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This study systematically analysed peer-reviewed publications describing validation aspects of the Dermatology Life Quality Index (DLQI) and used Naicker's Critically Appraising for Antiracism Tool to assess risk of racial bias. Seven online databases were searched from 1994 until 2022 for articles containing DLQI validation data. Methodology followed PRISMA guidelines, the protocol was registered in PROSPERO, and articles reviewed independently by two assessors. Of 1,717 screened publications, 207 articles including 58,828 patients from >  49 different countries and 41 diseases met the inclusion criteria. The DLQI demonstrated strong test-retest reliability; 43 studies confirmed good internal consistency. Twelve studies were performed using anchors to assess change responsiveness with effect sizes from small to large, giving confidence that the DLQI responds appropriately to change. Forty-two studies tested known-groups validity, providing confidence in construct and use of the DLQI over many parameters, including disease severity, anxiety, depression, stigma, scarring, well-being, sexual function, disease location and duration. DLQI correlation was demonstrated with 119 Patient Reported Outcomes/Quality of Life measures in 207 studies. Only 15% of studies explicitly recruited minority ethnic participants; 3.9% stratified results by race/ethnicity. This review summarizes knowledge concerning DLQI validation, confirms many strengths of the DLQI and identifies areas for further validation.

Members of the European Academy of Dermatology and Venereology (EADV) Task Force on Quality of Life (QoL) and Patient Oriented Outcomes reviewed the instruments available for health-related (HR) QoL assessment in vitiligo and together with external vitiligo experts (including representatives of the EADV Vitiligo Task Force) have made practical recommendations concerning the assessment of QoL in vitiligo patients. The Dermatology Life Quality Index (DLQI) was the most frequently used HRQoL instrument, making comparison of results between different countries possible. Several vitiligo-specific instruments were identified. The vitiligo Impact Scale (VIS) is an extensively validated vitiligo-specific HRQoL instrument with proposed minimal important change and clinical interpretation for VIS-22 scores. VIS-22 was developed for use in India, where there are some specific cultural beliefs concerning vitiligo. The EADV Task Force on QoL and Patient Oriented Outcomes recommends use of the DLQI and the Children's Dermatology Life Quality Index (CDLQI) as dermatology-specific instruments in vitiligo. There is a strong need for a valid (including cross-cultural validation) vitiligo-specific instrument that can be either a new instrument or the improvement of existing instruments. This validation must include the proof of responsiveness., (© 2022 European Academy of Dermatology and Venereology.)

Skin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/drug reactions (10.2%), psoriasis (9.9%), vasculitis/immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies.

Skin conditions may have a strong impact on patients' sexual life, and thus influence personal relationships. Sexual issues are difficult to discuss directly in clinical practice, and a mediated instrument may be useful to capture such information. In this study item 9 of the Dermatology Life Quality Index was used to collect information on sexual impact of several skin conditions in 13 European countries. Among 3,485 patients, 23.1% reported sexual problems. The impairment was particularly high in patients with hidradenitis suppurativa, prurigo, blistering disorders, psoriasis, urticaria, eczema, infections of the skin, or pruritus. Sexual impact was strongly associated with depression, anxiety, and suicidal ideation. It was generally more frequent in younger patients and was positively correlated with clinical severity and itch. It is important to address the issue of sexual well-being in the evaluation of patients with skin conditions, since it is often linked to anxiety, depression, and even suicidal ideation.

Background/aims: The decision to discharge is a critical and common outpatient consultation event. However, little guidance exists over how discharge decision-making can be taught. We aimed to provide educational recommendations concerning outpatient discharge decision-making., Methods: Recommendations were drawn from prior interviews with 40 consultant dermatologists and 56 dermatology outpatients, and from the "traffic light" design discharge information checklist, developed using the Delphi technique., Results: The key strategies to follow to appropriately manage the outpatient discharge process are: to warn patients in advance, to understand patients' agendas, to allow extra time for the discharge process, to prepare patients to self-manage, to provide a "safety net" and provide the GP with a clear management plan. Aspects to be considered include patient mobility, presence of carer, type of employment, diagnostic certainty, and use of the checklist or guidelines. Key training aspects include teaching structured thought processes when discharging, discharging according to context, developing communication and negotiation skills, avoiding decision biases and encouraging good interprofessional collaboration. Training should include the consideration of the possibility of discharge at each consultation. Novel training strategies have been developed on how to appropriately manage the outpatient discharge process, including involving and informing patients. These strategies focus on safe decision-making, being patient-centred and organizing an efficient health care service framework., Conclusion: Structured outpatient discharge training for dermatologists is now possible, based on information from detailed doctor- and patient-based qualitative studies., (© 2017 S. Karger AG, Basel.)

