DLQI scores in vitiligo: reliability and validity of the Persian version

Comparing quality of life, anxiety, depression, sleep disturbance, and associated factors in vitiligo and alopecia areata patients

INTRODUCTION AND OBJECTIVES

Vitiligo and alopecia areata (AA) are two autoimmune skin diseases that affect patients' quality of life (QoL) and give rise to psychosocial complications, such as depression, negative self-image, less joyful social engagements, and low self-esteem. These two disorders have common and uncommon characteristics. Therefore, in this study, we tried to evaluate the similarities and differences in the psychological parameters including quality of life, sleep disturbance, anxiety, and depression levels between, vitiligo and AA patients.

MATERIALS AND METHODS

Patients with either vitiligo or AA visiting the outpatient dermatology clinic from November 2017 to December 2020 have been included in this study. Persian versions of three questionnaires including the dermatology life quality index (DLQI), hospital anxiety and depression scale (HADS), and Pittsburgh sleep quality index (PSQI), have been used to assess the QoL, sleep disturbance, anxiety, and depression levels in patients.

RESULTS

In total, 188 patients, including 94 (50%) cases of AA and 94 (50%) patients with vitiligo, met the criteria. In AA patients, a significantly higher DLQI score was found (p-value = 0.002) compared to the vitiligo cases, which means a better QoL in vitiligo patients. Additionally, AA patients had higher scores of anxiety (P-value<0.001) and depression (p-Value<0.001). However, sleep disturbance (64.9% of AA patients vs. 59.3% of vitiligo patients; p-Value = 0.4888) was not significantly different between the two groups.

CONCLUSIONS

Our data showed lower QoL and higher levels of anxiety and depression in AA patients compared to vitiligo cases, but no difference was seen in sleep disturbance in the PSQI-P score.

Impact of Vitiligo on Quality of Life in Patients of Skin of Color and Its Correlation With Clinical Severity Assessment Scores Utilizing Disease Specific Scores: A Cross-Sectional Study

INTRODUCTION

Assessment of disease severity of vitiligo is exigent as it is a psychosomatic ailment. VIDA (vitiligo disease activity score) and VASI (vitiligo area severity index) were previously used for this evaluation. Recently, the introduction of two vitiligo specific tools, vitiligo impact scale (VIS)-22 and Vitiligo Quality of Life Index (VitiQoL) has aided in assessing the quality of life (QOL) in a pertinent manner.

OBJECTIVES

To measure the QOL in vitiligo using disease specific indices (VitiQoL and VIS-22), to assess their relationship with disease severity (VASI and VIDA) and to determine the correlation between QOL scores (VIS-22 and VitiQoL).

METHODS

This observational cross-sectional study included 195 patients with vitiligo, and their disease severity was calculated using VASI and VIDA scoring. Patients were asked to fill questionnaires for assessing the QOL using validated tools i.e. VIS-22 and VitiQoL.

RESULTS

Significant correlation was demonstrated between both QOL scores and VASI score (P value 0.001) with slightly higher values for VitiQoL (r = 0.824) than with VIS 22 (r = 0.693). Both scores exhibited a significant association with VIDA score (P value < 0.001). Moreover, statistically significant correlation was found between VIS-22 and VitiQoL, thereby proving the concordance between these scores.

CONCLUSIONS

The study infers that QOL seemed to be remarkably dependent on the clinical severity scores and that higher disease activity corresponds to poorer QOL. It is imperative to precisely assess burden of vitiligo and the impairments caused by it in order to aid multi-modality management and allow more standardized research.

Assessing the Effectiveness of Stabilized Cysteamine 5% Cream Compared to Hydroquinone 4%/Ascorbic Acid 3% Combination Cream in Treating Acne-induced Post-inflammatory Hyperpigmentation: A Randomized, Controlled Study

Objective

Postinflammatory hyperpigmentation (PIH) is a common sequela of acne vulgaris. Topical treatment with hydroquinone is the standard treatment, but may be associated with complications. Cysteamine is a relatively safe depigmenting agent with an observed depigmenting effect. We designed this study to assess the efficacy of a cysteamine 5% cream in treating acne-induced PIH.

Methods

Twenty-eight out of 32 participants finalized this investigator-blind, randomized, and controlled trial (registered in Iranian Registry of Clinical Trials [IRCTID: IRCT20140212016557N5]). We randomized the patients to apply either cysteamine 5% or hydroquinone 4%/ascorbic acid 3% (HC) cream. Postacne hyperpigmentation index (PAHPI) and melanin index were the assessment measures after four months of treatment. We evaluated the quality of life by the Dermatology Life Quality Index (DLQI) questionnaire.

Results

Both cysteamine and HC cream significantly decreased the PAHPI score and melanin index of acne-induced PIH patients (p<0.05). The decrease in PAHPI score and melanin index were not significantly different in treatment groups after four months (p>0.05). Quality of life ameliorated significantly only with cysteamine treatment. However, no significant change in quality of life was observed between groups.

Limitations

Limitations of our study include the relatively small sample size and absence of follow-up.

Conclusion

Cysteamine cream is an effective treatment of post-acne PIH, with similar efficacy to the accepted treatment of PIH, i.e., hydroquinone cream.

Evaluation of Psychopathologies and Health-Related Quality of Life in Patients With Macular Amyloidosis

Macular amyloidosis (MA) is a skin condition with predominance in young women. We aimed to evaluate quality of life (QoL) and psychopathologies in these patients. In this cross-sectional study, patients with MA referring to the Imam Reza Hospital, Mashhad during 2018-2020, and their matched controls were included. Participants completed the 36-item short form survey (SF-36), the revised symptom checklist-90 (SCL-90-R), and the dermatology life quality index (DLQI). Overall, 40 women with a mean age of 36.80±10.19 years were studied. In the MA group, the SF-36 score was lower (P<0.001), and the SCL-90-R score was higher (P<0.001). The DLQI score was correlated with age (r=0.447; P=0.048) and pruritus severity (r=0.776; P<0.001), and was lower in patients with uncovered lesions (P=0.005). MA was associated with impaired QoL, which was determined by pruritus severity and lesion location; these patients can benefit from psychiatric interventions in this regard.

Evaluation of Psychopathologies and Health-Related Quality of Life in Patients With Macular Amyloidosis

Macular amyloidosis (MA) is a skin condition with predominance in young women. We aimed to evaluate quality of life (QoL) and psychopathologies in these patients. In this cross-sectional study, patients with MA referring to the Imam Reza Hospital, Mashhad during 2018-2020, and their matched controls were included. Participants completed the 36-item short form survey (SF-36), the revised symptom checklist-90 (SCL-90-R), and the dermatology life quality index (DLQI). Overall, 40 women with a mean age of 36.80±10.19 years were studied. In the MA group, the SF-36 score was lower (P<0.001), and the SCL-90-R score was higher (P<0.001). The DLQI score was correlated with age (r=0.447; P=0.048) and pruritus severity (r=0.776; P<0.001), and was lower in patients with uncovered lesions (P=0.005). MA was associated with impaired QoL, which was determined by pruritus severity and lesion location; these patients can benefit from psychiatric interventions in this regard.

