Bacteriological aspects of Darier’s disease

Background There are no established data on the prevalence of bacterial colonization of lesional skin, nares and perineum in Darier’s disease (DD), or its contribution to the clinical manifestations of the disease. Objective To determine the prevalence of bacterial colonization of lesional skin and Staphylococcus aureus (S. aureus) in nares and perineum in 75 patients with DD, the association of these parameters with disease and patient characteristics, and the features of the bacterial skin infection in this group. Methods Medical interviews and physical examinations were performed. Bacteria were isolated from swabs taken from lesional skin, nares and perineum. Results S. aureus was isolated in 68%, 47% and 22% of lesional skin, nares and perineum cultures respectively. Subjects with positive S. aureus culture from lesional skin and/or nares had a statistically significant higher percentage of skin area affected and a more severe disease than patients with negative culture. Thirty of the 75 patients (40%) recalled bacterial skin infection, most often on the chest. Conclusions Patients with DD have high prevalence of S. aureus colonization in lesional skin and nares, with a correlation between disease severity and extent of the colonization. Further studies examining the consequences of S. aureus eradication in those sites may establish the need for S. aureus lesional skin and nares colonization screening and eradication as part of the treatment of DD exacerbations.     

Analysis of three outcome measures in moderate to severe psoriasis: a registry-based study of 2450 patients

Summary Background As moderate to severe psoriasis is a systemic disease with large effects on health‐related quality of life, generic measures that include overall health, not only skin involvement, are necessary. Knowledge about the relationship between the generic preference‐based EuroQol 5D (EQ‐5D) and dermatology‐specific measures in psoriasis is limited. Objectives To analyse EQ‐5D, the Dermatology Life Quality Index (DLQI) and the Psoriasis Area and Severity Index (PASI) in patients with moderate to severe psoriasis in Swedish clinical practice by demographic characteristics, to compare EQ‐5D among patients vs. Swedish population values, and to analyse the relationships between EQ‐5D, DLQI and PASI. Methods This observational cohort study was based on PsoReg, the Swedish National Registry for Systemic Treatment of Psoriasis. EQ‐5D was compared among patients with psoriasis vs. a defined general population in Sweden, retrieved from a previous study. Relationships between measures were examined with correlation tests and regression analysis. Results In total, 2450 patients (1479 men and 971 women) were included. Median EQ‐5D, DLQI and PASI scores were 0·769, 4 and 4·7, respectively. Patients with psoriasis had a significantly lower EQ‐5D compared with the defined general population. EQ‐5D correlated moderately with DLQI (?0·55) and weakly with PASI (?0·25) (P < 0·001). Conclusions When assessing psoriasis treatments and making decisions about treatment guidelines and resource allocation, EQ‐5D, DLQI and PASI provide a useful set of complementary tools, answering to different needs. If EQ‐5D is not included in the original trial the second‐best option in cost‐effectiveness studies is to use mapping between DLQI and EQ‐5D.     

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.     

Oral finasteride improved the quality of life of androgenetic alopecia patients

Although androgenetic alopecia (AGA) is not a systemic disease, some patients suffer from anxiety about the progression of their condition. This study was conducted in order to ascertain whether treatment by oral finasteride can improve the quality of life (QOL) of these patients. Twenty‐seven male AGA patients aged 19–76 years (average, 33.8) answered the Visual Analog Scale (VAS), Dermatology Life Quality Index (DLQI), WHO/QOL‐26 and State–Trait Anxiety Inventory (STAI) questionnaires before and after the administration of finasteride (1 mg/day) for 6 months. Patients assessed by physicians as “excellent” or “good” were defined as “high responders”; those assessed as “moderate” or “no change” were “low responders”. The changes in QOL before and after the treatment were statistically analyzed, and the improved value of each QOL index of the high responders and low responders from baseline were compared. There was a statistical difference in the VAS (P < 0.0001) and DLQI (P < 0.01) indices before and after the administration of finasteride. No significant changes occurred in the WHO/QOL‐26 and STAI indices. Comparison of the high responders (11 cases) and low responders (16 cases) revealed no statistical difference in the improvement of VAS and DLQI scores. Oral finasteride improves the QOL of these patients, and VAS and DLQI are useful for the evaluation of patients’ QOL because of the high sensitivity of these tests. However, oral finasteride did not alleviate the patients’ anxiety nor did its efficacy correlate with the level of reported anxiety.     

