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BACKGROUND Chronic inflammatory vulvar diseases can have a huge detrimental impact on patient welfare. A few studies have addressed this issue so far, mainly measuring patients' quality of life or sexual dysfunction. OBJECTIVE To assess the burden of suffering in patients with chronic inflammatory vulvar diseases using the Pictorial Representation of Illness and Self-Measure (PRISM), a visual, non-verbal instrument. We also assessed (i) the concordance between PRISM and the Dermatology Life Quality Index (DLQI), (ii) whether some variables, both patient-related and disease-related, affect the patient's suffering and quality-of-life impairment. METHODS We evaluated for inclusion in this cross-sectional study all patients who attended our Vulva Unit over a 9-month period with histologically proven lichen sclerosus (LS), lichen planus (LP), lichen simplex chronicus (LSC), eczema, plasma cell vulvitis and psoriasis (at least five for each disease). Demographics and disease-related subjective and objective scores were recorded. The PRISM and DLQI were administered. RESULTS We included 87 patients affected with LS, 13 with LSC and seven with LP. Median PRISM values (0-273 mm) ranged from 95 to 120 mm, depending on the disease, and median DLQI scores (0-30) were five for all three groups. Neither PRISM nor DLQI scores differed significantly among the three groups. Moderate coherence was found between PRISM and DLQI (ρ = 0.5455, P

Background: A huge number of patients in our country are affected by Tinea Corporis (TC). The number of patients affected by dermatophytosis has increased by a large extent in the last 4 to 5 years. The quality of life in TC patients can be affected by various factors including the disease morbidity, duration of disease, social & demographic factors. Aims and Objectives: The aim of the study is to find out the effect of TC on the quality of life of the affected patients & along with that to assess whether there is some association of this effect on quality of life with some demographic & clinical factors. Methods: The effect on quality of life of 328 patients affected by TC who attended the Dermatology outpatient’s department of NRS Medical College was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Results: 12 (3.658 %) of the patients had an extremely large effect on quality of life. There was a very large effect on the QOL of 121 (36.890 %) patients. There was moderate effect on 134 (40.853 %) of the patients. There was a small effect on 59 (17.987 %) of the patients. 2 (0.609 %) patients had no effect on their QOL. Duration of disease & body surface area involved have significant impacts on QOL. Conclusion: The quality of life is adversely affected by TC. Early detection & treatment of the disease is very important. Steps must be taken to increase awareness about the disease among the general population. Background: A huge number of patients in our country are affected by Tinea Corporis (TC). The number of patients affected by dermatophytosis has increased by a large extent in the last 4 to 5 years. The quality of life in TC patients can be affected by various factors including the disease morbidity, duration of disease, social & demographic factors. Aims and Objectives: The aim of the study is to find out the effect of TC on the quality of life of the affected patients & along with that to assess whether there is some association of this effect on quality of life with some demographic & clinical factors. Methods: The effect on quality of life of 328 patients affected by TC who attended the Dermatology outpatient’s department of NRS Medical College was assessed using the Dermatology Life Quality Index (DLQI) questionnaire. Results: 12 (3.658 %) of the patients had an extremely large effect on quality of life. There was a very large effect on the QOL of 121 (36.890 %) patients. There was moderate effect on 134 (40.853 %) of the patients. There was a small effect on 59 (17.987 %) of the patients. 2 (0.609 %) patients had no effect on their QOL. Duration of disease & body surface area involved have significant impacts on QOL. Conclusion: The quality of life is adversely affected by TC. Early detection & treatment of the disease is very important. Steps must be taken to increase awareness about the disease among the general population.