Patient-Reported Outcome Measures and Their Clinical Applications in Dermatology

With more disease- and symptom-specific measures available and research pointing to increased usefulness, patient-reported outcome measures (PROMs) can be routinely used in clinical care. PROMs increase efficiency in healthcare, improve the clinician-patient relationship, and increase patient satisfaction with their care. PROMs can be administered before, during, and after clinic visits using paper-and-pencil, mobile phones, tablets, and computers. Herein, we combine available literature with expert views to discuss overcoming barriers and helping dermatologists incorporate PROMs into routine patient-centered care. We believe dermatology patients will benefit from broader PROM implementation and routine clinical use. However, a few major barriers exist: (1) cost to implement the technology, (2) selecting the right PROMs for each disease, and (3) helping both patients and clinicians understand how PROMs add to and complement their current clinical experience. We provide recommendations to assist dermatologists when considering whether to implement PROMs in their practices.

Quality of life measurement in vitiligo. Position statement of the European Academy of Dermatology and Venereology Task Force on Quality of Life and Patient Oriented Outcomes with external experts

Members of the European Academy of Dermatology and Venereology (EADV) Task Force on Quality of Life (QoL) and Patient Oriented Outcomes reviewed the instruments available for health-related (HR) QoL assessment in vitiligo and together with external vitiligo experts (including representatives of the EADV Vitiligo Task Force) have made practical recommendations concerning the assessment of QoL in vitiligo patients. The Dermatology Life Quality Index (DLQI) was the most frequently used HRQoL instrument, making comparison of results between different countries possible. Several vitiligo-specific instruments were identified. The vitiligo Impact Scale (VIS) is an extensively validated vitiligo-specific HRQoL instrument with proposed minimal important change and clinical interpretation for VIS-22 scores. VIS-22 was developed for use in India, where there are some specific cultural beliefs concerning vitiligo. The EADV Task Force on QoL and Patient Oriented Outcomes recommends use of the DLQI and the Children's Dermatology Life Quality Index (CDLQI) as dermatology-specific instruments in vitiligo. There is a strong need for a valid (including cross-cultural validation) vitiligo-specific instrument that can be either a new instrument or the improvement of existing instruments. This validation must include the proof of responsiveness.

Characteristics associated with quality of life in the early stages of Mycosis Fungoides

Background

Mycosis fungoides (MF) is a lymphoproliferative disorder characterized by skin-homing atypical lymphocytes. This study aimed to evaluate the quality of life (QoL) in MF patients in the early stages of the disease and the associated factors using the Dermatology Life Quality Index (DLQI).

Methods

Thirty MF patients (21 females/9 males) with a mean age of 46.73±15.9 years and in the early stages of the disease (26 stage Ι and 4 stage ΙΙ) were enrolled and were asked to fill the DLQI questionnaire.

Results

The mean DLQI score was 9.93±5.89. The QoL was largely affected by the disease in near half of the patients (46.7% of patients had a DLQI score11-20). QoL was significantly correlated with educational level and was more impaired in patients with lower educational status (DLQI score spearman rho=-0.382, P=0.037). QoL was not associated with sex, age, disease stage and disease duration. The symptom and feeling dimension of DLQI was significantly more impaired in patients with both patch and plaque compared to patch only (spearman rho= 0.397, P= 0.03).

Conclusion

This study demonstrates how largely patients' QoL is influenced in the early stages of MF, especially in patients with lower educational levels.

Assessment of health-related quality of life in patients with frontal fibrosing alopecia

BACKGROUND

Frontal fibrosing alopecia (FFA) is a primary patterned cicatricial alopecia with different manifestations.

AIMS

Its incidence is increasing worldwide. Like other types of alopecia, FFA can affect patients' health-related quality of life (HRQOL). However, this effect has been rarely discussed. This study was designed to evaluate HRQOL in patients with FFA.

METHODS

In this cross-sectional study, 49 patients with confirmed FFA were asked to complete Dermatology Life Quality Index (DLQI) and the 36-Item Short Form Survey (SF-36) questionnaires. Disease severity was evaluated with the Frontal Fibrosing Alopecia Severity Score Index (FFASI).

RESULTS

Significant relation between SF-36 scores and other covariants was not detected. According to the DLQI, most of the patients (54%) had impaired HRQOL, which was of low grade for most of them (84%). Patients with face papules and patients who were in the group of nail, limb, and flexural involvement had significantly lower HRQOL (p-value 0.03).

CONCLUSION

We found that FFA negatively impacts HRQOL, which was more pronounced in patients with involvement of other ostensible areas.

Effect of Laser-Assisted Hair Removal (LAHR) on the Quality of Life and Depression in Hirsute Females: A Single-Arm Clinical Trial

Introduction: Hirsutism, mainly due to polycystic ovary syndrome (PCOS), causes stress, anxiety, and depression in females. Laser-assisted hair removal (LAHR) is currently accepted as a good treatment option for hirsutism. The goal of the current study was to ascertain how LAHR affected the degree of hirsutism, quality of life, and depression in hirsute females. Methods: A single-arm before/after clinical trial was designed and performed in the Razi hospital Laser Clinic over a 15-month period. All hirsute females visiting the Razi hospital laser clinic were enrolled and received three sessions of LAHR every 4-6 weeks if they were interested and signed an informed consent form. Before the commencement of LAHR and six to eight weeks after the last session, the Ferriman-Gallwey score (hirsutism severity), Beck score (depression index) and DLQI score (quality of life index) were calculated and stored. Results: There were 80 subjects in all. The mean ± SD of the Ferriman-Gallwey score was reduced from 7.05 ± 2.27 to 4.91 ± 2.41, P < 0.001. The mean ± SD of the Beck depression score was reduced from 13.3 ± 8.7 to 10.2 ± 8.4, P < 0.001, and the mean ± SD of the DLQI score decreased from 5.6 ± 5.2 to 3.5 ± 2.3, P < 0.001. No significant complications were reported. Conclusion: LAHR can improve hirsutism-related depression and degradation of quality of life, as well as hirsutism physical signs.

The humanistic burden of vitiligo: a systematic literature review of quality-of-life outcomes

Despite historical mischaracterization as a cosmetic condition, patients with the autoimmune disorder vitiligo experience substantial quality-of-life (QoL) burden. This systematic literature review of peer-reviewed observational and interventional studies describes comprehensive evidence for humanistic burden in patients with vitiligo. PubMed, EMBASE, Scopus and the Cochrane databases were searched through February 10, 2021, to qualitatively assess QoL in vitiligo. Two independent reviewers assessed articles for inclusion and extracted data for qualitative synthesis. A total of 130 included studies were published between 1996 and 2021. Geographical regions with the most studies were Europe (32.3%) and the Middle East (26.9%). Dermatology-specific instruments, including the Dermatology Life Quality Index (DLQI; 80 studies) and its variants for children (CDLQI; 10 studies) and families (FDLQI; 4 studies), as well as Skindex instruments (Skindex-29, 15 studies; Skindex-16, 4 studies), were most commonly used to measure humanistic burden. Vitiligo-specific instruments, including the Vitiligo-specific QoL (VitiQoL; 11 studies) instrument and 22-item Vitiligo Impact Scale (VIS-22; 4 studies), were administered in fewer studies. Among studies that reported total scores for the overall population, a majority revealed moderate or worse effects of vitiligo on patient QoL (DLQI, 35/54 studies; Skindex, 8/8 studies; VitiQoL, 6/6 studies; VIS-22, 3/3 studies). Vitiligo also had a significant impact on the QoL of families and caregivers; 4/4 studies reporting FDLQI scores indicated moderate or worse effects on QoL. In general, treatment significantly (P < 0.05) improved QoL, but there were no trends for types or duration of treatment. Among studies that reported factors significantly (P ≤ 0.05) associated with reduced QoL, female sex and visible lesions and/or lesions in sensitive areas were most common. In summary, vitiligo has clinically meaningful effects on the QoL of patients, highlighting that greater attention should be dedicated to QoL decrement awareness and improvement in patients with vitiligo.

