their design. R software was used to estimate global rates of success and adverse events with each drug. The main outcome of interest was clinical cure, defined as complete re-epithelialization of all lesions.

Results

A total of 37 studies involving 1259 patients that reported outcomes after fluconazole (9), ketoconazole (14) and itraconazole (15) treatments were included. Only 14 (38%) were randomized controlled trials (RCT). The pooled azole final efficacy rate was 64% (CI95%: 57–70%) for all studies and 60% (CI95%: 50–70%) (p = 0.41) if only RCTs studies were considered. Twenty-four studies were conducted in the Old World and 13 studies in the Americas. The final efficacy rate according to New and Old World were 62% (CI95%: 43–77%) and 66% (CI95%: 58–73%), respectively. The final efficacy rate of azoles according to species were 89% (CI95%: 50–98%) for L. mexicana; 88% for L. infantum (CI95%: 27–99%); 80% for L. donovani; 53% (CI95%: 29–76%) for L. major; 49% for L. braziliensis (CI95%: 21–78%); and 15% (CI95%: 1–84%) for L. tropica. The cure rates were similar among the fluconazole, ketoconazole and itraconazole group arms (p = 0.89), specifically 61% (CI95%: 48–72%), 64% (CI95%: 44–80%) 65% (CI95%: 56–72%), respectively. Adverse events during fluconazole, itraconazole and ketoconazole therapy were reported in 7% (CI95%: 3–14%), 12% (CI95% 8–19%) and 13% (CI95%: 6–29%) of treated patients, respectively, without difference among them (p = 0.35). This systematic review included studies with small samples and both non-comparative and non-randomized studies and the main limitation was the low quality of the available studies.

Conclusions

Available evidence suggests that fluconazole, ketoconazole and itraconazole have similar and modest efficacy rates for tegumentary leishmaniasis treatment. There is insufficient evidence to support the exclusive use of azole therapy as a single agent for leishmaniasis treatment.

Comparison of efficacy of chemical peeling with 25% trichloroacetic acid and 0.1% retinoic acid for facial rejuvenation

INTRODUCTION

Skin aging is a problem which negatively affects the psyche of the person, social relations, as well as work life and health and which compels the patients to find appropriate treatment methods. Numerous treatment methods have been developed in order to delay aging and to reduce the aging effects in addition to having a younger, healthier and more beautiful facial appearance.

AIM

To compare the efficiency, cosmetic results and possible adverse effects of the peeling treatment with 25% trichloroacetic acid (TCA) and 0.1% retinoic acid for facial rejuvenation in patients presenting with skin aging.

MATERIAL AND METHODS

Fifty female patients in total presenting with medium and advanced degree skin aging were subject to this study. Two separate treatment groups were formed; the first group underwent chemical skin treatment with 25% TCA while the other group was applied with 0.1% retinoic acid treatment. Following the 4 months' treatment the patients were controlled three times in total for post lesional hypopigmentation, hyperpigmentation, scars, skin irritation and other possible changes per month. The pretreatment and first follow-up visit, and final control images were comparatively evaluated by three observers via specific software.

RESULTS

The healing rates of the group subject to retinoic acid were statistically higher (p < 0.05) compared to patients in the TCA group in the final follow-up visit following the treatment according to the first and second observers. On the other hand, according to the third observer, patients applied with retinoic acid presented with higher healing rates compared to those treated with TCA, however; this rate was not statistically significant (p > 0.05). The frequency of TCA- and retinoic acid-associated adverse effects was similar in both groups (p > 0.05). As a result of both treatments, a reduction in the quality of life scores as well as a pronounced recovery (p = 0.001) in the quality of life of those patients with skin aging was observed.

CONCLUSIONS

The photo aging treatment option with 0.1% retinoic acid is cheaper and more feasible for patients compared to 25% TCA, and it is also as reliable and effective as TCA.

The impact of personality on quality of life and disease activity in patients with Behcet's disease: a pilot study

BACKGROUND

The aim of this study was to examine the personality characteristics of patients with Behcet's Disease (BD) using the Temperament and Character Inventory (TCI) compared with healthy control subjects and to investigate the relationship between the temperament and character properties and quality of life, disease activity, depression and anxiety in Behcet's patients.

METHODS

A total of 46 BD patients and 40 healthy subjects were included in the study. All patients and controls were determined using the TCI, Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders Clinical Version for Axis I disorders (SCID-CV), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Quality of life (QOL) Instrument for Skin Disorders and Behcet Disease Current Activity Form (BDCAF).

