Prevalence of fibromyalgia: a survey in five European countries

OBJECTIVE

A survey was performed in 5 European countries (France, Germany, Italy, Portugal, and Spain) to estimate the prevalence of fibromyalgia (FM) in the general population.

METHODS

In each country, the London Fibromyalgia Epidemiological Study Screening Questionnaire (LFESSQ) was administered by telephone to a representative sample of the community over 15 years of age. A positive screen was defined as the following: (1) meeting the 4-pain criteria alone (LFESSQ-4), or (2) meeting both the 4-pain and the 2-fatigue criteria (LFESSQ-6). The questionnaire was also submitted to all outpatients referred to the 8 participating rheumatology clinics for 1 month. These patients were examined by a rheumatologist to confirm or exclude the FM diagnosis according to the 1990 American College of Rheumatology classification criteria. The prevalence of FM in the general population was estimated by applying the positive-predictive values to eligible community subjects (ie, positive screens).

RESULTS

Among rheumatology outpatients, 46% screened positive for chronic widespread pain (LFESSQ-4), 32% for pain and fatigue (LFESSQ-6), and 14% were confirmed FM cases. In the whole general population, 13 and 6.7% screened positive for LFESSQ-4 and LFESSQ-6, respectively. 3The estimated overall prevalence of FM was 4.7% (95% CI: 4.0 to 5.3) and 2.9% (95% CI: 2.4 to 3.4), respectively, in the general population. The prevalence of FM was age- and sex-related and varied among countries.

CONCLUSION

FM appears to be a common condition in these 5 European countries, even if data derived from the most specific criteria set (LFESSQ-6) are considered.

Atopic Dermatitis: Impact on the Quality of Life of Patients and Their Partners

BACKGROUND

The impact of atopic dermatitis (AD) on the patient's quality of life is relatively well known. However, the influence on the patient's spouse has never been studied.

OBJECTIVE

To evaluate the impact of AD on the quality of life, sleeping and sexual life of patients and their partners.

METHODS

In this cross-sectional study, patients and their partners completed a number of questionnaires asking about their general health and their quality of life [Short Form 12, Epworth, Dermatology Life Quality Index (DLQI)] and completed an idiosyncratic measure asking about their sexual functioning. AD severity was clinician rated using Scoring atopic dermatitis (SCORAD).

RESULTS

A total of 266 patients were included. The mean DLQI score was 8.8. The physical and mental composite 12 scores were 50.7 and 39.5, respectively. These 3 scores were significantly related to SCORAD. A decrease in sexual desire due to AD was noted in 57.5% of patients. The quality of life of partners did not appear to be particularly impaired, but 36.5% reported that the appearance of eczema had an impact on their sex life.

CONCLUSION

The influence of AD on sex life is significant both for the patients and their partners.

Prevalence of most common skin diseases in Europe: a population-based study

BACKGROUND

The assessment of the prevalence of diseases is of primary importance in planning health policies. No complete data on the prevalence of skin diseases across European countries are available.

OBJECTIVE

To estimate the prevalence of the most frequent skin conditions or diseases in 27 European countries (24 EU countries, plus Norway, Switzerland, and UK).

METHODS

We conducted a population-based study on representative and extrapolable samples of the general population aged 18 years or more in each of the 27 countries surveyed. Participants were selected using a stratified, proportional sampling with replacement design. Data were collected using a web-based online survey. All participants were asked to fill in a questionnaire with sociodemographic data and to declare if they have had one or more skin conditions or diseases during the previous 12 months.

RESULTS

A total of 44,689 participants from 27 countries responded to the questionnaire, 21,887 (48.98%) men and 22,802 (51.02%) women. The proportion of participants who reported having suffered from at least one dermatological condition or disease during the previous 12 months was 43.35% [95% CI 42.89%, 43.81%)]. The projection in the total population of the 27 countries included in the study resulted in 185,103,774 individuals affected by at least one dermatological condition or disease. Accordingly, we can estimate that more 94 million Europeans complain of uncomfortable skin sensations like itch, burning, or dryness. The most frequent conditions were fungal skin infections (8.9%), acne (5.4%), and atopic dermatitis or eczema (5.5%). Alopecia, acne, eczema and rosacea were more common in women, whereas men were more likely to suffer from psoriasis and sexually transmitted infections.