Comparison of the Efficacy of Intralesional 5-Fluorouracil/Lidocaine/Epinephrine Injection with Cryotherapy to Treat Common and Palmoplantar warts: a Randomized, Controlled Trial

Cutaneous warts are treated by different treatments with various efficacy. Intralesional injection of 5-fluorouracil (IL 5-FU) has been compared with placebo and a few other wart treatments. Our objective was to compare the efficacy of IL 5-FU injection with cryotherapy to treat common and palmoplantar warts. Forty-five patients with common and palmoplantar warts were treated with either IL 5-FU admixed with lidocaine and epinephrine (5-FU+LE) or cryotherapy, once weekly for six sessions. The patients were assessed for clinical response score, the thickness of warts, pain score, and quality of life in treatment sessions, two weeks and eight weeks after the last session. Nine patients (64.3%) in the 5-FU+LE group, and 5 patients (35.7%) in cryotherapy group experienced complete response (p=0.285). Both treatments caused improvement of clinical response score in the patients during the treatment time (p<0.001), but the efficacy of treatments was not significantly different (p=0.793). Changes in wart thickness were significantly more marked in the 5-FU+LE group compared to the cryotherapy group (p=0.021). The patients in the cryotherapy group experienced more severe pain compared to the 5-FU+LE group (p=0.011). The quality of life better improved in the 5-FU+LE group compared to the cryotherapy group (p = 0.02). To conclude, most of the patients that experienced complete clinical response had received 5-FU+LE injection, though the difference was not significant. However, 5-FU+LE injection accompanied less pain and caused more reduction in wart thickness and more improvement in quality of life compared to the cryotherapy.

Validation of the Persian version of Skindex-16 among older patients with skin diseases

Background

Skin conditions often considerably impact the older patients’ psycho-social health and quality of life (QoL). The present study was aimed to examine the validity and reliability of the Persian version of Skindex-16 among older people with skin diseases.

Methods

In this validation study, 260 older patients suffering from a range of skin conditions were recruited from a dermatology clinic in Rasht, Iran. Data were collected using a checklist for demographic and clinical characteristics and the Skindex-16 questionnaire. In this study, validity (face, content, and construct) and reliability (Cronbach’s alpha) of the Skindex-16 were assessed and reported.

Results

The mean age of participants was 64.51 ± 5.04 years. The results of confirmatory factor analysis showed that the model had acceptable fitness into the expected three-factor structure [χ 2 /df = 249.363, P < 0.001; GFI = 0.961; TLI =0.952; RMSEA = 0.078 (90% CI = 0.06, 0.09) and SRMR = 0.06]. The reliability analysis results confirmed that the values of Cronbach’s alpha coefficient for Skindex-16 were in the acceptable range (0.923).

Conclusions

Our evaluation of the Skindex-16 indicates that it is reliable and a valid instrument that can be used for measuring QoL for Iranian dermatologic patients.

Comparison of the efficacy and safety of 308-nm excimer laser with intralesional corticosteroids for the treatment of alopecia areata: A randomized controlled study

BACKGROUND

Corticosteroids have been the mainstay of treatment for alopecia areata (AA). Recently, the 308-nm excimer laser has been proposed for treating AA.

OBJECTIVES

To compare the efficacy and safety of excimer laser with intralesional corticosteroid (ILCS) in AA.

METHODS

Patients with at least two alopecic patches were randomly assigned to receive weekly excimer laser treatments or monthly injections of ILCS. Photographs and trichoscopy images were examined at baseline, the last treatment session, and after one month of follow-up. The hair regrowth score was evaluated on a 6-point scale.

RESULTS

Sixteen patients with 99 alopecic patches completed the study. At the last treatment session, the mean score of hair regrowth for the laser was significantly lower than the ILCS (p = 0.003). However, after a month of follow-up, the difference was not statistically significant (p = 0.148). Positive response in hair regrowth (≥50%) was achieved in 47% of laser-treated patches and 66% in ILCS-treated ones. Four (25%) and 8 (50%) patients experienced severe adverse events of laser and ILCS, respectively.

CONCLUSIONS

The excimer laser was safe and effective in AA. The effect of laser on hair regrowth might be delayed as compared with ILCS.

Quality of life impairment amongst persons living with vitiligo using disease specific vitiligo quality of life index: A Nigerian perspective

Background

Vitiligo is an acquired pigmentary disorder of the skin and mucous membranes which manifests as white macules and patches due to selective loss of melanocytes. This condition can affect the patients' psychology, leading to an impairment of quality of life (QOL). Recently, much attention is been given to the emotional and psychological issues in the affected subjects.

Aim of the Study

This was to assess the QOL impairment among Nigerian patients with vitiligo using a disease-specific quality of life index questionnaire (VitiQoL).

Materials and Methods

Seventy seven adults aged 18 years and above with vitiligo attending the Dermatology Clinic of a tertiary health center were included in this cross-sectional study. The QOL was assessed using the vitiligo quality of life questionnaire (VitiQoL). Disease severity was assessed using Vitiligo Area Severity Index (VASI).

Results

The mean age of the study participants was 38.97 ± 13.2 years, comprising of 32 (41.6%) and 45 (58.4%) females. Almost half of the vitiligo patients belong to the lower socioeconomic class, 37 (48.1%). The mean age of first onset of vitiligo was 33.5 ± 14.84 years, with 32 (41.6%) of the participants having age of first onset between 24 and 42 years. The mean VitiQoL score was 30.51 ± 15.74 (range 3-64). There was a significant relationship between VASI score and VitiQoL (P = 0.036, r = 0.517). Other factors such as age, gender, socioeconomic status, disease activity, family history of vitiligo, duration of the disease and educational attainment were significantly associated with VitiQoL score (P < 0.05).

Conclusion

QOL is impaired significantly in Nigerian patients with vitiligo. Focusing on patient's QOL is an essential aspect in the management of patients with vitiligo.

Questionnaire Modifications and Alternative Scoring Methods of the Dermatology Life Quality Index: A Systematic Review

OBJECTIVES

Dermatology Life Quality index (DLQI) is the most widely used health-related quality of life questionnaire in dermatology. Little is known about existing questionnaire or scoring modifications of the DLQI. We aimed to systematically review, identify, and categorize all modified questionnaire versions and scoring methods of the DLQI.

