Validation of the Skindex-17 quality of life assessment instrument for a Brazilian population

BackgroundHealth-related quality of life assesses how diseases affect the daily life of people; there are several generic instruments for this assessment in dermatology. Skindex was created in 1996; it is a multidimensional instrument, aiming to encompass some psychological and social aspects not yet addressed by other questionnaires. Among its versions (Skindex-29, 16, and 17), Skindex-17 had not been validated in Brazil.ObjectivesTo validate Skindex-17 for use in Brazilians with dermatological diseases.MethodsThis was a methodological, cross-sectional, and prospective study of 217 patients attended at the Dermatology Service Outpatient Clinic, Faculdade de Medicina de Botucatu - Universidade Estadual Paulista (Botucatu, SP, Brazil), from December 2017 to September 2019. The following were evaluated: content validity, filling time, internal consistency, dimensional structure, concurrent validity (DLQI), temporal stability, and responsiveness.ResultsThe sample consisted of 71% women, mean age (SD) of 45 (16) years; phototypes II−IV accounted for 95% of the cases. Cronbach's alpha coefficients were 0.82 and 0.93 for the symptoms and psychosocial conditions, respectively. A high correlation was observed with the DLQI score: symptoms (rho = 0.69) and psychosocial conditions (rho = 0.75). The instrument's two-dimensional structure was confirmed through confirmatory factor analysis. Temporal stability (ICC > 0.9) and score responsiveness (p ≤ 0.02) were verified. The instrument was shown to be feasible in clinical practice due to the content validation performed by professionals and patients, as well as the low time spent completing it (< 5 min).Study limitationsSingle-center study, with patients exclusively from the public healthcare system.ConclusionsSkindex-17 was shown to be a valid and consistent instrument for assessing quality of life among patients with dermatological diseases, in Brazil. Its two-dimensional structure was confirmed.     

Impact of chronic urticaria on quality of life and work in Japan: Results of a real‐world study

Little attention has been given to the burden of chronic urticaria (CU) in Japan compared with other skin diseases, such as atopic dermatitis (AD) and psoriasis. The primary objective of the RELEASE study was to evaluate the real‐life quality‐of‐life impairment in CU patients in Japan. Data were collected from 1443 urticaria, 1668 AD and 435 psoriatic patients; 552 urticaria patients who presented urticaria symptoms for over 6 weeks were defined as CU. The mean Dermatology Life Quality Index (DLQI) total score was 4.8, 6.1 and 4.8 in CU, AD and psoriatic patients, respectively. Disease control of urticaria evaluated by the Urticaria Control Test (UCT) and DLQI exhibited a strong correlation with a Spearman's rank correlation coefficient of ?0.7158. CU and AD patients had relatively higher scores in all Work Productivity and Activity Impairment – General Health subscales except for absenteeism. At the time of the survey, approximately 64% of CU patients reported UCT scores of <12 and demonstrated higher work productivity loss and activity impairment versus patients with UCT scores of ≥12. Patients with lower UCT scores also displayed a higher percentage of dissatisfaction with their health state and the treatment they received. Approximately 85% of patients with CU had visited dermatology clinics, and less than 20% had visited hospital, indicating existence of a highly burdened population outside specialized centers. These results highlight the unmet medical needs of CU patients, suggesting the need to increase awareness of CU burden among both physicians and patients and to pursue improved real‐life patient care.     

An assessment of the quality of life in older patients with skin disease

BACKGROUND: There are few data regarding quality of life in older people with skin disease, particularly concerning those with skin cancer. Access to U.K. secondary care dermatological services is increasingly focusing on skin cancer, which may have a negative effect on waiting times for patients with rashes. OBJECTIVES: To assess the quality of life in patients aged 65 years and over and to determine how this relates to type and extent of skin disease. METHODS: One hundred consecutive new dermatology patient referrals aged 65 years and above had quality of life assessed by the Dermatology Life Quality Index (DLQI), the Hospital Anxiety and Depression Scale (HADS) and the Illness Perception Questionnaire. Patients were examined for type and extent of skin disease. RESULTS: There were 49 men (mean age 75.1 years) and 51 women (mean age 75.0 years). Fifty-five per cent of patients had been referred with one or more lesions (76% premalignant or malignant) and 45% had rashes. There was no significant difference between the quality of life scores of men vs. women regarding all three of the questionnaires. However, patients with rashes scored significantly higher (i.e. poorer quality of life) on all but one of the questionnaire parts compared with patients with lesions. Patients with more extensive disease had significantly higher DLQI scores. CONCLUSIONS: Older people suffering from rashes had significantly poorer quality of life than patients with lesions, even those with skin cancer. The quality of life is negatively associated with extent of skin disease. Access to specialist dermatological care should take into account the suffering caused by extensive skin diseases. DLQI and a general quality of life questionnaire such as the HADS are quick to deliver and to score, particularly in the setting of a busy outpatient department. They provide an excellent screening tool for psychological problems in older people with skin disease.     

