Thyroid autoimmunity in children and adolescents with alopecia areata

BACKGROUND: Autoimmune thyroiditis (AT) is often associated with alopecia areata (AA) in children and adolescents. METHODS: Forty-six children (23 girls and 23 boys), with a mean age of 9.9 +/- 3.38 years (2.24-17.5 years), were included in a study to assess thyroid function and thyroid autoantibody formation in AA. The size and function of the thyroid gland [triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), and thyrotropin releasing hormone (TRH) test; fluoroimmunologic assay (FIA), Delfia], antithyroglobulin (TAT) and antimicrosomal (MAT) antibodies (microhemagglutination method), thyroid gland ultrasound, and indices of cellular and humoral immunity were assessed. RESULTS: Thyromegaly was found in 29 children (63%). Increased basal TSH levels were present in six of the 29 (13.3%) and hypothyroid-type stimulated secretion (TRH test) in two (out of 12). TAT was increased in 17 (39.5%) and MAT in 14 (33.3%) children with AA. Thyroid ultrasound examination was suggestive of AT in 13 (34.2%) and typical of AT in five (13.2%) children. CONCLUSIONS: We diagnosed AT in 22 of 46 children with AA (47.8%). The immune studies revealed increased activated T lymphocytes. We recommend that thyroid gland size and function and antibody formation be examined at the diagnosis of AA and twice a year thereafter.     

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

Background:Androgenetic alopecia is one of the most common forms of hair loss. Alopecia areata is a common autoimmune disorder which causes hair loss. It has been previously reported that both alopecia disorders can have negative effects on quality of life. However, only a few studies have compared the effects of the two disorders.Objective:The aim is to show the impact of alopecia on patients’ quality of life and compare patients with androgenetic alopecia and alopecia areata.Methods:82 androgenetic alopecia and 56 alopecia areata patients were recruited. All patients were evaluated with the Hairdex scale and dermatology quality of life instrument in Turkish (TQL), and the scores were statistically compared according to age, sex, employment and education status, and severity of illness in the two groups. Also, female patients were statistically evaluated according to whether they wore headscarves.Results:Androgenetic alopecia patients had significantly higher total Hairdex scores in terms of emotions, functioning, and symptoms, while self-confidence was significantly higher in the alopecia areata patients. No significant differences were found in stigmatization or TQL scores between groups. The Hairdex scale and TQL scores did not show differences between the groups in terms of wearing headscarves.Study limitations:The validity and reliability of the Hairdex index have not been established in Turkey.Conclusions:Based on the Hairdex scale, our findings revealed that androgenetic alopecia patients are more affected by their disorder than alopecia areata patients. Although androgenetic alopecia is common and neither life-threatening nor painful, it is a stressful disorder with increased need for improvement in the patient’s quality of life.     

雄激素性脱发和斑秃患者生活质量及抑郁情况调查分析

目的 调查脱发患者生活质量与抑郁状态及其影响因素,为改善其生活质量采取相应临床对策提供依据.方法 采用皮肤病生活质量指数(DLQI)和流行病学研究中心抑郁量表(CES-D),对雄激素性脱发和斑秃脱发患者237例进行问卷调查,评估其生活质量与抑郁状况,使用方差分析和logistic回归分析其影响因素.结果 237例脱发患者收集到有效答卷218份,218例脱发患者DLQI量表均分为9.1±5.4,总体上脱发对生活质量的影响为中度影响,重度及以上影响者占38.07%.CES-D量表均分为14.8±9.9,有抑郁倾向者占37.61%.DLQI得分和CES-D得分呈正相关(r=0.29,P<0.01).单因素方差分析结果显示,不同年龄、性别、文化程度及就诊次数对DLQI得分差异无统计学意义.多因素logistic回归分析显示,脱发患者发生抑郁倾向的危险因素有:就诊次数(OR=1.81,95%CI:1.21~2.69)和DLQI影响程度(OR=1.08,95%CI:1.03~1.13).结论 脱发不仅影响患者生活质量,而且给患者心理带来负面影响.     