METHODS

We performed a systematic literature search in PubMed, Web of Science, CINAHL, and PsychINFO. Methodologic quality and evidence of psychometric properties were assessed using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and Terwee checklists.

RESULTS

The included 81 articles reported on 77 studies using 59 DLQI modifications. Modifications were used for a combined sample of 25 509 patients with 47 different diagnoses and symptoms from 28 countries. The most frequently studied diseases were psoriasis, hirsutism, acne, alopecia, and bromhidrosis. The modifications were categorized into the following nonmutually exclusive groups: bolt-ons or bolt-offs (48%), disease, symptom, and body part specifications (42%), changes in existing items (34%), scoring modifications (27%), recall period changes (19%), response scale modifications (15%), and illustrations (3%). The evidence concerning the quality of measurement properties was heterogeneous: 4 of 13 studies were rated positive on internal consistency, 1 of 3 on reliability, 3 of 5 on content validity, 9 of 22 on construct validity, 6 of 6 on criterion validity, and 1 of 1 on responsiveness.

CONCLUSION

An exceptionally large number of DLQI modifications have been used that may indicate an unmet need for adequate health-related quality of life instruments in dermatology. The psychometric overview of most questionnaire modifications is currently incomplete, and additional efforts are needed for proper validation.

Family impact of pemphigus disease in an Iranian population using the Family Dermatology Life Quality Index

Background

Pemphigus vulgaris (PV) is a rare but seriously disabling disorder of the skin and mucous membranes that can gravely impact the quality of life (QoL) of patients.

Objective

The aim of the present study was to identify how family members of patients with PV are affected by the disease.

Methods

A total of 118 patients with confirmed PV and one of their family members (caregivers) were enrolled in the study. To calculate disease severity, the Autoimmune Bullous Skin Disorder Intensity Score was used. The Persian version of the Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate the QoL of patients and the Family Dermatology Life Quality Index (FDLQI) to evaluate the QoL of caregivers.

Results

The mean age of patients was 43.14 ± 12.5 years. Ninety patients (76.3%) were female. Eighty-one patients (68.6%) had the mucocutaneous phenotype and 37 cases (31.4%) the mucosal phenotype. The DLQI score was 10.1 ± 7.1 for patients. The DLQI score was higher for patients with the mucocutaneous phenotype (11.8 ± 7.5) than those with the mucosal phenotype (6.4 ± 4.9; p < .001). QoL was significantly affected by disease severity. FDLQI score was 13 ± 7 for caregivers, and was significantly higher in older caregivers and married ones. There was a positive correlation between patients' admission frequencies and FDLQI score. FDLQI score was also significantly affected by the Autoimmune Bullous Skin Disorder Intensity Score of patients' disease severity. The QoL of patients and their caregivers showed a significant positive correlation.

Conclusion

The QoL of patients and their families are impaired significantly, and is considerably prominent in the mucocutaneous phenotype of PV and more severe forms.

Limitation

Pemphigus Disease Area Index (PDAI) and Autoimmune Bullous Disease QoL (ABQoL) were not used in this study.

Alopecia Areata-Quality of Life Index Questionnaire (Reliability and Validity of the Persian Version) in Comparison to Dermatology Life Quality Index

Background

Alopecia areata (AA) is an autoimmune disease with an incidence of 2% globally and plays a key role in the quality of life (QOL) of patients with AA. It has been recently shown that there are no sufficient disease-specific questionnaires to assess the QOL in patients with AA.

Aims

This study tried to evaluate the validity and reliability of the Persian version of AA-Quality of Life Index (AA-QLI) and compare it with the Dermatology Life Quality Index (DLQI) questionnaire.

Materials and Methods

During 1 year, 100 individuals were enrolled in this study and asked to complete the DLQI questionnaire and AA-QLI questionnaire. First of all, we enrolled 25 individuals for evaluating the validity of the Persian version of the questionnaire, and after achieving the proper validity, 75 additional patients were enrolled in this project.

Results

The results showed that the test had an appropriate validity (P < 0.001, R = 0.76), reliability (P < 0.001 , internal stability R = 0.89), and (α = 0.91). In this study, we observed that the scores of both questionnaires are quite close. In this regard, in both questionnaires, females had higher scores in comparison to males (P = 0.03), and also both of them correlated with age, age of onset of disease, and skin involvement percentage.

Conclusions

The Persian version of the AA-QLI questionnaire is valid and reliable. The QOL of AA patients needs to be considered more seriously. Psychological evaluation of patients is one of the important suggestions in this study.

Quality of life and mental health status in patients with lichen planopilaris based on Dermatology Life Quality Index and General Health Questionnaire-28 questionnaires

Background

Lichen planopilaris (LPP) is a relatively uncommon inflammatory skin condition that causes permanent hair loss. Irreversible hair loss can have a significant psychosocial and psychological impact on patients’ lives. Limited studies have assessed the psychological status of patients suffering from LPP, and to our knowledge, none have evaluated patients with LPP as a separate group in this regard.

Objective

This study aimed to assess the quality of life (QoL) and general health of patients with LPP using the Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire-28 (GHQ-28), respectively.

Methods

Our study employed a cross-sectional design. In total, 41 patients with LPP attending the follow-up skin clinic at the Razi Hospital in Tehran, Iran were asked to complete the DLQI and GHQ-28. Furthermore, selected demographic information was obtained from patients to evaluate their association with general health and QoL.

Results

Forty-one patients (14 men and 27 women) with a mean age of 44.02 ± 10.8 years completed both questionnaires. QoL was affected moderately to extremely in 70.7% of patients. Also, 26 patients (63.4%) were at risk for psychological disorders. Lower QoL was reported by patients age <45 years (p < .05). Both QoL and general health had a negative relation with the disease activity index (p < .05), but were not affected by sex, marital status, education level, treatment type, presence of mucous lesions, and disease duration.

Conclusion

LPP significantly affects patients’ QoL and general health. Dermatologists should address these issues in patients with LPP alongside treating physical symptoms.

The Efficacy of Colloidal Oatmeal Cream 1% as Add-on Therapy in the Management of Chronic Irritant Hand Eczema: A Double-Blind Study

Background

Irritant contact dermatitis (ICD) is the most frequent cause of hand eczema (HE). There is promising evidence with the use of topical oatmeal compounds in the management of inflammation- and itch-responses associated with diverse dermatologic conditions. This study aimed to evaluate the clinical benefit of colloidal oatmeal cream in the management of chronic irritant HE.

Methods

From October 2018 to November 2019, 79 patients with diagnosis of chronic irritant HE were allocated into either intervention or control groups by block randomization method. Besides fluocinolone 0.025% ointment for the first 2 weeks of treatment period, patients in the intervention and control groups were asked to use colloidal oatmeal 1% cream or base cream for additional 4 weeks as monotherapy. Changes in the HE severity based on the hand eczema severity index (HESCI) score, pruritus severity based on the visual analogue scale (VAS), and impact of skin disorder on patients quality of life based on the Dermatology Life Quality Index (DLQI) from baseline to weeks 2, 4, and 6 were assessed in the study groups.