Self-reported health outcomes in patients with psoriasis and psoriatic arthritis randomized to two etanercept regimens

Background Moderate/severe psoriasis combined with psoriatic arthritis (PsA) impairs health‐related quality of life (QoL). Etanercept, a fully human tumour necrosis factor‐α receptor fusion protein, is approved for treatment of both diseases. Objective To compare patient‐reported health outcomes (PROs) of two etanercept regimens in patients with moderate/severe psoriasis and PsA. Methods In this randomized, double‐blind, multicenter study, participants received etanercept 50 mg twice weekly (BIW; n = 379) or 50 mg weekly (QW; n = 373) for 12 weeks and open‐label etanercept 50 mg QW for 12 additional weeks. PROs included: the EuroQOL‐5D (EQ‐5D), which measures general health status and consists of the utility index measuring five dimensions of health, and a visual analogue scale (VAS) allowing patients to assess health status; the Dermatology Life Quality Index (DLQI), which measures the impact of skin disease on QoL; the Health Assessment Questionnaire‐Disability Index (HAQ‐DI), an assessment of physical function; the Hospital Anxiety and Depression Scale (HADS), which screens for anxiety and depression symptoms; and individual questions on general health, disease activity, fatigue, itching, joint pain and morning stiffness. Results At baseline, patients reported QoL worse than that seen in many chronic medical conditions. Significant within‐group improvements in each PRO occurred from baseline to Week 12 (P < 0.001) in both groups and were maintained at Week 24; DLQI, EQ‐5D, HAQ‐DI and self assessments improved significantly (P < 0.001) from baseline as early as Week 3. At Week 12, but not Week 24, improvement in DLQI, itching and psoriasis activity was greater in the BIW arm (P ≤ 0.004). Improvements in other PROs were always similar between groups. Conclusions Greater improvements in PROs specific to skin disorders were seen with etanercept BIW than QW at Week 12, but not at Week 24. Both etanercept regimens led to sustained PRO improvements, starting as early as Week 3.     

Effect of a family history of psoriasis and age on comorbidities and quality of life in patients with moderate to severe psoriasis: Results from the ARIZONA study

Psoriasis is a chronic inflammatory skin disease whose clinical characteristics vary from patient to patient. We aimed to analyze how comorbidities and quality of life (QoL, as per the Dermatology Life Quality Index [DLQI]) may be affected by a family history of psoriasis and by age. The ARIZONA study was a multicenter, cross‐sectional study in 1022 adult patients diagnosed with moderate to severe psoriasis at least 6 months prior to inclusion. The severity of psoriasis and the proportion of patients with comorbidities were not affected by the presence of a family history. The regression analysis revealed that the presence of a family history of psoriasis was associated with the effect on the patient's QoL (P = 0.002), regardless of disease severity. The mean DLQI total score varied significantly across age groups (5.1 ± 5.3 for the 18–30‐year group, 5.7 ± 6.5 for the 31–60‐year group and 3.8 ± 5.1 for the >60‐year group; P = 0.001). In conclusion, the presence of a family history of psoriasis appears to disrupt QoL in patients with moderate to severe psoriasis, but it hardly affected the prevalence of comorbid conditions. The effect of age on QoL was particularly noticeable in younger patients, highlighting its negative impact. As expected, older patients appeared to be burdened with a higher number of comorbidities than their younger counterparts.     

Patient‐reported health outcomes in patients with non‐melanoma skin cancer and actinic keratosis: results from a large‐scale observational study analysing effects of diagnoses and disease progression

Background

Non‐melanoma skin cancer (NMSC) and actinic keratosis (AK) are very common among fair‐skinned individuals. A disease continuum from AK to squamous cell carcinoma (SCC) has been frequently postulated. AK and NMSC may influence quality of life (QL) of patients, and it can be suspected that disease progression entails a QL reduction. The purpose of this study was to document QL in patients with NMSC and AK using the health‐outcome questionnaire EQ‐5D‐5L.