Psychiatric symptoms and health-related quality of life in children and adolescents with psoriasis

Information about the relationship between psoriasis and psychiatric morbidity and quality of life in children and adolescents is limited. We aimed to examine the symptoms of depression and anxiety and health-related quality of life levels in children and adolescents with psoriasis. Forty-eight outpatients with psoriasis aged 8 to 18 years are included in this study. Child Depression Inventory (CDI), State-Trait Anxiety Inventories for Children (STAI-C) and Pediatric Quality of Life Inventory Parent and Child Versions (PedQL-P and C) were applied to both patient and control groups. Psoriasis symptom severity was measured by the Psoriasis Area Severity Index (PASI). Both study and control groups were divided into two age groups, child (8-12 yrs) and adolescent (13-18 yrs), to exclude the effect of puberty on psychological condition. The mean CDI score was higher, and PedQL-C psychosocial and total scores were lower in the children compared with controls. Duration of psoriasis had an increasing effect on physical-health and total scores of PedQL-C in the child group and all PedQL-C scores in the entire sample. Psoriasis severity showed a negative correlation with psychosocial and total scores of PedQL-P in the adolescent group and PedQL-P physical-health scores in the entire sample. Psoriasis is related to depression and impaired quality of life in children. The depressive symptoms in children with psoriasis should not be overlooked and psychiatric assessment of these children should be provided.     

Disease‐related behavioral patterns and experiences affect quality of life in children and adolescents with vitiligo

Background Vitiligo is an acquired, non‐contagious depigmentation disorder involving a patchy loss of skin color. It often leads to stigmatization, embarrassment, and reduced quality of life (QoL) in adult patients. Little is known about children’s reactions. Objectives This study aimed to explore disease‐related QoL and experiences in a multinational group of children and adolescents. Methods Quality of life, disease‐related experiences and behavior, and sociodemographic data were examined in 24 boys and 50 girls (age range: 7–17 years) using the Children’s Dermatology Life Quality Index (CDLQI) and additional questions. Eighteen children without skin disorders served as age‐, sex‐ and skin color‐matched controls. Results The mean disease duration was 3.5 years. The most common sites of onset were the trunk, legs, and head and neck. Overall, 35.1% of the 74 subjects reported a positive family history, 91.9% had visited a doctor, and 75.7% had received treatment. Two‐thirds (66.2%) were distressed by their vitiligo, and 93.2% had experienced low‐key stigmatization, 44.6% nasty comments, and 21.7% bullying. A total of 24.4% had concealed their disease, and 29.7% had avoided situations because of vitiligo. Frequency of stigmatization influenced avoidant behavior. Parents, particularly mothers, and friends were important sources of support. Patients and controls had similar numbers of friends and leisure time activities. The mean CDLQI score of the group was low (2.8). Higher CDLQI scores were related to stigmatization, hiding of white spots, facial depigmentation, avoidance of situations, and a vitiligo‐negative family history. Conclusions Disease‐related stigmatization, negative experiences, and avoidant behavior affect QoL. Therefore, the CDLQI should be combined with other instruments to screen for disease burden. These results call for the careful evaluation of young patients with vitiligo.     

Quality of life in alopecia areata: a disease‐specific questionnaire

Background Alopecia areata (AA) is an autoimmune disease affecting about 2% of the population, which has a considerable impact on quality of life (QoL). There are no disease‐specific questionnaires to assess QoL in patients suffering from AA. Objective To validate a new disease‐specific questionnaire for AA, named AA‐QLI, and to compare the consequent Quality of Life Index (QLI) with the commonly known Dermatology Life Quality Index (DLQI) to verify if it can provide a more comprehensive tool for patients. Methods A total of 50 patients affected by AA were administered both the AA‐QLI, created by us, and the well‐known DLQI. With the aim to detect suitable QLI, we propose to use two multivariate analyses:

• ? a principal component analysis approach on the data collected with both questionnaires to compare their capability to measure the QoL;
• ? a structural equation modelling on our AA‐QLI to identify which category of symptoms mostly affects the QoL.

Results The scores of both the questionnaires are quite close, except for a few cases. Statistical analysis shows a higher specificity of the AA‐QLI for evaluating QoL. Among the three areas in which AA‐QLI is divided, ‘Relationship’ has a major impact on the QLI, followed by ‘Subjective symptoms’; ‘Objective signs’ has a lower weight on the QLI. Conclusion AA‐QLI is a good instrument to evaluate the real impact of AA on QoL. It can be helpful both for the physician and for the patient.     