银屑病患者生活质量调查

目的:研究银屑病对患者生活质量的影响及皮肤病生活质量指数(DLQI)作为判断银屑病病情及疗效新指标的可信性。方法:采用DLQI研究银屑病患者治疗前、后的生活质量及其影响因素,并与传统的银屑病皮损面积和严重度指数(PASI)进行比较。结果:女性患者的DLQI评分明显高于男性,未婚者的DLQI评分高于已婚者,面部受累者的DLQI评分高于面部未受累者(P<0.05)。DLQI和PASI评分呈显著正相关(r=0.633,P<0.001)。治疗后随着临床病情的改善,PASI和DLQI评分均显著下降,且DLQI改善率和PASI改善率呈显著正相关(r=0.722,P<0.001)。结论:银屑病对患者生活质量的影响较大,DLQI可作为判断银屑病病情及疗效的新指标。     

Effects of patient satisfaction with care on health-related quality of life: a prospective study

OBJECTIVES: To evaluate the effect of patient satisfaction on health-related quality of life among dermatological outpatients, independently of patients' sociodemographic, and clinical characteristics. DESIGN: Prospective cohort study. Satisfaction was evaluated with a standardized questionnaire three days after the visit by telephone interview. Quality of life and psychiatric disorders were measured with validated instruments (Skindex-29 and Ghq-12) before the dermatological visit and after four weeks. At the four week interview also self-reported medication adherence was assessed. SETTING: Outpatient clinics of a large dermatological hospital in Rome, Italy. PATIENTS: A consecutive sample of 1389 outpatients was approached, and 52% agreed to participate. Inclusion criteria were met by 424 patients, and 396 (93%) of them completed the study. MAIN OUTCOME MEASURES: Improvement in health related quality of life. RESULTS: At multivariate analysis satisfied patients have approximately twice the odds for an improved quality of life on the emotions scale (OR = 1.99; 95%CI 1.1 to 3.7; P = 0.03) and on the functioning scale (OR = 2.2; 95%CI 1.1 to 4.7; P = 0.03). Patients with psychiatric disorders at baseline were less likely to have an improved quality of life on the functioning scale (OR = 0.3; 95%CI 0.2 to 0.8; P = 0.01). CONCLUSIONS: This is the first prospective study showing that patient satisfaction and psychiatric disorders have a significant effect on quality of life improvement among dermatological patients, independently of patient characteristics. Particular attention should be devoted to improving physicians' interpersonal skills, the major component of patient satisfaction.     

Quality of life evaluation in epidermolysis bullosa (EB) through the development of the QOLEB questionnaire: an EB‐specific quality of life instrument

Background Epidermolysis bullosa (EB) has a profound effect on quality of life (QOL); however, generic QOL assessments are poor indicators of the impact of EB. Objectives To develop a valid and reliable EB‐specific QOL tool for use in measuring the effects of disease impact and interventions. Methods Open, nonstructured interviews were conducted with 26 patients with EB, along with 33 family members and 11 health professionals (70 individuals) for item generation. A pilot questionnaire was compiled, refined and distributed to 130 patients with EB. From the 115 returned questionnaires a principal axis factor analysis was undertaken producing a 17‐item final questionnaire. Discriminative validity was assessed by differences in scores between EB subtypes. Content validity was assessed by expert ranking of items in terms of importance. Construct validity was evaluated by correlation with existing QOL tools. Test–retest reliability and internal consistency were evaluated. Factor analysis was performed. Results A 17‐item questionnaire was developed: the QOLEB questionnaire. This gave distinguishing QOL scores to different EB subtypes, and correlated highly with existing QOL instruments. Conclusions The QOLEB questionnaire is the first EB‐specific QOL measurement tool, and is a valid and reliable measurement tool for the quantification of QOL in patients with various subtypes of EB. In addition, the QOLEB has potential as a sensitive instrument to monitor QOL, and to identify dimensions of QOL as targets for interventions and research.     

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.     