Methods

The study was designed as a non‐interventional, prospective, cross‐sectional study. Patients with AK, SCC, basal cell carcinoma (BCC) or multiple diagnoses were enrolled in this study in 29 dermatological centres across Germany. Patients were asked to complete the EQ‐5D‐5L (compromising EQ Index and EQ VAS), and the dermatologists provided diagnosis, disease history and treatment data.

Results

A total of 1184 patients were enrolled and diagnosed as follows: 73% AK, 49% BCC and 17% SCC. 66% had a single diagnosis, 28% two different diagnoses and 6% three different diagnoses. QL was strongly associated with patients’ diagnosis. Patients with a single AK diagnosis had significantly higher mean EQ VAS (78) than patients with BCC (74), SCC (72), and BCC plus SCC (69), P < 0.050. When the effects of disease progression were calculated, patients with AK plus SCC reported significantly less mean EQ VAS (71) than patients with a single AK diagnosis (78), P < 0.011.

Conclusions

While rarely being imminently life‐threatening, NMSC and AK have an impact on QL as quantified by the EQ‐5D‐5L. This impact is associated with diagnosis (AK vs. NMSC) and clinical progression (AK vs. AK plus SCC). Both lead to a clear decline in QL. This shows that disease progression is perceived and judged as detrimental by patients and that AK and NMSC should be diligently treated to preserve and restore QL.     

Evaluation of the correlation between severity of acquired idiopathic generalized anhidrosis and quality of life scores

Symptoms of acquired idiopathic generalized anhidrosis (AIGA) include heat retention and/or heat stroke due to the effects of the disorder on the perspiration ability of the whole body under thermal environmental changes or exercise. Additionally, cholinergic urticaria can also occur in these patients. AIGA has a major impact on everyday life. However, the effects of AIGA severity on the quality of life (QOL) of the patients have not been sufficiently defined. The objective of this study was to evaluate the correlation between AIGA severity and QOL. Study subjects comprised 44 patients diagnosed with AIGA at three registered institutions. AIGA severity assessment was conducted and the Dermatology Life Quality Index (DLQI) questionnaire was administered. Correlations between AIGA severity and DLQI, as well as severity by DLQI subscale, were assessed. We found a positive correlation between total score of AIGA severity criteria and DLQI total scores (R = 0.720, P = 0.001). The impairment increased with the increase in AIGA severity (P < 0.01). In relation to the DLQI subscales, leisure (social and sporting activities) impairment was significantly higher for patients with severe AIGA than those with mild AIGA (P < 0.01). Comparing QOL for AIGA patients with that of patients with other dermatological disorders, it is possible that QOL impairment for AIGA patients is as severe as that for patients with atopic dermatitis. AIGA severity and DLQI are correlated and AIGA patients experience disruption of everyday life more broadly than conventionally perceived.     

Disease severity and quality of life in a follow-up study of patients with occupational contact dermatitis

Background Few studies have investigated how occupational contact dermatitis and its severity affect patients' quality of life (QoL). Objectives To investigate the impact of occupational contact dermatitis and its severity on patients' QoL, and to examine the association between different QoL measures. Method Patients previously diagnosed with occupational contact dermatitis completed the Short Form Health Survey (SF‐36) and Dermatology Life Quality Index (DLQI). Disease severity was rated both by the patient and by the physician. Results Of a possible 725, a total of 119 patients (16.4%) were included in the study, and, at follow‐up, just over 21% had normal skin and 18.3% had progressed to persistent dermatitis. The SF‐36 median physical component summary score was 52 [interquartile range (IQR): 43–56] and the mental component summary median score was 51 (IQR: 44–57). The correlation between patient‐rated and physician‐rated disease severity was moderate (r = 0.708, p < 0.00001). The correlation between the disease severity measures and DLQI was moderate, whereas the SF‐36 correlated poorly with both the DLQI and disease severity measures. Conclusions QoL was generally reduced in this group of patients with occupational contact dermatitis, with some correlation between severity and DLQI. The DLQI was a more sensitive measurement of QoL than the SF‐36 in this patient population. Incorporating disease severity rating with a QoL questionnaire is valuable in occupational contact dermatitis and is recommended.     