Background Acne confers an increased risk of physical, psychiatric, and psychosocial sequelae, potentially affecting multiple dimensions of health-related quality of life (HRQoL). Morbidity associated with truncal acne is poorly understood. Objective To determine how severity and location of acne lesions impact the HRQoL of those who suffer from it. Methods A total of 694 subjects with combined facial and truncal acne (F+T) and 615 with facial acne only (F) participated in an online, international survey. Participants self-graded the severity of their acne at different anatomical locations and completed the dermatology life quality index (DLQI). Results The F+T participants were twice as likely to report "very large" to "extremely large" impact on HRQoL (ie, DLQI > 10 and children's DLQI [CDLQI] > 12) as compared with the F participants (DLQI: odds ratio [OR] 1.61 [95% confidence interval {CI} 1.02-2.54]; CDLQI: OR 1.86 [95% CI 1.10-3.14]). The impact of acne on HRQoL increased with increasing acne severity on the face (DLQI and CDLQI P values = .001 and .017, respectively), chest (P = .003; P = .008), and back (P = .001; P = .028). Limitations Temporal evaluation of acne impact was not estimated. Conclusions Facial and truncal acne was associated with a greater impact on HRQoL than facial acne alone. Increasing severity of truncal acne increases the adverse impact on HRQoL irrespective of the severity of facial acne.

Purpose To develop a mapping algorithm for generating EQ-5D-5-level (EQ-5D-5L) utility scores from the Dermatology Life Quality Index (DLQI) in patients with atopic dermatitis (AD). Methods The algorithm was developed using data from 1232 patients from four countries participating in the National Health and Wellness Study. Spearman’s rank correlation coefficient was used to evaluate the conceptual overlap between DLQI and EQ-5D-5L. Six mapping models (ordinary least squares [OLS], Tobit, three different two-part models, and a regression mixture model) were tested with different specifications to determine model performance and were ranked based on the sum of mean absolute error (MAE), and root mean squared error (RMSE). Results The mean DLQI score was 7.23; mean EQ-5D-5L score was 0.78; and there were moderate negative correlations between DLQI and EQ-5D-5L scores (p = − 0.514). A regression mixture model with total DLQI, and age and sex as independent variables performed best for mapping DLQI to EQ-5D-5L (RMSE = 0.113; MAE = 0.079). Conclusion This was the first study to map DLQI to EQ-5D-5L exclusively in patients with AD. The regression mixture model with total DLQI, and age and sex as independent variables was the best performing model and accurately predicted EQ-5D-5L. The results of this mapping can be used to translate DLQI data from clinical studies to health state utility values in economic evaluations.

Background: Acne vulgaris is a common skin disease, affecting approximately 9.4% of the world’s population, with considerable effect on the quality of life. According to a previously conducted study, the prevalence rate of acne in Pakistan was found to be 5%. And to this date, no reliable data is available about the prevalence of acne in Rawalpindi and Islamabad, Pakistan. Objectives To determine the prevalence of acne vulgaris and its psycho-social impact on female undergraduate medical students of Rawalpindi and Islamabad. Methods A cross-sectional study was conducted during the month of August 2019 among female undergraduate medical students from three randomly selected medical colleges of Rawalpindi and Islamabad. The diagnosed cases of acne vulgaris were assessed by using the Dermatology Life Quality Index (DLQI). The collected data were then analyzed using SPSS version 20 (IBM Corp., Armonk, NY, US). Results The prevalence of acne vulgaris was found to be 14.47% in female undergraduate medical students of Rawalpindi and Islamabad. Sixty percent (n=99) were found to have itchy sores and stinging skin, 66.7% (n=110) were embarrassed by their acne-prone skin, and the social activity of 60% (n=99) of the participants was affected by their active acne. Of the students, 73.9% were not affected by their acne while studying or working. Around 61.2% (n=101) complained that their acne treatment was a problem and hiding it took time or made a mess. Two percent showed a severe impact, with 14% having very large, 44% moderate, 30% low, and the remaining 10% with no effect of acne in their psychosocial functioning. Conclusion Acne vulgaris is a chronic skin disease that considerably affects the psychosocial functioning of female undergraduate medical students. A holistic approach in treating acne requires the participation of a dermatologist and mental health professional.