Results

Fifty subjects, 26 in intervention and 24 in control, completed the course of the study. The results indicated, though relatively comparable decrease in mean HESI and VAS scores was observed in both groups by the end of week 2, thereafter until end of the study a non-return of symptoms to baseline conditions was observed in the intervention group, while there was a significant return of symptoms to baseline conditions in the control group (p value<0.001 in both conditions). Further, a noticeable improvement in the DLQI score was seen in the intervention group compared with the control group (p value<0.001).

Conclusion

Findings demonstrate that colloidal oatmeal, a natural product with proven barrier protection, moisturization, anti-inflammatory, and soothing properties, can have ameliorative effects on eczema severity symptoms in patients with chronic irritant HE.

Evaluating prevalence of depression, anxiety and hopelessness in patients with Vitiligo on an Iranian population

INTRODUCTION

Vitiligo is caused by partial or complete destruction of melanocytes in the affected skin area and influences the patient's quality of life. Besides physical involvement, vitiligo patients experience a high level of stress. Depression and Anxiety are common psychiatric disorders in vitiligo patients.

AIM

This study, as the first study, evaluates hopelessness, anxiety, depression and general health of vitiligo patients in comparison with normal controls in an Iranian population.

METHOD

Hundred patients with vitiligo and hundred healthy controls were examined. General health, depression, hopelessness and anxiety were evaluated based on general health questionnaire. Anxiety, depression and hopelessness levels were analyzed using Chi-Square, and the mean value of general health was evaluated through t-test.

RESULTS

The results showed that anxiety and hopelessness levels were significantly higher in vitiligo patients than those who are in healthy controls. This significant difference refers to high levels of anxiety and hopelessness among women with vitiligo. It was also found that the single patients were more anxious, hopeless and depressive, while the married patients were only more anxious and hopeless than those who are in the control group, respectively. General health of patients was significantly worse than in healthy controls. The low level of general health in patients was related to poorer level of general health among women with vitiligo.

CONCLUSION

It seems that women with vitiligo are more mentally stressed than men with vitiligo. Both singles and married vitiligo patients suffer from anxiety and hopelessness.

Assessing child quality of life impairments following pediatric burn injuries: Rasch analysis of the children's dermatology life quality index

AIMS

There is a need for a brief, validated measure of quality of life (QOL) for children to monitor their adjustment to burn injuries. We aimed to apply a Rasch analysis to an existing measure of QOL from the dermatology literature to a clinical sample of pediatric burn patients.

METHODS

The Children's Dermatology Life Quality Index (CDLQI) was administered to pediatric burn patients (N = 253) during a standard clinic visit. Rasch analysis was used to examine psychometric properties of this measure with a burn sample.

RESULTS

The CDLQI showed an adequate fit to the Rasch model. Test difficulty is .61 logits greater than person ability. Results of item reliability and separation analyses were sufficiently strong and indicated a unidimensional latent trait. Person reliability (.74) and separation analyses (1.64) were moderate. Finally, the CDLQI was able to moderately separate the group of respondents into low and high levels of QOL impairments related to burn injuries.

CONCLUSION

The Rasch model demonstrated that the CDLQI is a reliable and valid scale that adequately measures QOL impairments in children following burn injuries.

Quality of Life in Patients with Non-melanoma Skin Cancer: Implications for Healthcare Education Services and Supports

Non-melanoma skin cancer (NMSC) is the most prevalent type of cancer among Caucasian populations worldwide. The purpose of this work was to measure quality of life (QOL) of the patients with diagnosis of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) who were referred to our cancer clinic. During 1 year, 95 patients were selected and asked to complete Dermatology Life Quality Index (DLQI) questionnaires. Ninety-five patients with NMSC (74 men and 21 women) with mean age of 64.6 ± 12.5 participated in this cross-sectional study. From 95 patients, 75 had BCC, 15 had SCC, and 5 patients had both SCC and BCC. The total DLQI scores of the all participants were between 0 and 16; the mean was 4.1 ± 4.25 and median was 2. Variables which were associated with impaired QOL were marital status (P = 0.03) and tumor location (P = 0.02). By using general dermatology QOL questionnaire, it had been demonstrated that patients with NMSC faced with minimal QOL impairment; also, this handicap was more pronounced in younger patients and singles and patients with tumors located in exposed areas. Our findings demonstrated a need to educate our patients to improve patients' knowledge about different aspects of disease.

Efficacy and safety of acupuncture for patients with chronic urticaria: study protocol of a randomized, sham-controlled pilot trial

Background

Chronic urticaria (CU) is a refractory skin disease with long duration and a high recurrence rate. Acupuncture has been widely used for the treatment of CU in clinical practice in China. However, until now, there has been no appropriately designed randomized controlled trial (RCT) to provide explicit evidence about the effectiveness of acupuncture for the treatment of CU worldwide. Therefore, we plan to conduct a pilot study to explore its effectiveness and safety and determine the feasibility of studying acupuncture in a future, full-scale, RCT of CU.

Methods/design

This randomized, sham-controlled, participant-blinded and assessor-blinded pilot trial is underway in China. A total of 60 participants with CU will be randomly assigned to two groups in a 1:1 ratio: one treated with real acupuncture and the other with sham acupuncture, for 10 sessions over 2 weeks. The experimental group will receive acupuncture on a fixed prescription of acupoints, whereas the control group will receive sham acupuncture, namely minimal acupuncture on non-acupuncture points. The primary outcome will be the urticaria activity score (UAS). The secondary outcomes will include a visual analogue scale (VAS) score for itching intensity, the Dermatology Life Quality Index (DLQI), the Hamilton Depression Scale (HAMD), the Hamilton Anxiety Scale (HAMA), the humoral immunity index, serum total IgE, and adverse events. The UAS, VAS for itching and the DLQI will be conducted at baseline and at 1, 2, 3, and 4 weeks after randomization. The HAMD, HAMA, humoral immunity index, and serum total IgE will be assessed at baseline and at 2 weeks after randomization. Adverse events will be summarized at 1 week and 2 weeks after randomization.

Discussion

The pilot study mainly aims to investigate trial feasibility, and confirm basic information about its effects and safety. Results of this trial will help clarify whether the acupuncture treatment is beneficial for symptom improvement in patients with CU. The finding of this study will provide preliminary evidence on the effectiveness and safety of acupuncture for CU.

Trial registration

Acupuncture-Moxibustion Clinical Trial Registry, AMCTR-ICR-18000190. Registered on 19 June 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3433-1) contains supplementary material, which is available to authorized users.