Willingness-to-pay and quality of life in patients with vitiligo

Background Vitiligo is a chronic pigmentary disorder of the skin, affecting 1–2% of the general population. Although not life threatening, vitiligo may considerably influence patients’ health‐related quality of life (QoL) and psychological well‐being. Willingness‐to‐pay (WTP) is a construct reflecting disease burden and QoL reduction which has not yet been used in vitiligo. Objectives To assess the WTP and the QoL of patients with vitiligo. Methods Patients with vitiligo were included in a nationwide German postal survey. WTP was assessed by two standardized items, and QoL was evaluated using the Dermatology Life Quality Index (DLQI) and the EuroQol (EQ‐5D) questionnaire. QoL data were compared with n = 1511 patients from a national survey on psoriasis. Results The questionnaire was completed by 1023 patients (71·5% women, mean age 44·4 years, mean disease duration 20·3 years) with vitiligo. The mean DLQI was 7·0 (7·5 in women, 5·5 in men) compared with 8·6 in psoriasis. Of the patients with vitiligo, 24·6% had a DLQI > 10 which indicates severe QoL reductions, compared with 34·1% in patients with psoriasis. The highest mean DLQI value was observed in the patient group aged 20–29 years. EQ‐5D mean score was 83·6 compared with 75·3 in psoriasis. Of the patients with vitiligo, 32·9% would pay more than 5000 Euro in order to achieve complete disease remission. WTP was highest among middle‐aged patients (30–60 years). There was a significant correlation between DLQI scores and WTP (χ² = 65·43, P < 0·001). Moreover, WTP significantly correlated with duration of disease, and with body surface area affected (P < 0·001). Conclusions Vitiligo causes substantial disease burden as reflected by QoL impairment and high WTP, especially in women. These results should draw the attention of physicians to this disease, as appropriate education and treatment are likely to improve the QoL of patients with vitiligo and may support patients’ compliance and empowerment.     

Quality of Life Assessment in Korean Patients with Pemphigus

Background

Measuring the quality of life (QOL) is important in the evaluation of nonclinical aspects of diseases, for the discovery of functional and psychological limitations, and in choosing treatment in the initial phase of the disease. Pemphigus is a potentially fatal autoimmune bullous disease caused by autoantibodies against desmogleins (cadherin family proteins in desmosomes). Thus far, there has been no published study on QOL in Korean patients with pemphigus.

Objective

To study the impact of pemphigus on the QOL in a large number of Korean patients.

Methods

Sixty-six patients enrolled at the Gangnam Severance Hospital from March 2012 to March 2013 were assessed for QOL by using the Dermatology Life Quality Index (DLQI), and for anxiety and depression by using the General Health Questionnaire (GHQ). Spearman''s rank-order correlation, t-test, and ANOVA were used to identify the relations between the DLQI score and other clinical variables.

Results

Pemphigus vulgaris and pemphigus foliaceus significantly reduced the QOL of patients. The average DLQI score for all patients was 10.18. The mean DLQI score was 13.45 in patients in the active state and 5.15 in the patients in the remission state. The DLQI score highly correlated with disease severity, titer of anti-desmoglein 1 in enzyme-linked immunosorbent assay, and the corticosteroid dose. However, the QOL was not affected by sex, age, subtype of pemphigus, duration of disease, or comorbidities. Forty-two percent of the patients showed a positive result in the GHQ, reflecting probable minor psychiatric nonpsychotic conditions, and the GHQ score positively correlated to the DLQI score.

Conclusion

Pemphigus significantly impairs the QOL of patients. The QOL of Korean pemphigus patients significantly correlates with clinical severity. Therefore, considerable attention should be paid to the patients'' QOL and psychological states as well as clinical status.     

