Summary
Background
Generic instruments measuring health‐related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical ...conditions, as well as calculation of utility data.
Objectives
To measure HRQoL in patients with common skin diseases and healthy controls across Europe using the EQ5D.
Methods
This multicentre observational cross‐sectional study was conducted in 13 European countries. Each dermatology clinic recruited at least 250 consecutive adult outpatients to complete questionnaires, including the EQ5D.
Results
There were 5369 participants (4010 patients and 1359 controls). Mean ± SD self‐rated health state reported by patients was 69·9 ± 19·7; for controls it was 82·2 ± 15·5. When adjusted for confounding factors, including comorbidity, mean patient EQ visual analogue scores were 10·5 points lower than for controls (standardized β = −0·23). Odds ratio with 95% confidence interval for impairment in all five dimensions of EQ5D adjusted for confounders was doubled for patients compared with controls. Patients with hidradenitis suppurativa (HS), blistering conditions, leg ulcers, psoriasis and eczemas had the highest risk for reduction in HRQoL in most dimensions (2–10‐fold). Data on differences of impairment by dimensions offer new insights.
Conclusions
This study confirms the large impact skin conditions have on patients’ well‐being, differentiating between aspects of HRQoL. Patients with HS, blistering diseases, leg ulcers, infections and most chronic skin diseases reported reduced HRQoL compared with patients with chronic obstructive lung disease, diabetes mellitus, cardiovascular disease and cancers. These findings are important in the prioritization of resource allocation between medical fields and within dermatological subspecialities.
What is already known about this topic?
The EQ5D™ can be used to compare life quality impairment from diseases across a range of specialties and to generate utility data.
The EQ5D has previously been little used in dermatology.
What does this study add?
This study has generated EQ5D data across a range of dermatological diagnoses in a large cohort of patients across Europe.
Skin diseases affect quality of life differently across different dimensions.
This EQ5D information may assist appropriate care and resource allocation.
Respond to this article
Itch is the most frequent symptom in dermatology and has been researched more extensively in recent years. Nevertheless, there are few true epidemiological studies on itch. The aim of this paper is ...to review the current state of research on the epidemiology of chronic itch in Western and non-Western populations. The electronic databases PubMed, Medline and the Cochrane Library were searched. Conference proceedings and national and international studies were included. It is difficult to compare existing studies due to differing methodology and lack of standardized measures. The symptom of itch is a challenge, not only to clinicians, but also within the structure of regional health systems, and with regards to accessibility to specialized medical doctors in non-Western countries. Published studies show that the symptom of itch is highly prevalent; it should therefore receive adequate attention from physicians and other healthcare providers, including healthcare planners.
The burden of atopic dermatitis (AD) was assessed. A population-based, cross-sectional questionnaire study was performed among 34,313 Swedish adults in 2017. The prevalence of AD was 14%. Adults with ...mild AD had an increased relative risk ratio (RRR) of severe depression (aRRR 1.78, 95% confidence interval (95% CI) 1.50-2.12) and anxiety (aRRR 1.97, 95% CI 1.69-2.30), which was higher for severe AD (aRRR 6.22 95% CI 4.60- 8.42, aRRR 5.62 95% CI 4.10-7.71, respectively). Persons with severe AD were less likely to have a university degree (aRRR 0.55, 95% CI 0.34-0.90) and more likely to have a lower annual income (238,000-324,000 SEK: aRRR 0.51, 95% CI 0.39-0.77; 325,000 SEK or more 0.36; 0.25-0.58) compared with individuals without AD. These results suggest that AD implies an increased prevalence of comorbid mental conditions and an adverse impact on academic achievement and work. These adverse associations increase substantially for patients with severe AD and comorbid asthma.
Background
Acne is a very common skin condition, and it is of great interest to elucidate lifestyle factors that may contribute to its occurrence. In the last decade, the acne‐diet connection has ...been brought back to credibility.
Objective
To examine whether high intakes of dairy products in early adolescence is associated with moderate to severe acne in later adolescence.
Methods
The study is a longitudinal, questionnaire‐based population study of Norwegian adolescents. Students attending the 10th grade (15–16 years old) of compulsory schooling in Oslo in 2000–2001 and the 13th grade (18–19 years old) 3 years later, in 2004, were invited. Dairy product consumption was self‐reported at age 15–16 and acne severity was self‐assessed and reported at age 18–19.
