Quality of Life in Patients with Psoriasis Seen in the Department of Dermatology, Antananarivo, Madagascar

Validation and application of the Dermatology Life Quality Index score, a modification of the DLQI score, in psoriasis patients

BACKGROUND

All the scoring methods for the DLQI miss the moderate impact of the disease on patients, which may underestimate the impact of psoriasis on patients' quality of life. To improve the accuracy of the assessment of the Dermatology Life Quality Index score (DLQI) for patients with psoriasis, this study proposed and validated a new scoring method, the DLQI-NS, which includes the moderate impact option in the self-assessment of each item in psoriasis patients.

METHODS

A cross-sectional study was conducted in which patients with psoriasis were enrolled. A total of 425 participants completed the DLQI, DLQI-NS and Skindex-16 questionnaires. Reliability, validity, ceiling and floor effects were evaluated of both DLQI and DLQI-NS questionnaires.

RESULTS

About 14.4-32.5% of the patients reported a moderate impact on quality of life. The DLQI-NS allowed 17 more patients (4.0%) to achieve severe disease. The Cronbach's alpha coefficient of the DLQI-NS was 0.90, and that of the DLQI was 0.89. The KMO test results for the DLQI-NS and DLQI were 0.927 and 0.916, respectively. One factor was identified for each questionnaire. The items of the DLQI-NS showed an item-total correlation from 0.52 to 0.82, and the DLQI questionnaire's item-total correlation ranged from 0.47 to 0.83. The DLQI-NS, DLQI total score and Skindex-16 had Spearman's rank correlation coefficients of 0.89 and 0.84, respectively. Both the DLQI-NS and DLQI showed significant moderate correlations with the BSA (0.51 vs. 0.50) and PASI (0.47 vs. 0.46). No ceiling effects were observed for any of the items of both questionnaires.

CONCLUSION

The validity and reliability of the DLQI-NS and DLQI were good, but the DLQI-NS was superior to the DLQI. The DLQI-NS is an effective self-assessment tool for assessing quality of life in psoriasis patients.

Life quality among psoriasis patients based on Dermatology Life Quality Index evaluation and its association with psoriasis severity in China: a cross-sectional study

BACKGROUND

Psoriasis critically influences the psychosocial well-being of patients and reduces their quality of life and work efficiency beyond skin symptoms. However, evidence on the association between life quality based on the Dermatology Life Quality Index (DLQI) and psoriasis severity is limited, particularly in China. This study aimed to explore the association between life quality based on the DLQI evaluation and disease severity among psoriasis patients in China.

METHODS

Four thousand two hundred and thirty psoriasis patients were recruited from the Chinese National Clinical Research Center for Skin and Immune Diseases from 2020 to 2021. Information was collected by applying a structured questionnaire and onsite physical examination. Data analysis was performed by using SAS software (version 9.4; SAS Inc., Cary, NC), and statistical significance was set at p < .05.

RESULTS

Four thousand two hundred and thirty psoriasis patients were predominantly male (64.6%), with a median age of 38.6 years (interquartile range (IQR): 30.0-50.9). The Psoriasis Area and Severity Index (PASI) score for patients with psoriasis was 7.2 (IQR: 3.0-13.5), and 50% of patients with PASI scored over 7. A total of 84.1% of psoriasis patients reported that psoriasis affected their quality of life from mild to severe. The DLQI scores among psoriasis patients were positively correlated with PASI scores (r = 0.43, p < .01), both in patients of different sex and different age. Logistic regression analysis with the adjustment of potential confounders indicated that patients with higher PASI score also had higher DLQI score, the odds ratio (OR) were 1.69 (95% confidence interval (CI): 1.38-2.08) for patients with PASI score 3-7, 2.61 (95% CI: 2.10-3.25) for patients with PASI score 8-11 and 3.36 (95% CI: 2.78-4.07) for patients with PASI score ≥12, compared with patients with PASI score <3, respectively.

CONCLUSIONS

Life quality based on DLQI evaluation positively correlated with disease severity among patients with psoriasis, especially among male patients and those with higher body mass index. Therefore, we recommend that clinicians treat the DLQI as an important indicator during patient treatment.