Camouflage for patients with vitiligo vulgaris improved their quality of life

Background  Cosmetic camouflage is important for patients with vitiligo vulgaris. However, few studies have investigated its benefit for vitiligo patients.
Objectives  To analyze the psychological effects on patients with vitiligo vulgaris by camouflage lessons performed in vitiligo clinics in Kyoto University Hospital and Fukui Red Cross Hospital, Dermatological Life Quality Index (DLQI) questionnaires were collected before and 1 month after camouflage lessons.
Patients  Patients with vitiligo vulgaris, who visited our clinics in 2008 and had never experienced camouflage, were enrolled in this study. They took camouflage lessons and continued subsequent self-camouflage for 1 month. Control patients took no lessons and no camouflage.
Results  Camouflage improved the scores of DLQI when compared with those without camouflage ( P  = 0.005). Camouflage improved DLQI scores from 5.90 to 4.48. In DLQI subcategories, camouflage lessons improved a subcategory of symptoms and feelings ( P  = 0.0037).
Conclusions  These data supported the idea that camouflage for patients with vitiligo not only covers the white patches but also improves their quality of life.     

妊娠期高血压疾病遗留高血压患者肾损伤及性生活质量的变化观察

目的:观察与分析妊娠期高血压疾病遗留高血压患者肾损伤及性生活质量的变化情况。方法:选取2014年10月至2016年6月期间本院收治的65例妊娠期高血压疾病遗留高血压患者为A组,同时期的65例妊娠期高血压无遗留高血压患者为B组,65例健康妊娠者为C组,然后统计及比较三组的肾功能指标、肾动脉血流参数及性生活质量评分,同时将A组中不同血压水平者的上述统计结果进行比较。结果:A组的肾功能指标、肾动脉血流参数及性生活质量评分均差于B组及C组,B组的统计结果则差于C组,且A组中不同血压水平者的统计结果也存在显著性差异,经spearman分析显示,上述方面与疾病均有密切的相关性,P均0.05。结论:妊娠期高血压疾病遗留高血压患者肾损伤及性生活质量处于较差的状态,且血压水平对上述方面状态的影响较大,因此应加强对上述方面的调节与改善。     

The Impact of Chronic Skin Disease on Daily Life (ISDL): a generic and dermatology-specific health instrument

BACKGROUND: In dermatological research and clinical practice, there is a need for comprehensive self-report instruments that assess a broad spectrum of health implications of chronic skin diseases, including generic and skin-specific aspects of disease-related quality of life. The advantages of dermatology-specific, multidimensional instruments over generic instruments or single-dimensional quality-of-life measures are in the detailed and specific information they provide about health areas that are affected by the skin condition and that may change through therapeutic intervention. OBJECTIVES: The development of a multidimensional health status inventory for chronic skin diseases (Impact of Chronic Skin Disease on Daily Life, ISDL) is described. The dermatology-specific part of the inventory assesses dimensions of physical functioning, more specifically skin status, physical symptoms of itch, pain and fatigue and scratching responses as well as disease-related stressors like stigmatization. The generic part gauges dimensions of psychological functioning, disease-related impact, illness cognitions and social support by means of existing scales validated for other chronic diseases. METHODS: Reliability and validity of the questionnaire were studied in various samples of patients with psoriasis and atopic dermatitis. RESULTS: The ISDL showed high reliability and test-retest reliability in both patient groups. Convergent validity was indicated by moderate to strong correlations with other validated questionnaires. The scales proved sensitive to change both for dermatological ultraviolet B radiation therapy and cognitive behavioural treatment for itching. CONCLUSION: With its convincing results for reliability and validity the present evaluation supports the usefulness and applicability of the instrument for different chronic skin diseases.     

Effects of skin care and makeup under instructions from dermatologists on the quality of life of female patients with acne vulgaris

Acne vulgaris significantly affects patients' quality of life (QOL) and their lives in various ways, including social behavior and body dissatisfaction. This may be heightened by acne's typical involvement of the face. We investigated whether the use of skin care and makeup could influence the QOL of affected patients without deteriorating conventional acne treatments. Fifty female patients with acne were recruited for our study. Twenty-five patients were instructed how to use skin care and cosmetics, while 25 patients received no specific instructions from dermatologists. Both groups received conventional topical and/or oral medication for acne during the study period for 4 weeks. Both groups did not show any significant difference in clinical improvement of acne severity. Two validated QOL questionnaires, World Health Organization (WHO)QOL26 and the Dermatology Life Quality Index (DLQI) were administered to all patients at first visit and 4 weeks later. The mean scores of psychological and overall domains in WHOQOL26 for patients with instructions were improved significantly, while only the overall score was significantly improved for patients without instructions. The total mean scores and all domains except work/school in DLQI for patients with instructions were improved significantly, while the total scores and all domains except discomfort for treatment in DLQI were significantly improved for patients without instructions. Thus, instructions on the use of skin care and cosmetics for female acne patients did not deteriorate acne treatment and influenced patients' QOL effectively. We therefore suggest that instructions for using skin care and cosmetics complement conventional medical treatments for acne.     