574例斑秃患者生活质量及影响因素分析

目的: 评价影响斑秃患者生活质量的相关因素.方法: 采用皮肤病生活质量指数(dermatology life quality index,DLQI)量表,对574例斑秃患者进行调查评估.结果: 574例患者中,38.7%生活质量中重度受损;年龄、初发年龄、病程、复发、局部症状、指甲累及和斑秃类型与DLQI评分相关.结论: 在斑秃临床治疗中应关注心理精神问题.     

EADV Taskforce's recommendations on measurement of health‐related quality of life in paediatric dermatology

The impact of skin conditions in children can profoundly affect a variety of lifestyle parameters that may have important personal consequences. Several national guidelines for children with different skin conditions recommend health‐related quality of life (HRQoL) measurement as part of the assessment process. HRQoL also plays an important role in educational programmes for children with chronic skin conditions and their parents. In this paper, the EADV Taskforce on Quality of life provides researchers and clinicians data on the achievements in this field, as well as the peculiarities of HRQoL assessment in children, and an overview of the most commonly used and validated generic, dermatology‐specific and disease‐specific instruments related to paediatric dermatology. Finally, an analysis of the current problems of HRQoL assessment in children with skin diseases and directions for future studies are also discussed. The main goal of this paper is to help dermatologists decide which HRQoL instrument to use with children, depending on the context.     

Health‐related quality of life in adolescents with psoriasis: an interview‐based study

Psoriasis is a common skin disease affecting the physical, psychological and social well‐being of patients and their families. Most research so far has been limited to adults, and little is known about the experiences of young people with psoriasis. The aim of this study, from Denmark, was to provide an in‐depth understanding of the impact of psoriasis on adolescents’ health‐related quality of life (HRQoL). Thirty‐sixs interviews were conducted with 18 adolescents with psoriasis (aged 12–17 years), 14 of their parents and four health professionals working with psoriasis. The interview guide included broad, open‐ended questions asking about different life domains (e.g. physical, emotional and social) rather than specific issues previously addressed in existing (e.g. questionnaire‐based) research. However, when participants raised issues previously addressed in existing questionnaires, the authors prompted them to provide more information on these issues. The participants reported that psoriasis affected their quality of life within six main themes: physical symptoms (e.g. itching and flaking, fluctuation of symptoms), feeling different (e.g. feeling alone, body image issues), psoriasis‐related worry about the future (e.g. disease worsening, education and work, starting a family), increased attention (e.g. comments, staring, bullying), attempts to conceal skin (e.g. choosing specific clothing, avoiding swimming) and treatment‐related frustrations and worry (e.g. side‐effects and inconvenience). Taken together, a broad range of the reported difficulties appeared to arise from appearance‐related concerns. The impact of psoriasis and its treatment on the adolescents’ daily lives varied considerably. The authors believe that dermatologists during consultations could help by including patients’ HRQoL concerns in planning treatment, and also simply asking about these factors. In more complicated cases, referral to psychologists or counselling might be necessary.     

Development of a disease-specific instrument to measure quality of life in patients with alopecia areata

Alopecia areata (AA) is a common hair loss disorder that frequently follows a chronic course. Although AA is apparently associated with disturbance of quality of life (QoL), no disease-specific instrument to measure the QoL has been developed. This study was conducted to develop a disease-specific self-administered instrument to measure AA patients' QoL (AAQ). A two-step cross-sectional study was conducted. Items were generated from qualitative interviews with five patients with AA (two men and three women, age 28±6.4 years). Then, a preliminary questionnaire was produced and delivered to the patients (n=122). The AAQ was examined in terms of statistical performance. The AAQ included 7 items in the following three subscales: 'restriction of activity', 'concealment' and 'adaptation'. The reliability of internal consistency was fair with Cronbach's alpha coefficients of 0.59-81 for each subscale. Confirmatory factor analysis and correlation analysis demonstrated that the AAQ had good construct validity. Interestingly, the AAQ was only correlated with subjective severity scores as rated by the patients, but not with objective disease severity assessed by investigators.