Search

Background Body dysmorphic disorder (BDD) is a common psychiatric disorder associated with high costs for healthcare systems as patients may repeatedly ask for different, often not effective, interventions. BDD symptoms are more prevalent in patients with dermatological conditions than in the general population, but there are no large sample studies comparing the prevalence of BDD symptoms between patients with dermatological conditions and healthy skin controls. Objectives To compare the prevalence of BDD symptoms between patients with different dermatological conditions and healthy skin controls and to describe sociodemographic, physical and psychological factors associated with BDD symptoms to identify patients who may have a particularly high chance of having this condition. Methods This observational, cross-sectional, comparative multicentre study included 8295 participants: 5487 consecutive patients with different skin diseases (56% female) recruited among dermatological outpatients at 22 clinics in 17 European countries, and 2808 healthy skin controls (66% female). BDD symptoms were assessed by the Dysmorphic Concern Questionnaire. Sociodemographic data and information on psychological factors and physical conditions were collected. Each patient was given a dermatological diagnosis according to ICD-10 by a dermatologist. The study was registered with number DRKS00012745. Results The average participation rate of invited dermatological patients was 82.4% across all centres. BDD symptoms were five times more prevalent in patients with dermatological conditions than in healthy skin controls (10.5% vs. 2.1%). Patients with hyperhidrosis, alopecia and vitiligo had a more than 11-fold increased chance (adjusted Odds Ratio (OR) > 11) of having BDD symptoms compared with healthy skin controls, and patients with atopic dermatitis, psoriasis, acne, hidradenitis suppurativa, prurigo and bullous diseases had a more than sixfold increased chance (adjusted OR > 6) of having BDD symptoms. Using a logistic regression model, BDD symptoms were significantly related to lower age, female sex, higher psychological stress and feelings of stigmatization. Conclusions Clinical BDD symptoms are significantly associated with common dermatological diseases. As such symptoms are associated with higher levels of psychological distress and multiple unhelpful consultations, general practitioners and dermatologists should consider BDD and refer patients when identified to an appropriate service for BDD screening and management. What is already known about this topic? Body dysmorphic disorder (BDD) is a common psychiatric disorder with a prevalence of about 2% in the general population. Skin diseases pose a high psychological burden on patients. People with these problems often experience increased self-consciousness, skin-related shame and stigmatization. Single-centre studies including small samples of patients with skin conditions showed that these patients show symptoms of a similar nature to BDD more often than the general population. What does this study add? In this large multicentre study, BDD symptoms were fivefold more prevalent in dermatological patients than in healthy skin controls, and were related to young age, female sex, psychological stress and stigmatization experience. Certain patient groups (e.g. hyperhidrosis) had a greater than 11-fold increased chance of BDD symptoms compared with controls.Doctors should consider appearance-related concern and BDD more often and refer patients when needed to an appropriate service for assessment and treatment.

P15 Background: Dupilumab, an anti-interleikin-4-receptor-a monoclonal antibody, is a new treatment for atopic dermatitis in adults. Objective: To evaluate – at week 52 – patient reported outcomes, satisfaction, efficacy and safety, with dupilumab in adult patients with moderate-to-severe atopic dermatitis refractory to the usual treatments previously performed under conditions of usual clinical practice. Methods: Twelve patients were enrolled. Patients from our hospital, under routine clinical practice, were treated with subcutaneous dupilumab 300 mg every 2 weeks. The outcomes were evaluated at baseline, week 4, 8, 12, 16, 28 , 40 and week 52. The variables evaluated were: itch, difficulty to sleep, previous stressful life events, severity (SCORAD), anxiety and depression symptoms (HADS), quality of life (DLQI, EQ5D3L), satisfaction, adherence to the treatment, efficacy and safety. Results: At week 52 significant improvement was observed in severity, itch, difficulty to sleep, anxiety and depression symptoms, and quality of life. Satisfaction with dupilumab compared to previous treatments was significantly higher in all aspects assessed. No significant dupilumab-induced laboratory abnormalities were noted, and adverse events were mild and transient. Conclusions: Dupilumab used under routine clinical practice for 52 weeks improved atopic dermatitis signs and symptoms, with a good safety profile and patient satisfaction.