Objective: To explore whether clinicians used formal quality of life (QoL) information if provided by patients completing the Dermatology Life Quality Index (DLQI) questionnaire and whether the information influenced treatment decision-taking., Methods: The DLQI was completed by adult patients attending a dermatology secondary-care clinic as they arrived at their appointment and given to the clinician. Clinicians recorded whether the DLQI information was used and whether it influenced treatment decision-making., Results: A total of 417 patients attended and 268 questionnaires (64.3%) were completed. The mean DLQI score was 7 (median = 5, range = 0-30). In 64 consultations (28.8%), clinicians used the DLQI information; in 37 of these consultations (57.8%) the DLQI information influenced the clinicians' treatment decision-making. The mean DLQI score for these 37 consultations was 11.3 (median = 10.0, range = 0-29), indicating a large effect on patients' QoL. QoL discussion occurred in 85 of 98 consultations observed. The domains of QoL most frequently discussed concerned symptoms (74 consultations) and problems caused by the treatment (24 consultations)., Conclusions: Clinicians may use formal QoL information if available in routine clinics. Treatment decisions may be influenced for those with high QoL impairment. Routine systematic assessment of QoL may therefore be of benefit., (2007 S. Karger AG, Basel)

Background: Financial and managerial constraints have resulted in the rationalization of dermatology inpatient services in the United Kingdom and the United States. Therapeutic regimes may vary locally, regionally, and internationally but the clinical outcome of treatment remains the same., Objective: We studied 2 inpatient units: the University of Wales College of Medicine, Cardiff, United Kingdom, and the University of Miami School of Medicine, Miami, Florida, to compare the use and effectiveness of the service provided., Methods: Data were collected prospectively from inpatients during a 12-month period. The Dermatology Life Quality Index was administered on admission and after discharge. Data were recorded about the diagnosis, duration of admission, and referring dermatologist., Results: In all, 295 patients (Cardiff, UK) and 366 patients (Miami, Fla) participated. The average duration of admission in Miami was 6.7 days compared with 14.2 (P <.0001) in Cardiff. In Miami, the most common reasons necessitating admission were extensive disease (54%), the patient being unwell (18%), photophoresis (14%), outpatient treatment failure (8%), and acute deterioration of disease (4%). In Cardiff, the common reasons were acute deterioration (35%), extensive disease (28%), outpatient treatment failure (22%), and liver biopsy (4%). The most common diagnoses in Cardiff were psoriasis (31%) and eczema (26%). In contrast, the most common diagnoses in Miami, were psoriasis (19%), leg ulcers (17%), and mycosis fungoides (14%). The mean Dermatology Life Quality Index value for all patients decreased after admission in Cardiff (14.9-8.2, P <.0001) and Miami (12.0-8.5, P <.0001)., Conclusion: Despite the differences in the 2 health care systems, inpatient therapy remains an important and effective therapeutic option in the United States and the United Kingdom.

Background Over 29 years of clinical application, the Dermatology Life Quality Index (DLQI) has remained the most used patient-reported outcome (PRO) in dermatology due to its robustness, simplicity and ease of use. Objectives To generate further evidence of the DLQI's utility in randomized controlled trials (RCTs) and to cover all diseases and interventions. Methods The methodology followed PRISMA guidelines and included seven bibliographical databases, searching articles published from 1 January 1994 until 16 November 2021. Articles were reviewed independently by two assessors, and an adjudicator resolved any opinion differences. Results Of 3220 screened publications, 454 articles meeting the eligibility criteria for inclusion, describing research on 198 190 patients, were analysed. DLQI scores were primary endpoints in 24 (5.3%) of studies. Most studies were of psoriasis (54.1%), although 69 different diseases were studied. Most study drugs were systemic (85.1%), with biologics comprising 55.9% of all pharmacological interventions. Topical treatments comprised 17.0% of total pharmacological interventions. Nonpharmacological interventions, mainly laser therapy and ultraviolet radiation treatment, comprised 12.2% of the total number of interventions. The majority of studies (63.7%) were multicentric, with trials conducted in at least 42 different countries; 40.2% were conducted in multiple countries. The minimal clinically importance difference (MCID) was reported in the analysis of 15.0% of studies, but only 1.3% considered full score meaning banding of the DLQI. Forty-seven (10.4%) of the studies investigated statistical correlation of the DLQI with clinical severity assessment or other PRO/quality of life tools; and 61–86% of studies had within-group scores differences greater than the MCID in 'active treatment arms'. The Jadad risk-of-bias scale showed that bias was generally low, as 91.8% of the studies had Jadad scores of ≥ 3; only 0.4% of studies showed a high risk of bias from randomization. Thirteen per cent had a high risk of bias from blinding and 10.1% had a high risk of bias from unknown outcomes of all participants in the studies. In 18.5% of the studies the authors declared that they followed an intention-to-treat protocol; imputation for missing DLQI data was used in 34.4% of studies. Conclusions This systematic review provides a wealth of evidence of the use of the DLQI in clinical trials to inform researchers' and -clinicians' decisions for its further use. Recommendations are also made for improving the reporting of data from future RCTs using the DLQI. [ABSTRACT FROM AUTHOR]