RESULTS

BD patients demonstrated significantly lower Reward Dependence than healthy controls. Among the subscales; Explarotory Excitability, Shyness with Strangers, Attachment, Spiritual Acceptance were lower and Self-Acceptance was higher in patients compared to control subjects. Decreased quality of life and increased disease activity of the patients were correlated with increased anxiety and depression. Responsibility, Self-Forgetfulness and Transpersonal Identification were associated with quality of life while Responsibility was the major factor effecting QOL. Disease activity was not found related with TCI properties.

CONCLUSION

Temperament and Character traits of BD patients were different from healthy group that might be due to many factors like genetics, biological or socio-cultural differences. BD patients were demonstrated as materialistic, self-contained, self-confident, cold, detached, and reserved although they are not shy. Considering the different personality traits of BD patients in psychotherapeutic approaches, may have a positive impact on QOL and comorbid major depressive disorder.

Effect of the pruritus on the quality of life: a preliminary study

Background

Pruritus affects the quality of life (QoL) in the patients. However, little is known of the impacts of itching on the QoL in the literature.

Objective

In this study, a questionnaire eliciting specific responses about pruritus was used to determine the effect of itching and its severity on QoL in chronic pruritic patients.

Methods

One hundred ten adult patients with chronic pruritus were surveyed. Once itch severity had been self-reported by patients, together with Skindex-29, they have been given the 18-item Pruritus-related Life Quality Index (PLQI) questionnaire, which was used to generated the new index.

Results

Significant correlations have been found between the pruritus severity score of participants and their total Skindex-29 (p<0.001) with its function, emotion and symptom subscale scores (p<0.001 for each). Also, significant correlations were evident between total PLQI (p<0.001) and its psychosocial negativities, difficulties in everyday activities and social live subscale scores (p<0.001 for each). In particular, the emotion subscale of Skindex-29 (p=0.02) and psychosocial negativity subscale of PLQI (p=0.02) were significantly high in psychopathologic patients. A highly positive statistical correlation between Skindex-29 and PLQI scales was evident (r=0.845, p<0.001). For reliability, Cronbach's coefficient a coefficients were 0.931 for the Skindex-29 scale and 0.918 for the PLQI scale.

Conclusion

The results demonstrate that chronic pruritus appreciably reduces the QoL. PLQI could be used in the development of new questionnaires for determining the QoL of patients with chronic itch.

Association of erectile dysfunction with atopic dermatitis: a population-based case-control study

INTRODUCTION

Some studies have highlighted the high prevalence of erectile dysfunction (ED) in patients with dermatological diseases such as psoriasis, chronic hand eczema, and systemic sclerosis. However, to date, there is still no study that has explored the relationship between ED and atopic dermatitis (AD).

AIM

Using a population-based data set, this case-control study aimed to examine the association of ED with prior AD by comparing the risk of prior AD between patients with ED and matched controls in Taiwan.

METHODS

This study used administrative claims data from the Taiwan National Health Insurance program. We identified 3,997 patients with newly diagnosed ED as cases and randomly selected 19,985 subjects without a history of ED as controls. Conditional logistic regression was used to calculate the odds ratio (OR) and corresponding 95% confidence interval (CI) for previously diagnosed AD between cases and controls.

MAIN OUTCOME MEASURE

The prevalence and risk of having been previously diagnosed with AD between cases and controls were calculated.

RESULTS

Of the 23,982 sampled subjects, 1,758 (7.3%) had been previously diagnosed with AD; it was found among 425 (10.6%) cases and among 1,333 (6.7%) controls (P<0.001). Conditional logistic regression analysis demonstrated that cases were more likely to have prior AD than controls (OR=1.60, 95% CI=1.42-1.80, P<0.001) after adjusting for monthly income, geographic location, urbanization level, hypertension, diabetes, coronary heart disease, hyperlipidemia, obesity, and alcohol abuse/alcohol dependence syndrome.

CONCLUSIONS

There was an association between ED and prior AD. We suggest that clinicians should be more attentive to sexual complaints from patients with AD.

The levels of depression, anxiety and quality of life in patients with chronic idiopathic urticaria

BACKGROUND

Chronic idiopathic urticaria (CIU) is associated with severely impaired quality of life (QoL).

OBJECTIVE

To determine the levels of depression, anxiety and QoL in CIU patients.

PATIENTS AND METHODS

This study included 73 patients with CIU, and 34 healthy subjects matched for age and sex were used as controls. The levels of depression, anxiety and QoL were assessed with the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the World Health Organization Quality of Life Assessment-Brief (WHOQOL-BREF), respectively. The reliability and validity of the Turkish versions of these instruments have been examined.