CONCLUSION

Skin diseases are an important public health concern. Their high prevalence has to be taken into account in planning access to dermatological care to address patient needs.

Peaux sensibles en France : approche épidémiologique

INTRODUCTION

Sensitive skin is a frequently evoked cosmetic disorder, but its prevalence in France is unknown.

METHODS

Using a survey of a representative sample of the French population aged over 15 carried out by ISPSOS-Santé, we assessed the frequency of sensitive skin. We used the quota method (gender, age, occupation of the head of the family) and stratification by area and category of the agglomeration.

RESULTS

One thousand and six persons were surveyed. The non-response rate was less than 1 p.cent. Fifty-two percent claimed they had sensitive or very sensitive skin. Women were predominantly concerned (59 vs. 44 p.cent, p<0.0001). There was no significant difference between the socio-professional categories. Twenty-eight p.cent of the population claiming their skin was very sensitive declared they had a concomitant dermatological disease, whereas 14 p.cent with sensitive skin, 7 p.cent with not very sensitive skin and 2 p.cent with normal skin declared likewise. Skin sensitivity was triggered by emotion, cold, heat or cosmetics. A quality-of-life assessment using the SF-12 scale showed significant alteration in the psychological dimension (but not physical) of the score for those with sensitive and very sensitive skin compared with the others, notably in the women (p<0.0001).

DISCUSSION

This survey revealed a prevalence of sensitive skin in France equal to that found in England. It only measured the subjective feeling of sensitive skin experienced by those surveyed, since there was no clinical examination. The phenomenon appears frequent. Although women appeared to suffer more, a large proportion of men also suffered from sensitive skin.

Development and validation of nail psoriasis quality of life scale (NPQ10)

BACKGROUND

The chronic and treatment-resistant nature of nail psoriasis affects patients' lives not only physically but also psychologically. Although there are scoring systems available for disease severity, there is as yet no scale to evaluate the impact of this condition upon the patients' quality of life.

OBJECTIVES

This study aims to develop and validate a quality of life scale specifically for nail psoriasis.

METHODS

A questionnaire was developed during a study conducted in France between 2004 and 2005. With the cooperation of l'Association Pour la Lutte Contre le Psoriasis, the questionnaire was sent to a random sample of 4000 of its 17,000 members.

RESULTS

The response rate was 33%. Of the 1309 questionnaires returned, 795 showed the presence of nail psoriasis and these were eligible. The scale score is obtained by adding together the responses to the 10 questionnaire items and the result is expressed as a percentage. The value of the score obtained is proportional to the functional difficulty experienced. The determination of Cronbach's a coefficient and a Principal Component Factor Analysis show, respectively, very good internal consistency and the unidimensional nature of the scale. Test-retest results on 15 patients showed good reproducibility. Results were validated with reference to the Dermatology Life Quality Index. In this study, the NPQ10 score is significantly influenced by gender (women have a higher score) and by the duration of psoriasis (recent onset implies greater functional difficulty). Finally, the score is much higher when the nail psoriasis affects both the hands and the feet.

CONCLUSION

This study confirms a change in the quality of life of patients who have nail psoriasis. The NPQ10 scale, specific to this condition, is simple to use and has the attributes needed in a quality of life scale. The scale must now be tested in longitudinal studies (such as clinical trials) to confirm its ability to measure a change in status.

Sensitive skin in France: a study on prevalence, relationship with age and skin type and impact on quality of life

BACKGROUND

Many epidemiological studies have been performed, but a potential increase in the prevalence of sensitive skin, its relationship with age and skin type and the impact of sensitive skin on quality of life are still debated.

OBJECTIVE

To answer these unresolved questions.

METHODS

An opinion poll was conducted on a representative French 5000 person sample.