Introduction: Skin diseases affect patients at any age, but as each period in life is different, tools used to assess quality of life impairment should be adjusted according to the particular age group. Adolescence is a unique time, when young individuals go through many changes, making them especially vulnerable to stress. Aim: Translation and validation of a Polish language version of the Teenagers Quality of Life questionnaire (T-QoL) questionnaire. Material and methods: T-QoL was translated following international guidelines. A group of 34 dermatological patients, aged 12-19 years old, with various skin diseases were given the T-QoL as well as the CDLQI or DLQI to complete. They were also asked to complete the T-QoL questionnaire for the second time after 3-5 days. Statistical analysis of the results was performed. Results: The Polish version of T-QoL is internally consistent (Cronbach a 0.893 for the whole questionnaire). Moreover, it presents very good convergent validity (ICC = 0.864). No statistically significant differences between each question were noticed between the first and second time of completing the form. T-QoL scores correlated significantly with DLQI (p = 0.008, r = 0.636) and CDLQI (p < 0.001, r = 0.777) scores. Conclusions: The Polish version of the T-QoL questionnaire is a reliable instrument with adequate convergent validity, consistency and reproducibility. It can be successfully used to measure quality of life impairment among teenagers. [ABSTRACT FROM AUTHOR]

Purpose: The Dermatology Life Quality Index (DLQI) and the European Quality of Life-5 Dimension (EQ-5D) are separate measures that may be used to gather health-related quality of life (HRQoL) information from patients. The EQ-5D is a generic measure from which health utility estimates can be derived, whereas the DLQI is a specialty-specific measure to assess HRQoL. To reduce the burden of multiple measures being administered and to enable a more disease-specific calculation of health utility estimates, we explored an established mathematical technique known as ordinal logistic regression (OLR) to develop an appropriate model to map DLQI data to EQ-5D-based health utility estimates.Methods: Retrospective data from 4010 patients were randomly divided five times into two groups for the derivation and testing of the mapping model. Split-half cross-validation was utilized resulting in a total of ten ordinal logistic regression models for each of the five EQ-5D dimensions against age, sex, and all ten items of the DLQI. Using Monte Carlo simulation, predicted health utility estimates were derived and compared against those observed. This method was repeated for both OLR and a previously tested mapping methodology based on linear regression.Results: The model was shown to be highly predictive and its repeated fitting demonstrated a stable model using OLR as well as linear regression. The mean differences between OLR-predicted health utility estimates and observed health utility estimates ranged from 0.0024 to 0.0239 across the ten modeling exercises, with an average overall difference of 0.0120 (a 1.6% underestimate, not of clinical importance).Conclusions: This modeling framework developed in this study will enable researchers to calculate EQ-5D health utility estimates from a specialty-specific study population, reducing patient and economic burden. [ABSTRACT FROM AUTHOR]