P14 Introduction: Hidradenitis Suppurativa (HS) has been associated with impaired quality of life (QoL). There are various measuring systems to assess physical severity; however, there are no specific QoL questionnaires for this disease in the Spanish language. Objective: To develop and validate a disease-specific instrument to measure QoL in patients with HS. Methods: A literature search was carried out to prepare a semi structured interview for patients with HS, as well as a Delphi expert consensus among health professionals. The validation with a sample of 130 patients is presented. The preliminary validation of the HSQoL-24 was passed twice to a group of 30 patients with 30 ± 10 days of interval. The DLQI and the Skindex-29 were used for its validation. Results: Cronbach alpha 0.87 indicates a good internal consistency of the questionnaire. The intraclass correlation coefficient (ICC) with the DLQI was 0.70 (p-value) (< 0.001), and 0.87 (p-value) (< 0.001) with the Skindex-29. Conclusions: The HSQoL-24 is the first specific self-administered questionnaire to assess QoL in patients with HS in Spanish. It is user friendly and easy to. This study demonstrates the excellent properties of the instrument: comprehensibility, reliability (test-retest), internal consistency, validity, comparison with DLQI and SKINDEX-29, and discriminative capacity.

Altres ajuts: reports grants, personal fees, non-financial support and other from Abbvie, Almirall, Amgen, Boehringer, Celgene, Janssen-Cilag, Leo Pharma, Lilly, MSD-Schering-Plough, Novartis, Pfizer and UCB, outside the submitted work. TGC reports personal fees from Lilly and Novartis, outside the submitted work. LP reports grants and personal fees from AbbVie, Almirall, Amgen, Boehringer Ingelheim, Celgene, Janssen, Leo-Pharma, Lilly, Novartis, Pfizer, Regeneron, Roche, Sanofi, and UCB, personal fees from Baxalta, Biogen, Fresenius-Kabi, JS Biocad, Mylan, Sandoz, Samsung-Bioepis, and Bristol Myers Squibb, outside the submitted work. The other authors have no conflicts of interest to declare. To date, there are no disease-specific instruments in Spanish to assess quality of life of patients with hidra-denitis suppurativa. A multicentre study was pre-viously carried out in Spain between 2016 and 2017 to develop the Hidradenitis Suppurativa Quality of Life-24 (HSQoL-24), a disease-specific questionnaire to assess quality of life in patients with hidradenitis suppurativa. The objectives of this study are to revali-date the HSQoL-24 in Spanish with a larger sample of patients, and to present the English version. In this multi centre study in Spain, patients with hidradenitis suppurativa completed the HSQoL-24, the Dermatology Life Quality Index and the Skindex-29. The Hurley staging system was used to assess the severity of the disease. Validation of the questionnaire was carried out in 130 patients, of whom 75 (57.7%) were women. This study demonstrates adequate values of reliability and validity of the HSQoL-24, confirming the previous test re-test validation and making this questionnaire one of wide clinical validity in terms of results perceiv-ed by patients.

Children with epidermolysis bullosa (EB) experienced the highest quality of life impact among several skin conditions and have problems which had not been reported by parents of children with other skin diseases. The EB-specific module of the Infants and Toddlers Dermatology Quality of Life (InToDermQoL) questionnaire was recently developed to measure the impact of disease-specific aspects in children from birth to the age of 4 years. The aim of this study was initial validation of the InToDermQoL-EB questionnaire. Parents of 44 children with EB from seven countries completed the InToDermQoL-EB questionnaire. Cronbach's alpha was.86,.89 and.91 for three age-specific versions. Differences between severity levels were all significant except for that between moderate and severe level in the version for 3- to 4-year-old children. All items of the three versions of the InToDermQoL-EB showed very high levels of relevance except “problems with defecation” in children younger than 1 year and “rejection by other children” in 3- to 4-year-old children. The three versions of the InToDermQoL-EB instrument showed good internal consistency and discriminated well between different severity levels. All InToDermQoL-EB items were confirmed as being of high relevance and the questionnaire may be used in practice and clinical trials. © 2020 Wiley Periodicals LLC.