RESULTS

Fifty-nine per cent of the people declared very sensitive or fairly sensitive skin (together: sensitive skin), and women (66%) declared sensitive skin more frequently than men (51.9%). The results also showed that sensitive skin is more common (more than 60%) in younger people (<35 years old), and there was a decrease in the following age groups. The univariate analysis demonstrated that sensitive skin was more likely to be reported by people with fair skin (OR = 1.83) and by people with an atopic predisposition (OR = 2.51). The risk of sensitive skin is higher for people with dry skin (OR = 6.18 compared with normal skin), but sensitive skin can occur in other skin types (OR = 2.45 for mixed skin and OR = 2.16 for greasy skin). Quality of life was clearly altered in patients with sensitive skin, as assessed by SF-12 and DLQI.

CONCLUSION

This large study demonstrates that sensitive skin can alter quality of life and is more common in young people and in women as well as patients with dry skin or fair skin or an atopic predisposition. It also suggests that there is an increase in the prevalence of sensitive skin.

Acne relapses: impact on quality of life and productivity

BACKGROUND

Acne is a common skin disease that mostly affects teenagers, with a negative impact on quality of life. Recently, adult acne and acne relapses have increased in frequency, for yet unknown reasons.

OBJECTIVE

This non-interventional, real-life study sought to investigate the rate of acne relapses and their impact on quality of life and productivity (loss/absenteeism) among teenagers and adults.

METHODS

An online self-administered questionnaire was proposed to ≥15-year-olds suffering from acne who spontaneously consulted their dermatologist. To ensure homogeneous assessment of acne severity, the global acne severity scale was applied. Quality of life was assessed via Cardiff Acne Disability Index (CADI), SF12-physical score and SF12-mental score questionnaires. Productivity loss or absenteeism in middle/high school was estimated based on the number of days off work or school over the last 30 days.

RESULTS

Overall, 1048 questionnaires were considered assessable, with 448 (43%) mild acne, 434 (41%) moderate acne and 166 (16%) severe acne. Overall, 755 (72%) participants were in middle/high school, 267 (25%) employed and 26 (3%) with no professional activity. Considering the population by age groups, 68% (n = 716) were ≤20-year-olds and 32% (n = 332) >20-year-olds, with a mean age of 20.26 (SD: 7.43) years. Acne relapses were reported by 44% of respondents. Analyses revealed that poorer quality of life scores was observed in acne relapsers vs. non-relapsers, with a significant difference for CADI scores (P < 0.01) in >20-year-olds. Acne-related absenteeism was recorded in 5.7% of cases. On multivariate analyses, after adjusting for other variables, acne relapse was proven a significant determinant of absenteeism/productivity loss.

CONCLUSION

This real-life study first demonstrated acne relapse rates of 44%, which appeared to be generation-dependent, affecting 39.9% of ≤20-year-olds vs. 53.3% of >20-year-olds. Acne relapses were significantly associated with impaired quality of life and productivity loss/absenteeism.

Sensitive skin: psychological effects and seasonal changes

INTRODUCTION

Sensitive skin is a frequent disorder, but its effects and its variability are unknown.

OBJECTIVES

To investigate the effects of sensitive skin first on quality of life and the psyche, and secondly, on seasonal changes.

METHODS

The French Opinion Poll Institute (IPSOS) conducted two opinion polls in March and July 2004. Samples included, respectively, 1006 and 1001 individuals, from a representative national sample of the French population aged 15 years or older. The polling subjects were interviewed by phone and selected by the quota method (gender, age, occupation of household head, type of geographical area and region). Questions about their perception of their sensitive skin and about potential aggravating factors were asked. Quality of life was assessed using the SF-12 questionnaire and depressive symptoms using the Hospital Anxiety and Depression (HAD) rating scale.

RESULTS

The characteristics of the two samples were strictly similar. Persons with sensitive skin and very sensitive skin were more numerous in summer than in winter. In both surveys, the degree of sensitivity was significantly higher in the female population. Quality of life was worse in people with sensitive or very sensitive skin, above all in its psychological component - the more sensitive the skin, the more the quality of life deteriorated. There was no significant relationship between depressive symptoms and skin sensitivity in the 'very sensitive' or 'sensitive' groups.

CONCLUSION

Our study was the first to show seasonal changes in skin reactivity and to study the psychological impacts of sensitive skin.