The Use of Janus Kinase Inhibitors in Vitiligo: A Review of the Literature

Vitiligo is a common acquired depigmenting disorder characterized by the development of white macules and patches due to the loss of melanocytes. Patients with vitiligo can be stigmatized by society, making the disease a source of psychological stress that can considerably affect quality of life. The goal of vitiligo treatment is to obtain skin repigmentation in the majority of cases, and less commonly to depigment the remaining normal skin. There is no consistent, long-term, durable therapy for vitiligo for all patients, highlighting the unmet need for new safe and effective therapies to control this disease. Recently, JAK inhibitors have been explored as a promising novel treatment option in vitiligo. The JAK and signal transducers and activators of transcription (STAT) pathway is an attractive therapeutic target because IFN-γ-dependent cytokines produced through this pathway have been implicated in the pathogenesis of disease. This literature review describes vitiligo pathophysiology, explains the usefulness of the JAK inhibitors for treatment, and summarizes published case reports, case series, and open-label studies. Research outlined here shows JAK inhibitors in patients with vitiligo have a favorable safety profile and effectively produce repigmentation of lesions, especially with concomitant ultraviolet exposure. Additional studies are required to confirm efficacy, establish safety, and investigate durability of repigmentation.

Understanding the Burden of Atopic Dermatitis in Africa and the Middle East

Atopic dermatitis (AD) is a common inflammatory skin disease characterized by intensely pruritic lesions. The prevalence of atopic dermatitis is increasing in developing regions, including Africa and the Middle East. However, these regions are underrepresented in the dermatology literature, and a better understanding of the growing burden of atopic dermatitis in Africa and the Middle East is necessary. Herein, we summarize current knowledge on atopic dermatitis epidemiology, disease burden, and treatment options in Africa and the Middle East, highlighting the unmet needs of patients in these regions. With these needs in mind, we provide clinical recommendations for appropriate management of atopic dermatitis in Africa and the Middle East. FUNDING: Pfizer Inc. Plain language summary available for this article.

A detailed analysis of 'not relevant' responses on the DLQI in psoriasis: potential biases in treatment decisions

BACKGROUND

Dermatology Life Quality Index (DLQI) is the most common health-related quality of life measure in dermatology that is widely used in treatment guidelines for psoriasis. Eight of the 10 questions of the DLQI offer a 'not relevant' response (NRR) option that is scored as the item had no impact on patients' life at all.

OBJECTIVE

To explore the occurrence of NRRs on the DLQI in psoriasis patients and to examine the effect of several socio-demographic and clinical factors on giving NRRs.

METHODS

Data were obtained from two cross-sectional surveys among psoriasis patients at two academic dermatology clinics in Hungary. Health-related quality of life was measured by employing DLQI and EQ-5D-3L, while disease severity was graded by Psoriasis Area and Severity Index (PASI). Multivariate logistic regression was applied to determine the predictors of providing NRRs.

RESULTS

Mean age of the 428 patients was 49 years, and 65% were males. Mean PASI, DLQI and EQ-5D-3L index scores were 8.4 ± 9.5, 6.8 ± 7.4 and 0.74 ± 0.28, respectively. Overall, 38.8% of the patients had at least one NRR: 19.6% (one), 11.5% (two), 5.1% (three) and 2.6% (more than three). Most NRRs occurred in sport, sexual difficulties and working/studying items of the DLQI (28.4%, 16.4% and 14.0%, respectively). Female gender (OR 1.65; 95% CI 1.04-2.61), older age (OR 1.05; 95% CI 1.03-1.07) and higher PASI score (OR 1.03; 95% CI 1.01-1.06) were associated with providing more NRRs, whereas highly educated patients (OR 0.34; 95% CI 0.16-0.72) and those with a full-time job (OR 0.47; 95% CI 0.29-0.77) less frequently tended to tick NRRs.

CONCLUSION

The high rate of psoriasis patients with NRRs, especially among women, less educated and elderly patients, indicates a content validity problem of the measure. A reconsideration of the use of the DLQI for medical and financial decision-making in psoriasis patients is suggested.

Quality of life in mild and severe alopecia areata patients

Background

Alopecia areata is a relapsing hair disorder characterized by a sudden hairloss and has a considerable impact on patient's quality of life. The goal of this study was to determine quality of life among patients with mild and severe forms of alopecia areata and compare the two groups.

Methods

During one year, 176 patients (96 mild, 80 severe) were selected and asked to complete Dermatology Life Quality Index (DLQI) questionnaires.

Results

Our study revealed that the severe group was predominantly female and had higher amount of unemployment, more prolonged disease duration, unstable disease course and facial involvement. The mean DLQI scores in the severe and mild groups were 10.7 ± 7.5 and 5.4 ± 6.8, respectively which was significantly different and severe group had higher DLQI scores and more quality of life impairment. As well, there was a significant association between total DLQI scores and acute stress during last 6 months.

Conclusions

Our study confirms that alopecia areata considerably impacts quality of life and this is more pronounced in patients with severe disease and those who had acute stress recently.

Psychosomatic aspects of vitiligo

Vitiligo is a chronic common skin disease. The asymptomatic hypopigmented cutaneous lesions are considered by many health care professionals as a cosmetic problem only; however, vitiligo can have a major psychosocial impact on patients' lives. We review some of the factors responsible for this impact, such as the general public's wrong perception of the disease, feelings and emotional responses from patients, how stressful events can act as triggers of the disease, stigmatization experiences suffered by the patients, the prevalence of psychiatric morbidity, the effects on relationships and sex life, how quality of life in adults and children is impaired, and how treatment can improve it.

Factors affecting patient presentation at a national dermatology referral clinic in Kampala, Uganda

BACKGROUND

This study sought to gain a better understanding of the patient population in Kampala and was further designed to elucidate barriers that may delay individuals from receiving proper dermatologic care.

METHODS

The study took place at the dermatovenereology clinic of a tertiary care hospital in Kampala. New adult patients were surveyed in July and August of 2013. The primary dependent variable was time from reported onset of symptoms to presentation to the clinic. Participant demographic characteristics, medical and treatment history, and perception of illness as measured by the dermatology life quality index (DLQI) were assessed.

RESULTS

A total of 232 subjects participated in the study. The most common skin diseases were allergic (20.3%), infectious (15.1%), follicular (7.8%), and papulosquamous (7.8%) disorders. Greater home distance from the clinic correlated with later presentation times (r = 0.259, P < 0.001). DLQI score was not correlated with presentation time. HIV+ individuals presented earlier (mean 5 vs. 11 months, P = 0.043) and had higher DLQI scores (mean 12.6 vs. 9.3, P = 0.006) than HIV- individuals. The majority of participants (72.5%) had contact with at least one other healthcare worker (HCW) for management of their dermatologic symptoms; 65.8% reported that these previous treatments were ineffective.

CONCLUSIONS

Efforts to educate HCWs should be focused on districts outside of Kampala and highlight recognition and proper treatment of allergic diseases. HCWs should aggressively treat skin problems in HIV+ individuals. HCWs practicing in Kampala without formal dermatological training should refer patients with skin disease to the clinic, as patients may receive care that is more appropriate.

Quality of life in patients with vitiligo: a cross-sectional study based on Vitiligo Quality of Life index (VitiQoL)

BACKGROUND

Vitiligo is a multi-factorial pigmentary skin disorder. Recently, the importance of emotional and psychological issues is proposed in incidence, progression, relapse and remission of vitiligo. There are limited studies conducted in developing countries, which assess life quality of patients with vitiligo. The aim of this study was the application and evaluation of a disease-specific quality of life index in Iranian patients, for the first time.