Results
The overall prevalence of moderate to severe acne was 13.9%. High intakes (≥2 glasses per day) of full‐fat dairy products were associated with moderate to severe acne. In boys with exclusively high intakes of full‐fat dairy products, the odds ratio for acne was 4.81 (1.59–14.56). A high total intake of dairy products was associated with acne in girls (OR 1.80, 1.02–3.16). No significant associations were found between acne and intake of semi‐skimmed or skimmed dairy products, and not with moderate intakes of any fat variety of dairy products.
Conclusion
This study shows association between high intakes of dairy products and acne in adolescence. Our findings support a hypothesis suggesting that dairy consumption may be a factor contributing to acne. The study is based on multiple hypothesis testing, and the methodological limitations must be considered when interpreting the results.
Background
The term prurigo has been used for many decades in dermatology without clear definition, and currently used terminology of prurigo is inconsistent and confusing. Especially, itch‐related ...prurigo remains unexplored regarding the epidemiology, clinical profile, natural course, underlying causes, available treatments and economic burden, although burdensome and difficult to treat.
Objective
To address these issues, the multicentre European Prurigo Project (EPP) was designed to increase knowledge on chronic prurigo (CPG). In the first step, European experts of the EADV Task Force Pruritus (TFP) aimed to achieve a consensus on the definition, classification and terminology of CPG. Additionally, procedures of the cross‐sectional EPP were discussed and agreed upon.
Methods
Discussions and surveys between members of the TFP served as basis for a consensus conference. Using the Delphi method, consensus was defined as an agreement ≥75% among the present members.
Results
Twenty‐four members of the TFP participated in the consensus conference. Experts consented that CPG should be used as an umbrella term for the range of clinical manifestations (e.g. papular, nodular, plaque or umbilicated types). CPG is considered a distinct disease defined by the presence of chronic pruritus for ≥6 weeks, history and/or signs of repeated scratching and multiple localized/generalized pruriginous skin lesions (whitish or pink papules, nodules and/or plaques). CPG occurs due to a neuronal sensitization to itch and the development of an itch‐scratch cycle.
Conclusion
This new definition and terminology of CPG should be implemented in dermatology to harmonize communication in the clinical routine, clinical trials and scientific literature. Acute/subacute forms of prurigo are separated entities, which need to be differentiated from CPG and will be discussed in a next step. In the near future, the cross‐sectional EPP will provide relevant clinical data on various aspects of CPG leading to new directions in the scientific investigation of CGP.
Background
Hair diseases play an important burden on patients’ lives, causing significant emotional and psychosocial distress. However, the impairment due to different hair conditions, such as ...alopecia areata (AA) and androgenetic alopecia (AGA), has rarely been compared.
Objective
The aim of this study was to assess the psychological burden of subgroups of patients with different hair diseases and to compare them to a healthy population.
Methods
In this study, we analysed a subgroup of patients with hair diseases from patients of a large multicentre study including 3635 dermatological patients and 1359 controls from 13 European countries. In the subgroup of patients with hair diseases, we analysed the socio‐demographic characteristics, the stress level, and the impact of hair diseases on quality of life (QoL), anxiety, and depression and we compared them among patients with AA, AGA and healthy controls.
Results
The study population included 115 patients (77% women, 23% men) with hair diseases, 37 of whom with AA and 20 with AGA. Patients with hair diseases had a lower education level than healthy controls (medium educational level: 43% vs. 28%). Overall, 41% of the patients reported stressful life events during the last 6 months compared with 31% of the controls. Patients with the same age, sex, depression level and comorbidities had a worse QoL when suffering from AA than from AGA (Mean Dermatology Life Quality Index score: 5.8 vs. 2.5).
Conclusion
Patients with hair diseases are more anxious, depressed and have a lower QoL than controls.
Summary
Background
It was recently demonstrated that a significant number of patients with common skin diseases across Europe are clinically depressed and anxious. Studies have shown that physicians ...not trained as psychiatrists underdiagnose depression. This has not been explored among dermatologists.