Impact of Avène hydrotherapy on the quality of life of atopic and psoriatic patients

BACKGROUND

Atopic dermatitis and psoriasis engender a significant deterioration in patients' quality of life. Although the efficacy of patient management at the Avène hydrotherapy centre has been demonstrated by clinical studies, few data relating to changes in the quality of life following therapeutic management are available. The objective of this study was to evaluate the short- and medium-term effects of hydrotherapy not only on the patients' quality of life, but also on the quality of life of the parents of the treated children.

METHODS

In this 6-month longitudinal observational study, adult (n = 174) and paediatric (n = 212) atopic patients and psoriatic patients (n = 262) had to complete questionnaires relating to the quality of life at the beginning (D0) and after 3 weeks hydrotherapy (W3), and then, 3 (M3) and 6 months (M6) later. The dermatology life quality index (DLQI) and the Short-Form-12 Health Survey (SF-12) generic questionnaire were given to adult patients. The children's dermatological life quality index (CDLQI) was given to paediatric patients, and the SF-12 to their parents.

RESULTS

At D0, the DLQI score was 29.7 ± 20.1 and 26.9 ± 18.9 for atopic and psoriatic patients, respectively. At W3, this score had decreased significantly to reach 16.8 ± 14.9 (P < 0.01) and 10.0 ± 10.5 (P < 0.001) for atopic and psoriatic patients, respectively. The DLQI scores at M3 and M6 were 20.7 ± 16.4 and 23.1 ± 18.8 for atopic patients and 18.8 ± 16.7 and 21.9 ± 19.6 for psoriatic patients and remained significantly lower in comparison with D0 values (P < 0.05).

CONCLUSION

A 3-week course of treatment at the Avène hydrotherapy centre significantly improved the quality of life of patients suffering from skin diseases. This improvement persisted 3 and 6 months after management by hydrotherapy.

Construction and validation of a patient-reported outcome dedicated to chronic venous disorders: SQOR-V (specific quality of life and outcome response - venous)

BACKGROUND

Chronic venous disorders (CVD) have an impact on quality of life (QoL), both physically and psychologically. As of now, several vein specific QoL scales exist, but no patient-reported outcome (PRO) is available which takes into account altogether symptoms, impairment of activities, appearance of the legs and concerns regarding health risk. Since clinical severity and disability are mostly evaluated in severe patients, where the main outcome - namely skin changes - is obvious but rare, the authors considered that a reproducible and clinically relevant survey that could account for specific patients' complaints was needed, particularly for CEAP C0s-C3 patients.

OBJECTIVES

The objective of this study was to build a specific autoquestionnaire and to establish its statistical validity and clinical relevance.

METHODS

A review of existing questionnaires and an analysis of relevant literature were carried out by a committee of experts. The committee then developed a questionnaire of 46 items, with special attention to relevance for venous disorders and patients' main complaints. After construction, the French version was field-tested and results statistically analyzed. In the specific QoL & Outcome Response - Venous (SQOR-V), each item is given a value by the patient and items are grouped in five dimensions. Each dimension is weighed to a maximum value of 20, yielding an overall maximum score of 100.

RESULTS

Two hundred and two questionnaires were analyzed for the initial evaluation and 152 at a second (test-retest). Determination of the Cronbach's alpha coefficient (0.96) and structural analysis demonstrated an excellent internal and structural coherence. Test-retest comparisons confirmed good reproducibility. Comparison with SF-12 and CED-D questionnaires and with CEAP classification groups verified both structural and clinical validity.

CONCLUSIONS

This study demonstrates QoL impairment in patients suffering from chronic venous disorders (CVD). It also verifies the statistical validity of the SQOR-V questionnaire. More studies are needed to demonstrate the improvement in specificity and accuracy this questionnaire provides compared to existing vein-specific QoL scales, and to determine its ability to assess efficacy of any kind of treatment at any stage of the disease. Provided adequate acknowledgment of its authors, the use of SQOR-V is free. An English version is available, currently pending validation.

Importance of out-of-pocket costs for adult patients with atopic dermatitis in France

BACKGROUND

Currently, few studies investigated the economic burden of atopic dermatitis (AD) in adult patients and specifically the estimation of out-of-pocket costs. Patients with skin disorders primarily use comfort care to ease dryness, itch or pain, and the costs of comfort care are not subject to any reimbursement from mandatory or complementary insurance.