RESULTS

When compared with healthy controls, patients with CIU had significantly higher BDI and BAI scores and significantly lower physical health and psychological health subscale scores of the WHOQOL-BREF. BDI, BAI and all domains of WHOQOL-BREF were unrelated to age, duration of illness, urticaria activity score (UAS) and visual analogue score (VAS). There was a negative significant correlation between all domains of WHOQOL-BREF and BDI and BAI.

CONCLUSION

Our data confirm that QoL is markedly reduced in CIU patients. Physical health and psychological health were found to be the areas QoL most affected in CIU patients. And also we have found that CIU patients frequently suffer from depression and anxiety. The severity of these parameters was found to be positively correlated with the extent of QoL decrease.

Living with Acne

BACKGROUND

Acne can have important psychological repercussions.

OBJECTIVES

We studied adolescents' perceptions of acne, in a nonmedical context.

METHODS

Between November 2004 and January 2005, a questionnaire was presented to adolescents calling a youth helpline. It focused on perceptions of acne and, among callers with personal experience of acne, its severity and treatment. Callers were divided into those with acne, those having had acne and those never having had acne.

RESULTS

The questionnaire was completed by 1,566 callers. It showed that 51% of respondents with acne did not seek medical help; acne has as big a psychological impact as some far severer diseases; many respondents with no history of acne said they were very worried that they would develop this skin disorder.

CONCLUSIONS

This study underlines the major psychological impact of acne. Young people need to be informed that acne can be treated.

Cross validation of the Turkish version of dermatology life quality index

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.

Pruritus as a leading symptom: clinical characteristics and quality of life in German and Ugandan patients

BACKGROUND

Pruritus is the most frequent and distressing symptom associated with dermatoses and various internal and neurological diseases.

OBJECTIVES

To investigate two different populations of patients with pruritus, one in Germany and one in Uganda, with a particular focus on clinical characteristics, aetiology and quality of life.

METHODS

We investigated by questionnaire 132 patients (59 men, 73 women, mean age 54.5 years) who were referred to the Department of Dermatology at the University Hospital of Magdeburg, Germany, with the diagnosis of pruritus as a leading symptom. The questionnaire was also applied in 84 patients who consulted the Dermatology Clinic at Mbarara, Uganda for pruritus. The questions referred to personal data and disease history of the individual, history and present occurrence of concomitant diseases, present and past therapy, quality, frequency and triggers of itching and scratching, other disorders and complaints, quality of life and impact on work and disability.

RESULTS

Seventy-five (57%) of the German patients had pruritus due to dermatoses, 47 patients (36%) had pruritus due to a systemic disease and in 10 patients (8%) pruritus was of unknown origin. Most had a history of pruritus of several months up to years. Pruritus associated with dermatoses mostly affected the whole body and was permanent with an undulatory character. Affective reactions such as aggression and depression occurred more frequently in dermatological patients compared with those with systemic pruritus. The former group felt that pruritus had a greater impact on their lives. Almost all Ugandan patients had pruritus due to dermatoses except for three patients with pruritus of unknown origin. Eczema and prurigo were the most frequently observed dermatoses in both German and Ugandan patients. Patients with pruritus in both populations showed an impaired quality of life. There was no pronounced difference between the populations with regard to feelings of depression and suicidal thoughts.

CONCLUSIONS

A great deal of helpful information in this complex group of patients can be obtained using this questionnaire. Pruritus has a major impact on quality of life and especially impairs those patients with pruritus associated with dermatoses and pruritus of unknown origin.

The psychological impact of cutaneous leishmaniasis

A psychiatric disorder would be associated with extensive, unsightly lesions on exposed body parts. Cutaneous leishmaniasis (CL) has long been endemic in Sanliurfa and is called 'beauty scar'. The aim of this study was to determine psychological impact of CL. Patients with active CL, with CL that had healed with scaring, and healthy controls were included in this case-control study. The Hospital Anxiety Depression Scale (HAD), Body Image Satisfaction Scale (BIS), and Dermatology Quality of Life Scale (DQL) assessments were performed to determine the psychological effect of CL. The patients with CL had significantly higher HAD anxiety and depression subscale scores than the control groups. Patients with CL have decreased body satisfaction and lower quality of life than those in the control group. It was found that CL patients with active lesions have the lowest quality of life score than other groups. CL lesions on exposed body parts such as the face and hands, active CL for more than 1 year, permanent scar formation, and social stigmatization cause anxiety, depressive symptoms, decreased body satisfaction and quality of life in CL patients.