METHODS

This cross-sectional biphasic study was conducted on 25 patients as a pilot and another 173 patients as the main study group, in Razi Hospital, Tehran, Iran, 2013-2014. Persian version of Vitiligo Quality of Life index (VitiQoL) was developed with backward-forward method. Based on the pilot study, the validity and reliability were assessed. The Vitiligo Area and Score Index (VASI), VitiQoL, and their relationship, demographic and clinical characteristic of patients were measured.

RESULTS

The Mean and standard deviation of the VitiQoL score was 30.5 ± 14.5 (range 0-60 in Persian version). There was a significant relationship between VASI score and VitiQoL (p = 0.015, r = 0.187). Confirmatory factor analysis revealed three important factors within VitiQoL: participation limitation, stigma, and behavior. In subscale analysis based on behavior factor, female patients had poorer quality of life (p = 0.02). Concomitant psychiatric problems, e.g. anxiety and depression, were not associated with QOL; however, they were near to being meaningful (p = 0.06, r = 0.14).

CONCLUSION

VitiQoL is a valid index in estimating life quality of vitiligo patients and has proper relation to disease severity. Focusing on patient's life quality is an important entity in the management of vitiligo patients; relevant supportive group-based consultations and therapies are also important arms when approaching vitiligo.

Quality of life in patients with primary axillary hyperhidrosis before and after treatment with fractionated microneedle radiofrequency

Background:

Primary axillary hyperhidrosis (PAH) is a common condition with a great impact on the patient's quality of life (QOL). It is associated with serious social, emotional, and occupational distress. The aim of this study was to investigate the QOL in patients with PAH before and after treatment with fractionated microneedle radiofrequency (FMR).

Materials and Methods:

We evaluated 25 patients with severe PAH. Each patient had three sessions of FMR treatment using a novel applicator at 3-week intervals. The study was based on Dermatology Life Quality Index (DLQI) Questionnaires. Patients were evaluated at baseline and 3 months after the last session.

Results:

Our patients included 32% males and 68% females. The mean ± standard deviation (SD) age of subjects was 30.2 ± 6.27 years. The mean ± SD of the DLQI before and after treatment was 12.96 ± 5.93, and 4.29 ± 2.21, respectively. There was a statistically significant difference between the before and after intervention (P < 0.001). No major, permanent adverse effects were shown.

Conclusion:

Treatment with FMR can improve the DLQI of patients with PAH.

A Randomized Double Blind Clinical Trial on a Sabgh Formulation for Patients With Vitiligo

BACKGROUND

The cosmetic problem that vitiligo produces affects patients psychologically. Many patients with vitiligo are suggested to cover their white skin patches with cosmetic products. There are formulations in traditional Iranian pharmacy to color these white skin patches. In this study, one of these formulations was compared with a cosmetic formulation.

METHODS

Two groups of patients were selected. One group used a marketed formulation and other group used a traditional Iranian Pharmacy formulation. The quality of life of the patients was compared based on the Dermatology Life Quality Index Questionnaire.

RESULTS

Both interventions were associated with statistically improved Dermatology Life Quality Index scores over the 8-week intervention (P < .05), although the difference between the 2 was not statistically significant (P = .436).

CONCLUSION

Traditional Iranian Pharmacy formulation is effective in increasing the quality of life in vitiligo patients.

To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index

BACKGROUND

It is believed that vitiligo has an impact on the overall patient quality of life (QoL).

OBJECTIVE

To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire.

METHODS

One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire.

RESULTS

The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset.

CONCLUSIONS

The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.

Psychiatric morbidity and quality of life in vitiligo patients

BACKGROUND

Vitiligo has underlying mental illness but mostly not diagnosed and never used psychiatric medication. Hence, the problem persists affecting mostly the individual's quality of life.

AIM

Assessing the quality of life, level of depression, and self-esteem of patients with vitiligo and give psychiatric medication for underlying mental illness.

MATERIALS AND METHODS

The study conducted at Owaisi Hospital Research Centre, Hyderabad. The patients registered for dermatologist consultation were also registered for consultation with psychiatrist to rule out any mental illness after detailed evaluation using standardized scales.

RESULTS

Patients suffering with vitiligo had depression and low self-esteem; their quality of life was disturbed.

CONCLUSION

The findings provide the role of Mental Health Professionals involved in the field of dermatology for the patients suffering with vitiligo.

Dermatology Specific Quality of Life in Vitiligo Patients and Its Relation with Various Variables: A Hospital Based Cross-sectional Study

INTRODUCTION

Vitiligo is an acquired, idiopathic skin disease characterized by progressive loss of the inherited skin color. Vitiligo has a special significance to patients in our country because depigmentation is obvious on dark skin and due to the enormous stigma that the disease carries.

MATERIALS AND METHODS

One hundred vitiligo patients aged more than 18 years were included in our hospital based study depending on inclusion and exclusion criteria. All the patients were asked to fill a validated Hindi version of DLQI questionnaire. DLQI scores and its interpretation were recorded separately. correlation of DLQI Scores with different variables like age, body surface area, duration of disease and socioeconomic status were studied using Pearson's correlations. Mean DLQI scores were also compared between different groups.

RESULTS

Male and female patient were statistically similar in all variables, like their age, BSA of the involvement and DLQI score. DLQI interpretation showed that out of 100 patients of vitiligo, 16 felt no effect of vitiligo on their quality of life while 84 patients reported small to very large effect on their quality of life. Out of this 84, 37 felt small effects, 21 felt moderate effect and rest 26 felt very large effect on their quality of life. There was no significant difference among the different groups mentioned except very large effect on quality of life seen significantly more in unmarried patients compared to married one.

CONCLUSION

Vitiligo although a cosmetic disease without any symptoms, it carry a significant social stigma especially in Indian society. Data interpretation in this study indicates that vitiligo affects QOL in majority of vitiligo patients and such patients require more aggressive and empathic attitude from a dermatologist to cure/improve this so called chronic cosmetic disease.

Evaluating of life quality in patients with acne vulgaris using generic and specific questionnaires

Background. Acne vulgaris is a common skin disease that can adversely affect the quality of life of patients. Objective. The aim of this study was to determine the quality of life in patients with acne vulgaris. Methods. This study was carried out on 70 patients with acne vulgaris (28 males, 42 females). All the patients filled out two Persian versions of questionnaires: short form 36 (SF-36) and Dermatology Life Quality Index (DLQI). The obtained data were analyzed by using SPSS software (version 17). Results. The scores for physical functioning, social functioning, and bodily pain domains in patients were over 70%, but the scores for role physical, general health, vitality, role emotional, and mental health in patients were under 70%. Scores on the DLQI in patients with acne vulgaris ranged from 0 to 22 (mean ± SD, 8.18 ± 4.83). After comparing mean score of DLQI with respect to gender and age, it was found that the difference between the two groups was not statistically significant. Conclusion. Acne vulgaris has a significant effect on the quality of life. There was not any significant gender or age related difference in QOL.