P16 Objective: Atopic dermatitis affects patients’ quality of life (QoL) in many ways. It is important to analyze the impact that the disease produces in order to better define the healthcare needs of adult patients with atopic dermatitis. Patients and Methods: 14 adult patients with atopic dermatitis were interviewed. The qualitative interviews were semi-structured and supported by a simple script, which allowed a complete and flexible interview. Results: Six affected areas of the patient’s life with atopic dermatitis were identified: economic, work-related, personal, psychosocial, clinical and relational. It is emphasized that atopic dermatitis has a great psychosocial impact on the adult patient, since it alters interpersonal relationships, generates rejection, stigmatization and social isolation, limits the patient in various areas and activities of their daily life or alters sleep, among others. The visible aspect, the itching-scratching cycle, the lack of awareness and ignorance of the disease, the lack of a definitive solution among the treatments and the side effects of some of them are of great concern. Conclusions: The QoL of the patients with atopic dermatitis is negatively affected and a holistic multidisciplinary intervention is necessary in order to mitigate the negative impact of the disease.

Itch is an unpleasant symptom, affecting many dermatological patients. Studies investigating the occurrence and intensity of itch in dermatological patients often focus on a single skin disease and omit a control group with healthy skin. The aim of this multi-centre study was to assess the occurrence, chronicity and intensity (visual analogue scale 0–10) of itch in patients with different skin diseases and healthy-skin controls. Out of 3,530 dermatological patients, 54.3% reported itch (mean ± standard deviation itch intensity 5.5 ± 2.5), while out of 1,094 healthy-skin controls 8% had itch (3.6 ± 2.3). Chronic itch was reported by 36.9% of the patients and 4.7% of the healthy-skin controls. Itch was most frequent (occurrence rates higher than 80%) in patients with unclassified pruritus, prurigo and related conditions, atopic dermatitis and hand eczema. However, many patients with psychodermatological conditions and naevi also reported itch (occurrence rates higher than 19%).

We designed a qualitative study to interview 12 patients with Hidradenitis Suppurativa. This was done by means of a semistructured interview. Questions on quality of life, the impact of their skin disease on family, friends, work, intimate relationships, treatments, etc. were asked. Patients consented to be interviewed and to be video taped to facilitate the transcription of the interviews. The interviews lasted between 30 and 60 minutes and were carried out by a psychologist and a social worker. The dermatologist had previously seen the patients and filled in a form with the Hurley Stage, years of evolution and treatment...

Background: Until now, there was no validated dermatology-specific health-related quality of life (HRQoL) instrument to be used in youngest patients. Objective: To create dermatology-specific proxy instrument for HRQoL assessment in children from birth to 4 years. Methods: International focus groups, item selection and pilot tests were utilized. In order to avoid the problem of cross-cultural inequivalence, focus group work and pilot tests were planned simultaneously in all national centres of the project. Comprehensibility, clarity, acceptance and internal consistency of new instrument were checked. Results: The title ‘Infants and Toddlers Dermatology Quality of Life’ was chosen for our new instrument with the proposed acronym ‘InToDermQoL’. Focus group work was completed in seven national centres (Croatia, Germany, Greece, Malta, Poland, Romania and Ukraine). A total of 170 families of children with different skin diseases were interviewed, and a pilot version of the instrument was created. Centres from France, Denmark and Spain have joined the project at this stage. Parents of 125 children with skin diseases filled in the pilot versions of the instrument. Good comprehensibility, clarity, acceptance and internal consistency of the InToDermQoL were confirmed. The pilot test results showed that the InToDermQoL questionnaire well differentiates severity-dependent differences. It was also checked and confirmed during the pilot test that no significant information was missed in the questionnaire. Three age-specific versions of the InToDermQoL questionnaire with 10, 12 and 15 items, respectively, were approved for field tests. Conclusion: The pilot test results showed that the InToDermQoL questionnaire has good comprehensibility, clarity, acceptance and internal consistency and well differentiates severity-dependent differences. Further validation of the InToDermQoL during international field test will be performed. © 2018 European Academy of Dermatology and Venereology

Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3-Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health-related QoL assessment in acne and because of the high impact of acne on patients’ lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations. © 2017 European Academy of Dermatology and Venereology

Body Dysmorphic Disorder (BDD), is a mental health disorder that is difficult to diagnose, causes much suffering and is a challenge to treat. The main symptoms are the preoccupation with the perceived defect and the actions taken to reduce accompanying feelings of distress. Prevalence of BDD is between 9% and 12% in dermatology patients. Although the onset of BDD is usually during adolescence, patients are usually diagnosed after many years of suffering, in part because patients are too ashamed to talk about their symptoms. The main objective of this multicenter study carried out in Spain, was to screen patients diagnosed with acne vulgaris for BDD by asking appearance-specific questions. A total of 403 patients were screened...