Background: The essential physical role, visibility and social importance of the hands place a major psychological burden on patients with hand eczema. Objectives: The aim of this study was to identify the psychological, social and clinical characteristics of patients with hand eczema, in particular the prevalences of depression, anxiety, suicidal ideation, and comorbidities. Materials and methods: Data on patients with hand eczema were analysed from a large European multicentre study conducted with dermatology outpatients from 13 countries. Groups of patients and controls were compared to analyse the psychological burden of hand eczema. Results: Female patients with hand eczema had higher Hospital Anxiety and Depression Scale (HADS) scores for anxiety (n = 86, median = 7.0) than controls (n = 900, median = 5.0, P = .02), and for depression (median = 4.0) than controls (3.0, P < .001). Patients with high suicidal ideation, with low socioeconomic status and who were widowed or divorced were more likely to fulfil the HADS criteria for anxiety [odds ratio (OR) > 1, P = .038, P < .001, and P < .001, respectively]. The median Dermatology Life Quality Index score was 7.0 (n = 68). Discussion: This study identifies a specific psychological burden experienced by hand eczema patients, highlighting the need for focused psychosocial interventions. Physicians in particular should be aware of the need to identify anxiety and depression in female patients. [ABSTRACT FROM AUTHOR]

Background/aims: The decision to discharge is a critical and common outpatient consultation event. However, little guidance exists over how discharge decision-making can be taught. We aimed to provide educational recommendations concerning outpatient discharge decision-making.Methods: Recommendations were drawn from prior interviews with 40 consultant dermatologists and 56 dermatology outpatients, and from the "traffic light" design discharge information checklist, developed using the Delphi technique.Results: The key strategies to follow to appropriately manage the outpatient discharge process are: to warn patients in advance, to understand patients' agendas, to allow extra time for the discharge process, to prepare patients to self-manage, to provide a "safety net" and provide the GP with a clear management plan. Aspects to be considered include patient mobility, presence of carer, type of employment, diagnostic certainty, and use of the checklist or guidelines. Key training aspects include teaching structured thought processes when discharging, discharging according to context, developing communication and negotiation skills, avoiding decision biases and encouraging good interprofessional collaboration. Training should include the consideration of the possibility of discharge at each consultation. Novel training strategies have been developed on how to appropriately manage the outpatient discharge process, including involving and informing patients. These strategies focus on safe decision-making, being patient-centred and organizing an efficient health care service framework.Conclusion: Structured outpatient discharge training for dermatologists is now possible, based on information from detailed doctor- and patient-based qualitative studies. [ABSTRACT FROM AUTHOR]

Attachment styles of dermatological outpatients and satisfaction with their dermatologists were investigated within the framework of a multicentre study conducted in 13 European countries, organized by the European Society for Dermatology and Psychiatry. Attachment style was assessed with the Adult Attachment Scale. Patient satisfaction with the dermatologist was assessed with an 11-degree scale. A total of 3,635 adult outpatients and 1,359 controls participated in the study. Dermatological outpatients were less able to depend on others, were less comfortable with closeness and intimacy, and experienced similar rates of anxiety in relationships as did the controls. Participants who had secure attachment styles reported stressful life events during the last 6 months significantly less often than those who had insecure attachment styles. Patients with secure attachment styles tended to be more satisfied with their dermatologist than did insecure patients. These results suggest that secure attachment of dermatological outpatients may be a protective factor in the management of stress. [ABSTRACT FROM AUTHOR]

Introduction: Scarring on visible areas such as the face is associated with negative psychological impact. Many patients with acne have clinically relevant scarring for which they seek treatment, implying that there is an impact on their lives. Currently there are no validated tools to assess the burden of atrophic acne scarring from the patient's perspective or to assess treatment benefit. Methods: Two patient-reported outcome measures, the self-assessment of clinical acne-related scars (SCARS) and the facial acne scar quality of life (FASQoL) tools, both specific to facial atrophic acne scarring, were developed according to Food and Drug Administration guidance methodology. Patient interviews were conducted first to elicit patient-important concepts about scarring, then to validate patients' understanding of wording in the tools. These tools focus on symptoms (SCARS) and psychological and social well-being (FASQoL) and were designed to be suitable for self-completion and to be rapidly completed (2-5 min) within a clinical research setting. Results: Concept elicitation interviews were conducted with 30 subjects and cognitive interviews with 20 subjects. With acne scarring, important concepts for patients included size, surface area affected, counts, and depth. The SCARS and FASQoL tools were shown to address relevant concepts that were easily understood by patients. Conclusion: Two patient-reported measures, SCARS and FASQoL, have been developed to help clinicians assess the severity and impact of acne scars. Responsivity of these instruments to treatment will require further evaluation. Funding: Galderma R&D, Sophia Antipolis, France. [ABSTRACT FROM AUTHOR]

The article offers information about the concept of the minimal clinically important difference (MCID), which is reportedly used to interpret the meaning of health-related quality of life (HRQoL) score changes. Information about the proposed new concept of 2MCID, which represents a score change of twice the MCID and has been used in dermatology and other areas of therapies.