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.     

Impact of neurofibromatosis 1 upon quality of life in childhood: a cross-sectional study of 79 cases

Background  Neurofibromatosis 1 (NF1) has a significant impact on quality of life (QoL).
Objectives  To evaluate QoL in NF1 according to phenotype from the viewpoint of children and proxy.
Methods  One hundred and forty families with a child aged between 8 and 16 years, seen consecutively at the National Academic Paediatric Referral Centre for NF1 for a phenotype evaluation, were contacted by mail. Families agreeing to participate were sent two questionnaires, the DISABKIDS for children and proxy and the cartoon version of the Children's Dermatology Life Quality Index (CDLQI). QoL scores were compared with those in other major diseases and were analysed according to age, gender and phenotype.
Results  Eighty families agreed to participate, and 79 returned the questionnaires. Using DISABKIDS, NF1 had a higher impact on health-related QoL than asthma (mean ± SD 75·18 ± 18·22 vs. 79·78 ± 13·41; P  =   0·005). The total score was more altered when assessed by proxy than by children (71·20 ± 17·94 vs. 75·18 ± 18·22; P  =   0·002). Orthopaedic manifestations, learning disabilities and presence of at least two plexiform neurofibromas were independently associated with a higher impact ( P  <   0·01). The CDLQI score was slightly altered (11·3%). Dermatological signs, such as café-au-lait spots and freckling, did not have a significant impact.
Conclusions  Orthopaedic manifestations, learning disabilities and plexiform neurofibromas are the main complications impacting on QoL during childhood NF1. QoL could be considered as an endpoint for intervention studies in this context.     

Health-related quality of life in health care workers with work-related skin diseases

Background: Occupational skin diseases (OSDs) are common among health care workers (HCWs). Little is known about how OSD impacts on health-related quality of life (HRQoL) in HCWs with suspected OSD and associated factors.
Objectives: To describe HRQoL in 278 HCWs with suspected OSD, compare data with the general and populations with skin diseases and analyse HRQoL's associations with clinical and demographic variables.
Methods: HCWs with suspected OSD completed a generic (SF-36) and specific (Skindex-29) instrument.
Results: Seven of 8 SF-36 dimensions were significantly lower in HCWs than the general population. Compared with norms for patients with skin disease and cleaning and kitchen employees (CKEs) with suspected OSD, physical functioning (PF) and general health perception were less impaired in HCWs. Skindex-29 scores were similar to CKEs' while they appeared better than patients' norms. Multivariate analysis found severity unrelated to SF-36, apart from pain but associated with all Skindex-29 scales.
Conclusions: Although HCWs with suspected OSD display considerable HRQoL impairments, (general) PF and general health perception appear less affected than expected. Severity appears to affect specific and to a lesser extent general HRQoL. Clinical and demographic variables contributed moderately to the prediction of specific and little to the prediction of general HRQoL.     

Favorable effect of creams with skimmed donkey milk encapsulated in nanoliposomes on skin physiology

The use of donkey milk has a long history in external dermal application for cosmetic and medical purposes. The encapsulation of different drugs into nanoliposomes and nutrients may have many benefits for the delivery of the targeted substance. The aim of the present study is to test creams with nanoliposomes encapsulated with skimmed donkey milk, reported in our registered patent, compared with effect of the placebo cream and the untreated skin. To investigate the effect of formulated cream, we have measured the electrical capacitance, transepidermal water loss and the skin pH value. The study included 15 healthy volunteers (11 women and 4 men). The patented creams exhibited satisfactory moisturizing properties very soon after application, while hydration was reached earlier in the spots treated with night cream. Transepidermal water loss slightly decreased only after 4 weeks of treatment in each of the spots assessed. The pH value was similar after each of the treatments. Tested creams may enhance the moisture of skin very soon after application, in this way potentially enable deeper permeation of phospholipids and essential proteins, without changing the pH. It may also contribute to additional anti‐aging effects.