Atopic dermatitis (AD) is a dermatological disorder that affects patients’ mental health and psychological state in complex ways. The importance of understanding the entire scope of this burden is well recognized, but there is limited comprehensive information about the resulting stress on adult patients with AD. This study aimed to determine the degree of psychological stress in patients with AD compared to healthy participants. A total of 352 adult patients participated in this cross-sectional study—174 with AD and 178 healthy participants. Demographic and clinical data were collected. Itch and sleep disturbance were assessed using a numeric rating scale and a visual analogue scale. The 20-item Toronto Alexithymia Scale (TAS-20) and Beck Depression Inventory (BDI) questionnaires were administered to assess the symptoms of alexithymia and depression. Quality of life (QOL) was assessed in AD patients using the Dermatology Quality Index. In our study, we found high TAS-20 and BDI scores among patients with AD. The prevalence of alexithymic personality features was 56.3% in patients with AD versus 21.3% in healthy controls (p &lt, 0.001). Based on BDI scoring (BDI-21 &gt, 13), depression was suspected in a significantly higher number of patients with AD than in the control group (56.9% (99/174) vs. 15.7% (28/178), p &lt, 0.0001). Eczema Area and Severity Index (EASI) score did not show any significant correlations with psychological parameters. Among clinical parameters, only sleep disturbance was positively correlated with depression (R = 0.307, p &lt, 0.005). Our data show that the severity index score as a representative factor of skin involvement has a limited role in predicting the effect of skin diseases on mental status. Screening and assessment for psychiatric disorders, QOL, and sleep disturbance in patients with atopic dermatitis cannot be neglected by physicians and they should be treated in clinical practice with the consideration of psychosomatic approaches.

Background Psoriasis vulgaris is a common chronic dermatological disease that has a negative impact on the psychological status and the social interaction of the patient. Objective To correlate the quality of life and clinical severity of psoriasis vulgaris in patients using different types of treatment. Materials and methods This is a prospective observational cross-sectional study that took place over a 4 month period, from January to April 2014, at the King Abdul Aziz Medical City, Jeddah, Saudi Arabia. All patients with psoriasis vulgaris attending the dermatology clinics during this period were included. Results Of the total 41 Saudi patients, 25 were males and 16 were females. 21 were on combined (i.e. topical with either systemic or NB-UVB) and 20 were on topical treatments only. PASI score was moderate in the majority for both groups, that is, patients on topical (70%) and combined treatment (80%). DLQI score shows only a small effect on the patient’s quality of life for the majority (14/20) in the topical group and (16/21) for those on combined therapy. Conclusion There is no significant difference in terms of the effect of the type of treatment between the two groups.

Background: Obesity, metabolic syndrome (MetS), and psoriasis, largely driven by environmental factors, show multiple bidirectional associations, with important metabolic implications in psoriatic patients. Besides body mass index (BMI) as a measure of obesity, data on phase angle (PhA), a direct measure by bioelectrical impedance analysis (BIA), used as a marker of cellular health and a predictor of morbidity and mortality in various diseases, are still lacking in psoriasis. In this case–control, cross-sectional study, we investigated the PhA in 180 pairs of adult psoriatic patients and healthy controls, evaluating also the potential use of the PhA as marker of the clinical severity, the quality of life, and the presence of the MetS in psoriatic patients. Methods: Anthropometric measures, metabolic profile and bioelectrical variables were evaluated. The clinical severity was assessed by standardized psoriasis area and severity index (PASI) score and c-reactive protein (CRP) levels, and the quality of life was evaluated by dermatology life quality index (DLQI). MetS was diagnosed according to Adult Treatment Panel III. Results: Psoriatic patients presented smaller PhA (p < 0.001) and higher prevalence MetS compared with controls. The PhA was significantly associated with number of parameters of MetS in both groups (p < 0.001). After adjusting for BMI, this association remained significant in psoriatic patients only (p < 0.001). Among psoriatic patients, the PhA was the major index value for the diagnosis of MetS (OR 5.87, 95 % CI 5.07–6.79) and was inversely associated with both PASI score and DLQI, independently of BMI (p < 0.001). At multiple regression analysis, the PhA well predicted the PASI score and DLQI. Based on ROC curves, the most sensitive and specific cutoffs of PhA to predict the highest PASI score and the lowest DQLI were ≤4.8° and ≤4.9°, respectively. Conclusions: We reported that psoriatic patients presented small PhAs, with a novel association between PhA, clinical severity, quality of life in psoriatic patients, and MetS. Further studies are required to validate the PhA’s prognostic ability in assessing the clinical severity and MetS in psoriatic patients.