Background Acne vulgaris is a common skin condition that affects 8 out of 10 people. It varies from mild to severe, and different treatments target various aspects of the disease. Propionibacterium acnes, one of the culprits involved in the pathogenesis of acne vulgaris, is the main target of all major medical treatments used. Studies conducted in recent years have shown favorable effects within the visible light spectrum for the treatment of acne vulgaris. Objective In this study, we have evaluated the use of intense blue light within the spectral range of 415–425 nm (peak 420 nm) in the treatment of acne vulgaris. Methods Twenty-one patients with mild to moderate facial acne were treated with blue light phototherapy. All patients were given 14-min treatment sessions twice a week for 4 weeks. Acne severity was assessed using the Leeds Technique for grading and lesion counts. Disability was assessed using the Dermatology Life Quality Index (DLQI). In addition, standard digital and cross-polarized light photographs were taken and graded by a blinded evaluator. Visual analog scale (VAS) scores and cultures for P. acnes were carried out before starting the treatment and upon completion of the treatment. Results Significant improvement was achieved in the Leeds Acne Grade ( P = 0.001). The inflammatory ( P = 0.001) and noninflammatory ( P = 0.06) lesion counts also improved significantly. A similar change was noted in the DLQI ( P = 0.001); a degree of significance was also achieved in the patients’ and the investigators’ VAS scores ( P = 0.01 and P = 0.001, respectively). P. acnes colony counts failed to show a significant decrease at the end of the treatment and remained almost constant ( P = 0.660). Conclusions We believe that blue light does appear to have some role in the management of acne and may be beneficial for the treatment of a select group of mild to moderate acne patients. [ABSTRACT FROM AUTHOR]

There is no doubt that psoriasis can have adverse physical, social and psychological effects on an individual's quality of life (QoL). This has been demonstrated in a variety of studies that have employed an array of different qualitative and quantitative measures. The most effective method of measuring the impact of psoriasis on QoL will depend on the circumstances of the patient or study being considered. In most cases, it is best to use validated health-related QoL questionnaires. This has the potential to allow for more accurate comparisons to be made between patients, studies or populations, or comparisons in the same patient before and after interventions or over a period of time. This article reviews the studies and instruments that have examined the effects of psoriasis on QoL in the hope that this will improve our understanding of what is still a relatively new field in dermatology. [ABSTRACT FROM AUTHOR]

Background: Patient-reported quality of life is strongly affected by some dermatologic conditions. We developed a Japanese version of the Dermatology Life Quality Index (DLQI-J) and used psychometric methods to examine its validity and reliability. Methods: The Japanese version of the DLQI was created from the original (English) version, using a standard method. The DLQI-J was then completed by 197 people, to examine its validity and reliability. Some participants completed the DLQI-J a second time, 3 days later, to examine the reproducibility of their responses. In addition to the DLQI-J, the participants completed parts of the SF-36 and gave data on their demographic and clinical characteristics. Their physicians provided information on the location and clinical severity of the skin disease. Results: The participants reported no difficulties in answering the DLQI-J items. Their mean age was 24.8 years, 77.2% were female, and 78.7% had acne vulgaris. The mean score of DLQI was 3.99(SD: 3.99). The responses were found to be reproducible and stable. Results of principal-component and factor analysis suggested that this scale measured one construct. The correlations of DLQI-J scores with sex or age were very poor, but those with SF-36 scores and with clinical severity were high. Conclusion: The DLQI-J provides valid and reliable data despite having only a small number of items. [ABSTRACT FROM AUTHOR]

The article discusses dermatology training and career options in the Great Britain for Indian graduates. There has been a recent surge of overseas trainees arriving in the Great Britain and applying for clinical attachments. Most of these doctors have obtained the Professional and Linguistic Assessment Board certificate prior to seeking training posts. Dermatology requires a minimum of four years as a Specialist Registrar in a Dermatology Training Programme. Dermatology postgraduate training in the UK currently requires a period of training of at least 7 years after gaining a medical degree.

Explains the reasons for the measurement of the impact of skin diseases on patients' quality of life. Main methods of measuring quality of life in dermatology; Description of recent research in this area; Implications on dermatology, venereology and leprology.