Measuring quality of life in patients with psoriasis using the Arabic version for Morocco of the Dermatology Life Quality Index

BACKGROUND

Psoriasis has been demonstrated to have substantial impacts on dermatology-related functional limitations and health-related quality of life (HRQL). This study evaluated the HRQL in Moroccan psoriatics using the Arabic version of the Dermatology Life Quality Index (DLQI) and examined the psychometric properties of the questionnaire.

MATERIALS AND METHODS

The Moroccan Arabic version of the DLQI was developed and approved by the author of the questionnaire. The DLQI was administered to inpatient and outpatient adult psoriatics. Some participants completed the DLQI for a second time. Demographic and clinical characteristics were collected. Reliability of the DLQI was tested using Cronbach's coefficient alpha and intraclass correlation coefficient (ICC). Factor structure was tested by explanatory and confirmatory factor analysis. Construct validity was tested by known-groups comparison using the generalized linear model to assess factors influencing patients' HRQL.

RESULTS

A total of 176 psoriatics completed the questionnaire. The mean age was 36 ± 14 years. The mean Psoriasis Area and Severity Index (PASI) score was 11.8 ± 7.9. The mean DLQI score was 12.7 ± 5.9 (the higher the score the greater the impairment of HRQL). Cronbach's alpha coefficient was 0.84. ICC was 0.97. The principal component analysis confirmed the bidimensional structure of the questionnaire. Factors associated with poorer HRQL were higher PASI (P < 0.001), pustular and erythrodermal clinical forms (P < 0.001), and older age (P = 0.001).

CONCLUSIONS

The Arabic version for Morocco of the DLQI is reliable and valid. Severity of the psoriasis, older age, and severe clinical forms influence the HRQL of patients.

Efficacy and safety of immunotherapy with interferon-gamma in the management of chronic sulfur mustard-induced cutaneous complications: comparison with topical betamethasone 1%

The present trial investigated the efficacy of immunotherapy with interferon-gamma (IFN-γ) in the treatment of sulfur mustard (SM)-induced chronic skin complications. Forty subjects who were suffering from chronic skin complications of SM and were diagnosed to have severe atopic dermatitis, were assigned to IFN-γ (50 μg/m(2)) subcutaneously three times per week (n = 20) or betamethasone valerate topical cream 0.1% (n = 20) every night for 30 days. Extent and intensity of cutaneous complications was evaluated using scoring atopic dermatitis (SCORAD) index, and quality of life using dermatology life quality index (DLQI) at baseline and at the end of trial. SCORAD-A and SCORAD-B scores were significantly decreased in both IFN-γ and betamethasone. However, SCORAD-C score was decreased only in the IFN-γ group. There were significant reductions in overall as well as objective SCORAD scores in both groups. As for the magnitude of changes, treatment with IFN-γ was associated with greater reductions in overall, objective and segmented SCORAD scores compared to betamethasone. DLQI reduction was found to be significantly greater in the IFN-γ group. Promising improvements in quality life and clinical symptoms that was observed in the present study suggest the application of IFN-γ as an effective therapy for the management of SM-induced chronic skin complications.

Quality of life in chronic urticaria: a survey at a public university outpatient clinic, Botucatu (Brazil)

OBJECTIVE

To evaluate the impact of chronic urticaria on quality of life of outpatients through the university questionnaire Dermatology Life Quality Index (DLQI).

METHODS

Survey of the impact on quality of life caused by chronic urticaria, using the DLQI questionnaire validated for the Portuguese language. Patients were interviewed during visits to a specialized outpatient clinic between May 2009 and May 2010 at a Brazilian public service (Botucatu-SP). DLQI scores were analyzed according to the following subgroups: age, gender, education, disease duration, and presence of angioedema.

RESULTS

We interviewed 100 patients with chronic urticaria. There was a female predominance (86%), mean age 41.8 years, mean disease duration of 6 years, and angioedema occurrence in 82% of patients. The mean DLQI score was 13.5, characterized by serious impact on quality of life, higher than Hansen's disease, psoriasis, atopic eczema, and basal cell carcinoma. The presence of angioedema was associated with higher scores: 14.5 x 9.9 (p < 0.01). Female patients reported greater impact on clothing, while male patients reported treatment interference with work and study (p < 0.05).

CONCLUSION

Chronic urticaria seriously compromises the quality of life of patients evaluated at a university service in Brazil, particularly of patients with angioedema.

Quality of life in Iranian patients with acne

Acne is a chronic inflammatory disease of pilosebaceous units. Although the acne isnot a life threatening disease, studies have revealed that it has significant effect on self-image and quality of life. The purpose of this paper was to investigate the health-related quality of life in patients with acne in an Iranian context. Dermatology Life Quality Index (DLQI) and Cardiff Acne Disability Index (CADI) were used for measuring quality of life, and severity of acne was measured by Global Acne Grading System (GAGS). The mean (±SD) of DLQI and CADI scores was 6.42 (±4.77) and 5.97 (±2.97), respectively. Acne influenced the quality of life in 51.8% of patients from moderate to very much, and the quality of life was affected by the severity of acne (P < 0.01). Since acne has significant effects on patient's quality of life, the management of patients with acne requires more attention to different aspects of quality of life.

Quality of life and psychological status of patients with pemphigus vulgaris using Dermatology Life Quality Index and General Health Questionnaires

Pemphigus vulgaris with painful chronic blisters and/or erosions on skin and mucosa can impair quality of life (QOL). Therapeutic modalities in the long run can have additional negative impact. There are few studies that have focused on QOL of such patients except in treated cases. The aim of this study was to describe the effect of the disease per se on QOL before receiving treatment and evaluation of psychological status of the patients and its effect on their QOL. A total of 61 patients with newly diagnosed non-treated pemphigus vulgaris participated in the study. The Persian version of the Dermatology Life Quality Index (DLQI) questionnaire was used to evaluate their QOL and the 28-item General Health Questionnaire (GHQ-28) for their psychological status. In this study, the mean DLQI score was 10.9 ± 6.9. QOL was worse in patients with nasal and pharynx involvement, with positive Nikolsky sign, patients with severe skin involvement and those who showed the symptom of itching. There was a negative correlation between DLQI score and duration of the disease. More than 77% of patients experienced anxiety and depression with more impaired QOL. In conclusion, pemphigus vulgaris is responsible for great alteration in QOL, especially in its severe form. The disease in its initial stage may have greater impact on the QOL. The high probability of anxiety and depression in these patients and its negative effect on QOL should be taken into account in the management of these patients right from the start of the treatment.

Hypothesis: zinc can be effective in treatment of vitiligo

Vitiligo is a common depigmenting skin disorder (prevalence 0.1-2%), still represents a cause of stigmatization and quality of life impairment in a large population. Several theories on vitiligo etiopathogenesis have been suggested including in trauma, stress, and autoimmune and genetic predisposition, accumulation of toxic compounds, altered cellular environment, imbalance in the oxidant-antioxidant system, impaired melanocyte migration and/or proliferation, infection, and psychological factors. Zinc, as a trace element, has many vital functions in human. It is antiapoptotic factor and needed as a cofactor for antioxidant defense system. It plays an important role in the process of melanogenesis. It may be effective in prevention and treatment of vitiligo via some mechanism. Herein, we suggested some probable protective mechanism for zinc in association with vitiligo.