The Influence of Treatment Modalities on the Quality of Life of Psoriasis Patients

Background

We aimed to identify the quality of life (QoL) of patients with psoriasis, to determine the possible differences depending on the therapeutic modalities (biologic, conventional treatment and phototherapy), and to examine other variables that could affect the success of the treatment.

Methods

This research was a non-experimental, quantitative, observational study that included 183 psoriasis patients. The study was conducted from November 2021 to December 2022 at the University Clinical Center Kragujevac, Serbia. The following instruments were used: Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI), as well as a general questionnaire that contained a set of questions which referred to sociodemographic data.

Results

There was a statistically significant difference in the average values of the DLQI score concerning the application of different therapeutic modalities (P<0.001). Biologic treatment was the modality with the lowest impairments in the QoL domain (average value of DLQI score 10.6±7.3), followed by patients on conventional treatment (average value of DLQI score 12.9±7.9), and the highest levels of impaired QoL were in patients who received phototherapy (average value of the DLQI score 13.7±9.3).

Conclusion

Patients on biological therapy at all four time points individually (baseline, 4, 12 and 16 weeks) had the lowest average values of the DLQI score, i.e. the best QoL compared to subjects who received other therapy.

Sentiment analysis of tweets on alopecia areata, hidradenitis suppurativa, and psoriasis: Revealing the patient experience

Background

Chronic dermatologic disorders can cause significant emotional distress. Sentiment analysis of disease-related tweets helps identify patients' experiences of skin disease.

Objective

To analyze the expressed sentiments in tweets related to alopecia areata (AA), hidradenitis suppurativa (HS), and psoriasis (PsO) in comparison to fibromyalgia (FM).

Methods

This is a cross-sectional analysis of Twitter users' expressed sentiment on AA, HS, PsO, and FM. Tweets related to the diseases of interest were identified with keywords and hashtags for one month (April, 2022) using the Twitter standard application programming interface (API). Text, account types, and numbers of retweets and likes were collected. The sentiment analysis was performed by the R "tidytext" package using the AFINN lexicon.

Results

A total of 1,505 tweets were randomly extracted, of which 243 (16.15%) referred to AA, 186 (12.36%) to HS, 510 (33.89%) to PsO, and 566 (37.61%) to FM. The mean sentiment score was -0.239 ± 2.90. AA, HS, and PsO had similar sentiment scores (p = 0.482). Although all skin conditions were associated with a negative polarity, their average was significantly less negative than FM (p < 0.0001). Tweets from private accounts were more negative, especially for AA (p = 0.0082). Words reflecting patients' psychological states varied in different diseases. "Anxiety" was observed in posts on AA and FM but not posts on HS and PsO, while "crying" was frequently used in posts on HS. There was no definite correlation between the sentiment score and the number of retweets or likes, although negative AA tweets from public accounts received more retweets (p = 0.03511) and likes (p = 0.0228).

Conclusion

The use of Twitter sentiment analysis is a promising method to document patients' experience of skin diseases, which may improve patient care through bridging misconceptions and knowledge gaps between patients and healthcare professionals.

Clinical Characteristics, Quality of Life, and Risk Factors of Amputation Stump Skin Disease and Stump Fungal Infection in Adult Amputees in Shanghai, China

Introduction

The stump site of amputees is clinically vulnerable and prone to various skin diseases. Data regarding the impact on quality of life (QoL) of amputees with amputation stump skin disease (ASSD) and risk factors of ASSD and stump fungal infection in the Shanghai area are yet unknown.

Objective

This study aims to evaluate the QoL of amputees with ASSD and explore the risk factors of ASSD and stump fungal infection in the Shanghai area.

Methodology

A total of 104 amputees from Shanghai Hebin Rehabilitation Hospital, Otto Bock (China) Industries Co., Ltd., Shanghai Tongji Hospital, and Shanghai Rehabilitation and Vocational Training Center for the Disabled were enrolled in this study. We collected demographic, clinical, and skin fungal examination data from these amputees from April 2015 to May 2021. Dermatology life quality index (DLQI) questionnaire was used to evaluate the QoL. The risk factors for ASSD and fungal skin infection were analyzed by the univariate analyses.