Impact of ustekinumab on health‐related quality of life and sexual difficulties associated with psoriasis: results from two phase III clinical trials

Background Ustekinumab, a human anti‐interleukin‐12/23 monoclonal antibody, has been shown to effectively treat moderate‐to‐severe psoriasis which significantly affects health‐related quality of life (HRQoL), including patients’ sexual lives. Objectives The aim of this study was to determine if sexual difficulties associated with psoriasis are related to disease severity and whether sexual difficulties improve with skin disease during ustekinumab treatment. Methods  In phase III PHOENIX 1 and 2 trials, psoriasis patients were randomized to ustekinumab (n = 1334) at weeks 0 and 4 and q12 weeks thereafter or placebo (n = 662) at weeks 0 and 4 with crossover to ustekinumab at week 12. Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) were used to assess psoriasis severity and patient‐reported HRQoL respectively. Based on DLQI Question #9, impaired sexual function was defined as ‘very much’ or ‘a lot’ of sexual difficulties. Results At baseline, mean DLQI was 12.0, indicating a very large negative effect on patients’ lives. Impaired sexual function was reported by 22.6% (women = 27.1%; men = 20.8%) and was significantly associated with increased psoriasis severity. At week 12, ustekinumab‐treated patients had a greater mean improvement in DLQI (?9.13 vs. ?0.53 with placebo, P < 0.001) and the proportion of patients with impaired sexual function decreased from 22.4% to 2.7% compared with no change with placebo (P < 0.001). Patients with greater PASI improvement experienced a greater reduction of sexual difficulties due to psoriasis. A similar pattern of improved sexual function was observed at weeks 24–28 in placebo crossover patients. Conclusions Ustekinumab treatment is associated with significant improvement in HRQoL and sexual difficulties due to psoriasis.     

Costs and quality of life in patients with moderate to severe plaque‐type psoriasis in Germany: A multi‐center study

Background: This study evaluated costs, disease severity and health‐related quality of life (QoL) in patients with moderate to severe plaque‐type psoriasis. Patients and Methods: Patients with a ‘psoriasis area and severity index’ (PASI) > 12 and/or a body surface area (BSA) > 10 were enrolled in dermatological practices and hospital outpatient departments (n = 184) and the total costs of illness generated during the last 12 months were retrospectively calculated. QoL was assessed using the SF‐36 and the DLQI. Participants were stratified into three subgroups according to the treatment received during the 1 year documentation period; a) patients without and b) patients with phototherapy or standard systemic therapy, and c) patients who had failed, were intolerant or had contraindications to at least two standard systemic therapies. The study was performed before biologics became available for the treatment of psoriasis in Germany. Results: Included patients had severe skin symptoms (mean PASI 18.2) and a highly impaired QoL (mean DLQI 10.6). Total annual costs amounted to € 6,709. Patients belonging to subgroup C had the most severe skin symptoms (mean PASI 22.2), the lowest QoL (mean DLQI 12.6), the highest hospitalization rate and largest loss of productivity.These patients produced the highest total costs of 8.831 €/y. Conclusions: Patients who cannot (or can no longer) be adequately managed with standard treatments are characterized by high disease activity, high costs and reduced QoL. Improved treatment options particularly for these patients are medically necessary and appear economically sensible.     

Health‐related quality of life and healthcare resource use in European patients with plaque psoriasis: an association independent of observed disease severity

Background. Healthcare resource utilization (HCRU) by patients with plaque psoriasis increases with skin lesion severity; however, the relationship between patient quality of life (QoL), which correlates only weakly with clinical severity, and HCRU is less understood. Aim. To evaluate the relationship between QoL, HCRU and employment in European patients with plaque psoriasis. Methods. Patients (n = 897) were recruited in five European countries. Data were analysed by group according to the Dermatology Life Quality Index (DLQI): ≤ 10 (better QoL) and > 10 (worse QoL). Results. Mean numbers of primary dermatologist visits and hospitalizations were significantly higher for patients with DLQI > 10. Likewise, significantly more patients with worse QoL reported employment disadvantages. Significant differences were maintained even after adjusting for age, gender and body surface area affected. Conclusions. In patients with plaque psoriasis, poorer QoL is associated with increased HCRU, independent of clinical severity. This suggests that QoL, in addition to skin lesion severity, should be considered in predicting the economic burden of disease.     