Background: The objective of this study was to translate and to test the reliability and validity of the 10-item Dermatology Life Quality Index (DLQI) questionnaire in Iranian patients with vitiligo. Methods: Using a standard "forward-backward" translation procedure, the English language version of the questionnaire was translated into Persian (the Iranian official language) by two bilinguals. Seventy patients with vitiligo attending the Department of Dermatology, Saadi Hospital, Shiraz, Iran, were enrolled in this study. The reliability and internal consistency of the questionnaire were assessed by Cronbach's alpha coefficient and Spearman's correlation, respectively. Validity was performed using convergent validity. Results: In all, seventy people entered into the study. The mean age of respondents was 28.3 (SD = 11.09) years. Scores on the DLQI ranged from 0 to 24 (mean ± SD, 7.05 ± 5.13). Reliability analysis showed satisfactory result (Cronbach's α coefficient = 0.77). There were no statistically significant differences between daily activity (DA) and personal relationship (PR) scale mean scores in generalized versus focal-segmental involvement in sufferers (P = 0.056, P = 0.053, respectively). There were also strong differences between the mean scores of the PR (personal relationship) scale with the involvement of covered only and covered/uncovered areas (P= 0.016) that was statistically significant in the second group. Conclusions: The study findings showed that the Persian version of the DLQI questionnaire has a good structural characteristic and is a reliable and valid instrument that can be used for measuring the effects of vitiligo on quality of life. [ABSTRACT FROM AUTHOR]

Presents the guidelines for charter on visitation of training centers in dermatology and venereology in Europe. Important factors in the domain of quality of medical care; Visitation of training centers; Establishment of programs for statutory visits.

Background Measures of the impact of severe eczema on patients' lives are required for clinical, audit and political reasons, in order to argue for more resources for dermatology services. Objective The purpose of this study was to identify and measure the effects of severe eczema on quality of life of adults. Setting Dermatology hospital based clinics throughout the United Kingdom. Methods Ninety-two adults with severe atopic eczema completed a questionnaire concerning the effect of their disease on their quality of life. Results The mean Dermatology Life Quality Index was 18 (60%). S.D. 7.1. with subsections relating to "symptoms and feelings" and "treatment effects" scoring highest. Disease comparison utility questions demonstrated that patients with severe eczema consider that having diabetes (ratio = 1.21) or hypertension (1.38) would be better than having eczema, whereas having bronchitis (0.89) would be worse than having eczema (if diseases equal, ratio = 1). Over the long term, atopic eczema affects family life in 80% of patients and sexual relationships in 57%. 32% of patients had lost a median income of £5000 over the previous year because of their eczema, and those patients who were working had lost a median of 5 days from work over the previous year. 50% of patients would be prepared to give up 2 h or more a day in order to have normal skin, and 74% (49%) of patients would be prepared to pay £1000 (£10,000) or more for a cure. Conclusion This study confirms the major impact of severe atopic eczema on the quality of life of adults. [ABSTRACT FROM AUTHOR]

Twenty patients with disabling disorders of keratinization were treated with Tigason (etretinate, Ro 10-9359), an oral aromatic retinoid, and the clinical responses and the effects on the skin were monitored. Most patients showed a considerable clinical improvement within 4 weeks. Side effects, such as cheilitis, were common but mostly transient or minor. In the skin there was a decrease in glucose-6-phosphate dehydrogenase activity within the granular cell layer of the epidermis, and an increase in mean epidermal thickness and mean corneocyte area. However, there was little apparent effect on epidermal proliferation or on histological and ultrastructural appearances. These findings suggest that the drug acts at a late stage of epidermal differentiation. Certain congenital disorders of keratinization are physically and socially disabling. The treatment for these diseases, which include severe ichthyosis vulgaris, lamellar ichthyosis and erythrokeratoderma variabile, has been unsatisfactory and the patients have often been condemned to lead lives of incapacity, discomfort and isolation. Vitamin A has profound effects on epithelial differentiation and the synthesis of more potent and less toxic vitamin A derivatives (‘the retinoids’) has suggested a new approach to the treatment of these disorders. In this investigation we have studied the clinical response of a group of patients with severe congenital disorders of keratinization to one such drug, Tigason, and monitored its effects on the skin. [ABSTRACT FROM AUTHOR]

The article focuses on the attempts that have been made in the past concerning skin diseases and discusses the evaluation of the differing, but related impact on the lives of sufferers of skin disease in the developing and the developed world. The International Committee of Dermatology has noted that the important objective of "Health for All," promulgated by the World Health Organization, although having well being as an endpoint, has not so far emphasized the value of a healthy Skin.