Objectives
To estimate the concordance between clinical assessment of depression and anxiety by a dermatologist and assessment with the Hospital Anxiety and Depression Scale (HADS).
Methods
The study was an observational cross‐sectional multicentre study of prevalent cases of skin diseases in 13 countries in Europe. Consecutive patients were recruited in outpatient clinics and filled in questionnaires prior to clinical examination by a dermatologist who reported any diagnosis of skin disease and signs of mood disorders.
Results
Analysis of the 3635 consultations showed that the agreement between dermatologist and HADS was poor to fair (lower than 0·4) for all diagnosis categories. The true‐positive rate (represented by the percentage of dermatologists recognizing signs of depression or anxiety in patients with depression or anxiety as defined by a HADS value ≥ 11) was 44·0% for depression and 35·6% for anxiety. The true negative rate (represented by the percentage of dermatologists not detecting signs of depression or anxiety in non‐depressed or non‐anxious patients defined by HADS‐value < 11) was 88.8% for depression and 85.7% for anxiety.
Conclusions
Dermatologists in Europe tend to underestimate mood disorders. The results suggest that further training for dermatologists to improve their skills in diagnosing depression and anxiety might be appropriate. When present, the psychological suffering of patients with dermatological conditions needs to be addressed.
What's already known about this topic?
It has recently been demonstrated that patients with common skin diseases have more depression and anxiety than controls.
Research has shown that physicians who are not trained as psychiatrists miss depression in their patients.
What does this study add?
A large proportion of cases of depression in patients with skin disease are not diagnosed by dermatologists.
These results indicate that further training for dermatologists to assess depression and anxiety might be appropriate.
Linked Editorial: Montgomery and Thompson. Br J Dermatol 2018; 179:237–238.
Plain language summary available online
Respond to this article
Background
Prurigo is defined by the presence of chronic pruritus and multiple localized or generalized pruriginous lesions.
Objective
The aim of this study was to assess the psychological burden of ...prurigo in patients of European countries.
Methods
In this multicentre European study, 3635 general dermatology outpatients and 1359 controls were included. Socio‐demographic data and answers to questionnaires (regarding quality of life, general health, anxiety and depression and suicidal ideation) were collected.
Results
There were 27 patients with prurigo; of these, 63% were men, and the mean age was 58.6 years. Among patients with prurigo, 10 of 27 (37%) suffered from anxiety and 8 of 27 (29%) from depression. Suicidal ideation was reported in 5 of 27 (19%) patients, and for four of these five patients, suicidal ideation was related to their skin disease. These frequencies were higher in the 10 commonest dermatological diseases (including psoriasis, atopic dermatitis and leg ulcers). The impact on quality of life was severe, with a mean Dermatologic Life Quality Index (DLQI) of 12.4, with an extreme impact on quality of life for 23% of patients and a very large impact for 27% of patients.
Conclusion
The psychological comorbidities of prurigo are common, greater than those of other skin diseases, and their impact on quality of life is significant. Thus, it is important to study this condition and to find new treatments.
The patient is the centre of a web of relationships, and the impact of his/her disease on family members and caregivers must be taken into account. The aim of this study was to identify the specific ...instruments that measure the impact of a dermatological disease on the quality of life (QoL) of family members, by performing a systematic search of the literature. Fifteen papers were identified, describing the creation and validation of nine instruments. Four of them concerned atopic dermatitis (Dermatitis Family Index, DFI; Parents’ Index QoL Atopic Dermatitis, PiQoL‐AD; QoL in primary caregivers of children with atopic dermatitis, QPCAD; Childhood Atopic Dermatitis Impact Scale, CADIS), two measured the impact of psoriasis in family members (Psoriasis Family Index, PFI; FamilyPso), one the impact of epidermolysis bullosa (Epidermolysis Bullosa Burden of Disease, EB‐BoD), one of ichthyosis (Family Burden Ichthyosis, FBI), and one was generic for dermatological conditions (Family Dermatology Life Quality Index, FDLQI). The European Academy of Dermatology and Venereology quality of life taskforce recommends that the impact of a skin disease on family and caregivers should be measured as part of any thorough evaluation of the burden of a disease. Guidelines are given to choose the most appropriate instruments.
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