Results

The median age of the 104 amputees was 57.9 ± 11.9 years with an average amputation time of 17.7 ± 15.1 years, and 73% of cases were men. The mean DLQI score of amputees with ASSD was13.6, suggesting the severe impairment of QoL. Among amputees, 41 (39.4%) had confirmed ASSD, of whom 24 (58.5%) suffered from fungal skin infection and the remaining were subjected to intertriginous dermatitis and eczema (22%), cutaneous keratosis (12.2%), and others (7.3%). Aspergillus (50.0%) was the most common species. The other fungal organisms included Trichophyton rubrum (33.3%), Candida krusei (8.3%), T. mentagrophytes (4.2%), and C. albicans (4.2%). ASSD rather than non-ASSD was more common in men (80.4%) and summer (46.3%). Summer (OR = 3.31, 95% CI = 1.19–9.17) was an established risk factor for ASSD compared to spring. The daily artificial limb wearing time > 8 h was associated with stump fungal infection.

Conclusion

The QoL of amputees with ASSD was severely affected and the ASSD was characterized by fungal infection (tinea), intertriginous dermatitis, eczema, and skin keratosis. Summer and daily prosthesis wearing > 8 h was a risk factor for ASSD. Aspergillus was the most common fungal species, especially when the stump was exposed in summer.

Skin-Disease Specific and Generic Psychometric Measures in Patients with Psoriasis

INTRODUCTION

Psychosocial problems of patients with chronic dermatoses, such as psoriasis, add to their somatic ailments, which results in the lack of illness acceptance, lowered self-esteem, deteriorated quality of life, and an array of somatic comorbidities. The aim of this study was to analyze the effect of psoriasis on the quality of life, sense of stigmatization, self-esteem, and satisfaction with life in patients with psoriasis.

METHODS

The study was based on a short survey prepared by the authors and five validated scales: Dermatology Life Quality Index (DLQI), 6-Item Stigmatization Scale, 33-Item Feelings of Stigmatization Questionnaire, Rosenberg Self-Esteem Scale (SES), and Satisfaction With Life Scale (SWLS). The study included 111 patients with psoriasis (46.8% women and 53.2% men). The inclusion criteria of the study were the diagnosis of plaque psoriasis and written informed consent to participate.

RESULTS

DLQI scores ranged between 0 and 28 points (pts) (mean 10.8 pts). Mean stigmatization scores determined with the 33- and 6-Item Stigmatization Scale were 81.6 pts and 7.5 pts, respectively. The mean SWLS score for the study group (18.5 pts) was slightly below the average. The mean score SES of 27 pts implies that the study respondents' self-esteem level was slightly above the average.

CONCLUSIONS

Satisfaction with life turned out to be significantly modulated by overall stigmatization level on the 33-Item Stigmatization Scale (the stronger the sense of stigmatization, the lower the satisfaction with life) and education (respondents with higher education presented with higher satisfaction with life than those with non-higher education).

Effect of Disease Severity on the Quality of Life and Sense of Stigmatization in Psoriatics

INTRODUCTION

Psoriasis is a chronic inflammatory disease of the skin having a profound effect on the quality of life and contributing to the sense of stigmatization in the affected patients. The aim of this study was to analyze the effect of psoriasis severity on the quality of life and sense of stigmatization in psoriatics and to investigate relationships between these measures and sociodemographic variables.

PATIENTS AND METHODS

The study included 111 patients with psoriasis. The inclusion criteria of the study were the diagnosis of psoriasis and written informed consent to participate. The study was based on a short survey prepared by the authors and four validated scales: Dermatology Life Quality Index (DLQI), 6-item Stigmatization Scale, 33-item Feelings of Stigmatization Questionnaire, and Psoriasis Area and Severity Index (PASI).

RESULTS

Mean PASI score for the study group was 14 pts. Most respondents presented with low DLQI scores, with the mean value of 10.8 pts suggesting that the disease-related ailments were not extremely burdensome for the majority of the patients. Mean stigmatization scores for the 6- and 33-item scale were 7-8 and 81-82 pts, respectively.

CONCLUSION

The severity of psoriasis was the strongest determinant of the quality of life measured with the DLQI. Also, the levels of stigmatization determined with the 6- and 33-item scale correlated significantly with PASI scores.