The article discusses the Dermatology Life Quality Index (DLQI), which reflects the experience of patients suffering with skin diseases. It informs that the questions in DLQI are derived entirely from the experience of patients with a variety of skin diseases, which helps the dermatologist in the treatment of diseases. It further states that the main purpose for creating DLQI is enhancing the health related quality of life (HRQoL) issues in daily clinical practices.

Presents an introduction to the September 2005 issue of the periodical "Acta Dermato-Venereologica."

Abstract Skin conditions may have a major impact on the psychologic well-being of patients, ranging from depression to anxiety. The Dermatology Life Quality Index (DLQI) is the most commonly used quality of life tool in dermatology, though it has yet to be correlated with psychiatric measures used in clinical therapeutic trials. We conducted a systematic review to determine whether there is any correlation between the DLQI and psychiatric measure scores, potentially allowing the DLQI to be used as a surrogate measure for depression or psychiatric screening. Six databases were searched using the following keywords: "DLQI," "Dermatology Life Quality Index," "Psych*," "depression," "anxiety," "stress," and "trial*." All randomized trials where full DLQI and psychiatric scores were provided were included. PRISMA guidelines were followed. In all, 462 records were screened, but only seven met inclusion criteria. Hospital Anxiety and Depression Scale (HADS) was the most commonly used psychiatric measure; the "depression" component score changes correlated strongly with the DLQI (r = 0.715). There needs to be guidance on psychiatric measurement and reporting in clinical trials. Although the DLQI correlated well with the "depression" domain of the HADS scale, interviews and screening for depression are still vital for full assessment of patient psychologic well-being. [ABSTRACT FROM AUTHOR]

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants--3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67-3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68-2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33-2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications. [ABSTRACT FROM AUTHOR]

The expression of different keratin intermediate filaments has been used to define keratinocyte maturation and different phenotypic subtypes involved in acute wound (AW) healing. Immunohistochemistry with specific anti-keratin monoclonal and polyclonal antibodies was used to examine AW in normal healthy volunteers (n=16). In all wounds examined, basal keratinocytes and cells at the leading edge of the wound expressed keratins K5 and K14. However, suprabasal cells had a more complex pattern of keratin expression, which was dependent on their position relative to the wound and location within the suprabasal compartment of the epidermis. In general, K10 was expressed in suprabasal keratinocytes at the wound edge, but not in keratinocytes covering the wound center, which expressed K6, K16, and K17 in a complex fashion. Ki67 expression, a marker of cell proliferation, was restricted to basal and immediate suprabasal layers at the wound edge. Keratinocytes populated the wound bed below the scab by migration, which was supported by keratinocyte proliferation in the surrounding epidermis both at and adjacent to the wound edge. [ABSTRACT FROM AUTHOR]

This study's aim was to determine the relationship between Dermatology Life Quality Index (DLQI) scores and a Global Question (GQ) concerning patients' views of the overall impairment of their skin-related quality of life (QoL), and to express this relationship by identifying bands of DLQI scores equivalent to each GQ descriptor. A DLQI questionnaire and the GQ were mailed to 3834 adult general dermatology outpatients. There were 1993 (52%) responses: male 841; female 1152. Mean DLQI score=4.86 (range 0–30, standard deviation (SD)=5.83). Mean GQ score=1.22 (range 0–4, SD=1.20). The mean, mode, and median of the GQ scores for each DLQI score were used to devise several sets of bands of DLQI scores, and κ coefficients of agreement calculated. The set proposed for adoption is: DLQI scores 0–1=no effect on patient's life (GQ=0, n=754); DLQI scores 2–5=small effect on patient's life (GQ=1, n=611); DLQI scores 6–10=moderate effect on patient's life (GQ=2, n=327); DLQI scores 11–20=very large effect on patient's life (GQ=3, n=242); DLQI scores 21–30=extremely large effect on patient's life (GQ=4, n=59); κ coefficient 0.489. Banding of the DLQI will aid the clinical interpretation of an individual's DLQI score and allow DLQI scores to inform clinical decisions. [ABSTRACT FROM AUTHOR]