Background The Dermatology Life Quality Index (DLQI) is the most widely used measure of health-related quality of life (HRQoL) associated with skin disease. Recently, the psychometric properties of the DLQI have caused some controversy because the instrument appears not to meet the requirements of modern test theory. The purpose of this study was to assess whether these psychometric issues also occur in Chinese patients with neurodermatitis. Methods One hundred fifty consecutive outpatients (83 males and 67 females) seeking treatment for neurodermatitis were assessed for eligibility for this prospective study between July 1, 2011 and September 30, 2011. The DLQI and a demographic questionnaire were completed. One female participant who incompletely answered the DLQI was excluded. Data were analyzed using the Rasch model in order to obtain meaningful scores for the DLQI. Scale assessment included analysis of rating scale function, item fit to the Rasch model, aspects of person-response validity, unidimensionality, person-separation reliability, and differential item function. Results The rating scale advanced monotonically for all items in the DLQI, but item 9 did not demonstrate acceptable goodness-of-fit (Infit MnSq values >1.3) to the Rasch model. The 10 items of the DLQI met the criteria for person-separation reliability (PSI = 2.38) and the first latent dimension (general QoL) accounted for 50.8 % of the variance; but the variance explained by the second dimension (7.1 %) exceeded the criterion of 5 %. There were also limitations related to person-response validity, because ≥ 5 % (18.1 %) of cases demonstrated unacceptable fit. There was no uniform differential item functioning. Conclusions For neurodermatitis patients, the DLQI seems to have poor fit to the Rasch model; therefore, we recommend against using this instrument with neurodermatitis patients.

Port-wine stains (PWS) are congenital capillary malformations, usually occurring on the face, neck, and other exposed parts of the skin, that have serious psychological and social impact on the patient. Most researchers focus on the treatment of PWS, but the quality of life (QoL) of PWS patients is seldom researched. The objective of this study is to evaluate the QoL of patients with PWS on exposed parts and explore the factors influencing the QoL of PWS patients. The QoL of 197 cases with PWS on exposed parts were prospectively studied using the Dermatology Life Quality Index questionnaire (DLQI), and the factors influencing the patients’ QoL were analyzed by single-factor analysis and multiple-factor logistic regression analysis. The reliability and validity of the QoL of PWS patients were then assessed by DLQI. A total of 197 valid questionnaires were collected. The DLQI scores in PWS cases ranged from 2 to 16, with 2 to 5 in 52.29% (103/197), 6 to 10 in 42.13% (83/197), and 11 to 20 in 5.58% (11/197). The main score elements of the DLQI focused on symptoms and feelings, daily activities, and social entertainment. Single-factor analysis and multiple-factor logistic regression analysis showed that the main influencing factors were female sex, skin hypertrophy, and lesion area >30 cm2. The inter-item correlation averaged 47.46% and the Cronbach α was 0.740, indicating high internal consistency. Correlation of the 6 dimensions of the DLQI questionnaires with the total scores showed that the Spearman correlation coefficient r ranged from 0.550 to 0.782 (P

This cross-sectional study was done to determine the impact of acne vulgaris on the quality of life in Sarawak, Malaysia and to examine its relationship with acne severity. Quality of life was measured in 173 patients using Dermatology Life Quality Index (DLQI). The mean DLQI score was 4.1 which was not dissimilar to that of psoriasis locally. Patients with family income