OBJECTIVE

The purpose of this study was to measure the medical and non-medical expenses paid by the patient.

METHODS

Eczema Cohort Longitudinal Adults was a non-interventional study that aimed to assess the burden of AD in terms of quality of life and financial consequences. A self-assessment questionnaire was distributed to adult patients who were cared in four French hospitals. Patients were asked to list the resources consumed for the treatment of AD during the last 12 months and to estimate the corresponding amount of money they had to pay out of their own pockets. The severity of AD was subjected to a stratification based on the PO-SCORAD score.

RESULTS

A total of 1024 patients answered the questionnaire: 31.9% with severe AD, 40.4% with moderate AD and 27.6% with mild AD. The mean annual out-of-pocket cost was €462.1 for severe AD and €247.4 for moderate AD. Emollients were the most commonly used product: 74.4% for an average out-of-pocket cost of €151.4. The out-of-pocket costs increased significantly with the severity: 27% of patients with severe AD declared having bought specially textured clothes, while 19% of patients with moderate AD reported the same. The corresponding mean out-of-pocket costs were €162 and €91, respectively.

CONCLUSION

The amount of out-of-pocket costs for patients with AD for essential medical and non-medical expenses is relatively high, compared to the average out-of-pocket cost for French households. Integration of these essential resources into the list of reimbursed products and services appears necessary for a better coverage of AD.

Atopic Dermatitis Burden Scale for Adults: Development and Validation of a New Assessment Tool

Atopic dermatitis (AD) occurs in approximately 2-3% of adults. The aim of this study was to develop and validate the self-administered Atopic Dermatitis Burden Scale for Adults (ABS-A). Patients were enrolled consecutively from those attending the Station Thermale Avène for a diagnosis of AD. ABS-A was developed using standard methodology, and consisted of 3 phases: exploratory, development, and validation. Internal consistency (Cronbach's α), concurrent validity (Spearman's correlation between ABS-A, SF-12 and Dermatology Life Quality Index [DLQI)]), and discriminant validity, were analysed. A total of 128 adults (68.8% females) completed the ABS-A, consisting of 18 items grouped into 4 domains. ABS-A showed good internal coherence (Cronbach's α, 0.89) and was correlated with both SF-12 components [r = -0.36, p < 0.0001 (Physical); r = -0.52, p < 0.0001 (Mental)] and DLQI (r = 0.78; p < 0.0001). The ABS-A score varied significantly according to AD severity. To our knowledge, ABS-A is the first specific tool for assessing AD burden in adult patients.

Multidisciplinary consensus recommendations from a European network for the diagnosis and practical management of patients with incontinentia pigmenti

BACKGROUND

Incontinentia pigmenti (IP) is a rare multisystemic X-linked dominant genetic disorder characterized by highly diagnostic skin lesions. The disease can be misdiagnosed in infants, and complications affecting the eyes and/or the brain can be severe. Our objective was to highlight the urgency of an appropriate diagnosis and management strategy, as soon as the first symptoms appear, and the need for a well-codified monitoring strategy for each child.

METHODS

An in-depth literature review using a large number of databases was conducted. The selection criteria for articles were literature review articles on the disease, case series and retrospective studies based on the disease, clinical studies (randomized or not) on treatment, articles discussing patient care and management (treatment, diagnosis, care pathways), and recommendations. The research period was from 2000 until 2018. A group of multidisciplinary experts in IP management was involved, issued from different healthcare providers of the European Network for Rare Skin Diseases (ERN-Skin). The final recommendations have been submitted to two patient representative associations and to a general practitioner and a neonatal specialist prior to their finalization.

RESULTS AND CONCLUSION

The diagnosis of IP must be promptly performed to detect potential extracutaneous manifestations, thus allowing the timely implementation of specific therapeutic and monitoring strategies. Eye involvement can be a therapeutic urgency, and central nervous system (CNS) involvement requires a very rigorous long-term follow-up. Assessments and patient support should take into account the possible co-occurrence of various symptoms (including motor, visual and cognitive symptoms).