Atopic dermatitis is associated with a decrement in health-related quality of life

BACKGROUND: Although atopic dermatitis is a chronic skin disease that can have a major impact on a patient's life, the burden of illness associated with this condition has not been well characterized. OBJECTIVE: To determine the health-related quality of life (HRQL) of patients with atopic dermatitis by disease severity and to compare it with that of the general public and of patients suffering from other chronic illnesses or skin disorders. METHODS: Two hundred and thirty-nine atopic dermatitis patients aged 4-70 years completed the Medical Outcomes Study Short Form-36 Health Survey (SF-36) and the Dermatology Life Quality Index (DLQI) or the Children's Dermatology Life Quality Index. These HRQL scores were compared by self-reported patient disease severity ratings. Health-related quality of life scores were compared with those of the general population and those of patients with other chronic conditions (clinical depression, hypertension, type 2 diabetes) or skin disease (psoriasis). Dermatology Life Quality Index scores were also compared with those of other skin diseases (such as psoriasis, Darier's disease, and Hailey-Hailey disease). RESULTS: Patients with atopic dermatitis had inferior scores on the SF-36 vitality, social functioning, and mental health subscales compared with individuals in the general population. In seven of eight subscales, individuals reporting more severe disease had inferior DLQI and SF-36 scores. Patients with atopic dermatitis had inferior mental health scores compared with those with diabetes or hypertension, and inferior social functioning scores compared with patients with hypertension. When compared with a psoriasis cohort, patients with atopic dermatitis had inferior scores in the role-physical, vitality, social functioning, role-emotional, and mental health SF-36 domains. Patients with atopic dermatitis had similar DLQI scores to patients with other chronic dermatologic diseases. CONCLUSIONS: These results demonstrate that atopic dermatitis has an impact on HRQL, particularly in social functioning and psychological wellbeing. Patient-assessed severity of atopic dermatitis correlates with HRQL decrements, indicating greater HRQL impact with greater disease severity. Atopic dermatitis has as large an impact on HRQL as several chronic conditions and other dermatologic conditions.     

Dowling–Degos disease co‐presenting with Darier disease

We present a case of a patient with long‐standing hyperpigmented macules and erythematous papules over his chest, abdomen, back and arms, suggestive of Dowling‐Degos disease (DDD). In addition, there were hyperkeratotic papules, alternating red and white nail‐bed discolouration, and V‐shaped nail notching consistent with Darier disease (DD). Histology showed findings consistent with DDD and DD on separate specimens. The lack of acantholysis in areas of filiform hyperpigmented rete ridges ruled out Galli–Galli disease (GGD). DDD results from mutations in the genes encoding keratin 5 (KRT5), protein O‐glucosyltransferase 1 (POGLUT1) or protein O‐fucosyltransferase 1 (POFUT1), while DD results from mutations in the ATP2A2 gene. Both genes are present on chromosome 12. In this case, the patient presented with features of both DDD and DD, which suggests that either a cooperating mutation or a mutation in an unrelated gene locus may underlie the findings in this patient.     

Patient–physician consensus on quality of life in dermatology

This study was undertaken in order to establish the correlation between physician-assessed and patient self-reported quality of life (QOL) when using a proposed Dermatology Life Quality Index (DLQI) in a random Sample of 51 dermatological out-patients and in-patients. A substantial correlation was found between physician scores and DLQI (r²= 0·306, P < 0·001), suggesting that the DLQI can be used to assess QOL and general morbidity. Comparison of the observed and ideal patient–physician consensus suggests that patients with relatively benign or quiescent disease may overestimate disease impact, while dermatological patients with more malign or aggressive disease may underestimate it compared with the physician estimate.     

Effect on quality of life in patients with pityriasis rosea: Is it associated with rash severity?

BACKGROUND: It is unknown how the quality of life (QOL) is affected in patients with pityriasis rosea (PR), and whether it is related to rash severity. METHODS: We constructed a valid and reliable Cantonese version of the Dermatology Life Quality Index (DLQI). We recruited patients with PR, with atopic dermatitis and with acne vulgaris, and controls of the same sex and comparable age. We applied the DLQI and the Pityriasis Rosea Severity Score (PRSS) to the patients with PR, the DLQI and the SCORing Atopic Dermatitis Index (SCORAD) to the controls with atopic dermatitis, and the DLQI and the Leeds Acne Grading System (LAGS) to the controls with acne vulgaris. RESULTS: Total DLQI scores of the 22 patients with PR (mean: 6.36, SD: 5.79) were significantly lower than those of the 22 controls with atopic dermatitis (mean: 12.00, SD: 5.38) (P = 0.021), but were insignificantly different from those of the 22 controls with acne vulgaris (mean: 6.86, SD: 4.53) (P = 0.57). Correlation between the total DLQI and PRSS scores was weak (gamma(s) = +0.19) and insignificant (P = 0.40). All six DLQI parameters were insignificantly correlated with the PRSS scores. In contrast, the total DLQI scores and most of the DLQI parameters were strongly correlated with the rash severity scores for the control subjects. Significantly more patients with PR have concerns regarding disease etiology and infectivity. CONCLUSIONS: The QOL of the patients with PR was significantly less affected than that for the patients with atopic dermatitis, but was insignificantly different from the patients with acne vulgaris. Unlike atopic dermatitis and acne vulgaris, the effects on the QOL in PR are insignificantly correlated with rash severity. These results bear important implications on clinical management.     

Treatment satisfaction,willingness to pay and quality of life in Japanese patients with psoriasis

There is a range of psoriasis treatments available, from topical applications to biologic therapy, with corresponding cost variations. The efficacy of each treatment is usually evaluated by objective measures such as the Psoriasis Area and Severity Index (PASI) or subjective measures such as the Dermatology Life Quality Index (DLQI). However, the social and economic impacts of psoriasis, including cost‐effectiveness, have not been assessed in Japan. The EuroQol 5‐Dimension (EQ‐5D) is a generic instrument used worldwide to calculate quality‐adjusted life years, on which calculations of treatment cost‐effectiveness are based. We conducted a pilot study to determine the cost‐effectiveness of psoriasis treatment in Japan. We administered a questionnaire to 133 patients with psoriasis (105 men and 28 women) who visited four university hospitals in Fukuoka Prefecture. The questionnaire covered medical costs, satisfaction and willingness to pay (WTP), and we investigated the relationships between these items. PASI was evaluated by physicians. More participants indicated satisfaction with treatment in the group paying less than ¥5000/month. WTP, PASI and EQ‐5D showed little correlation. However, the DLQI and EQ‐5D showed a moderate correlation (r = 0.472). WTP seemed more dependent on participants' economic backgrounds. We found that it was difficult to reflect the PASI with the EQ‐5D. However, the DLQI may be used to estimate the cost–benefit relationship in patients with psoriasis. This is the first study to evaluate the EQ‐5D in patients with psoriasis in Japan.     

Treatment of Darier disease with oral alitretinoin

Darier disease (DD) is an autosomal dominant skin disease. Treatment is often difficult and unsatisfactory because of the chronic nature of the condition and the irritant potential of various therapeutic agents. Systemic vitamin A derivatives such as acitretin and isotretinoin are the treatment of choice, but their use is often limited by class‐specific side‐effects. Alitretinoin (9‐cis‐retinoic acid), has antiproliferative and anti‐inflammatory potential, and is licensed for the systemic treatment of chronic hand eczema in a number of countries. Unlike acitretin, alitrenoin requires contraception in women of childbearing age to be extended for only 1 month after the end of treatment. There is evidence that alitretinoin might be a well‐tolerated alternative for the systemic treatment of various retinoid‐responsive skin diseases. We present two cases of women with refractory DD successfully treated with alitretinoin without marked side‐effects, who both obtained near‐complete remission of their skin lesions.