A comprehensive health impact assessment and determinants of quality of life, health and psychological status in acne patients.

AIM: Acne adversely affects all aspects of quality of life (QoL). Although many papers assessed acne-specific QoL impairment, there are few data on its impact on general health and psychological status. Apart from acne severity, little is known about determinants of a worse QoL. The aims of this paper were to measure acne impact on QoL, health and psychological status and to analyze the relationship between socio-demographic variables, disease severity and mental status on QoL of acne sufferers. METHODS: Acne cases were selected from a survey conducted in 2010. The Short-Form 12-Item Health Survey and the Skindex-29 were used to assess health status and QoL. The 12-Items General Health Questionnaire was used to identify individuals at risk for non-psychotic psychiatric disorders (GHQ-positive). Physician (PhGA) and patient global assessments were obtained. We investigated the variables involved in the QoL through a logistic regression analysis. RESULTS: One hundred ninety-five cases were analyzed. Twenty-six percent were GHQ-positive; acne's impact on health status was worse compared to other chronic diseases. A GHQ-positive status (Skindex-29 overall: OR 2.6; 95% CI 1.20-5.60, P<0.05, functioning: OR 2.5; 95% CI 1.17-5.44, P<0.05, symptoms: OR 3.0; 95% CI 1.36-6.53, P<0.01; emotions: OR 2.55; 95% CI 1.19-5.46, P<0.05) and having a severe/very severe PhGA (Skindex-29 overall: OR 3.4; 95% CI 1.20-10.38, P<0.05) were associated with a poor QoL. Age of onset >25 was linked to being GHQ-positive (OR 2.92; 95% CI 1.2-7.1, P<0.05) controlling for gender, marital status and educational level. CONCLUSION: Acne is not a minor disease in comparison with other chronic conditions. Age of onset is capable to influence GHQ status which in turn affects QoL.

Psoriasis and seborrheic dermatitis in infancy and childhood.

Psoriasis is a common inflammatory dermatosis that may be seen in infants, children, and adolescents. The clinical presentation and course may be quite variable, and while patients with mild disease are often easily managed, those with recalcitrant or more severe disease often present a therapeutic dilemma given the number of therapies available and the relative lack of data on the efficacy and safety of use of these therapies in children. Diagnosis in children can be more difficult, but family history may be helpful. Moreover, sometimes clinical pattern of pediatric psoriasis is very different from its adult counterpart or it could manifests in association with atopic dermatitis, and for these reason it is possibly misdiagnosed and under recognized. We therefore focus on diagnostic patterns and effective treatments of this challenging disease.

An update on juvenile dermatomyositis.

Juvenile dermatomyositis (JDM) is a rare, severe, autoimmune disease characterized by a small-vessel vasculopathy that primarily affects skin and muscle, but also lung, joints, gut and heart. Nowadays prompt recognition of this entity and aggressive treatment, when needed, improves outcomes and has decreased mortality that, before corticosteroid became a mainstay in therapy, could reach 40%.

Burden of disease during quiescent periods in patients with pemphigus.

BACKGROUND: Studies conducted using different tools have invariably observed that physical and mental components of health status are seriously compromised in patients with pemphigus. An improvement in quality of life (QoL) has been commonly observed over the treatment period. OBJECTIVES: The aim of the study is to verify whether the patients' wellbeing is affected by pemphigus also in absence of cutaneous and mucosal lesions. MATERIALS AND METHODS: The clinical records of 203 patients were analysed. A total of 47 patients were without bullae/erosions and reported a score = 0 for both the Patient Global Assessment and the Ikeda index. In order to assess the QoL we used the Skindex-17 and the 12-item General Health Questionnaire (GHQ-12). RESULTS: Patients without bullae/erosions had a better QoL when compared with patients with active lesions. This difference, with a reduction of approximately 30% of the Skindex-17 scores in the patients without lesions, was statistically significant, for both the symptoms and the psychosocial scales. The proportion of patients at risk of anxiety/depression (GHQ-positive cases) was 44% lower in patients without lesions compared with patients with lesions. In a multiple linear regression model the presence of bullae/erosions negatively influences QoL with an average increase of Skindex-17 symptoms and psychosocial scale scores of 11·7 and 10·6 points, respectively. Female patients had a statistically significantly worse QoL than males on the symptoms but not on the psychosocial Skindex-17 scales. CONCLUSIONS: While patients without lesions reported a better QoL than patients with bullae/erosions, their Skindex-17 scores remained elevated. Dermatologists should be aware that a clearing of the skin manifestations does not mean 'perfect health' for the patient.

Evaluation of the impact of writing exercises interventions on quality of life in patients with psoriasis undergoing systemic treatments.

BACKGROUND: Emotional writing is a short-term psychological intervention that has been successfully used in several controlled studies. OBJECTIVES: The overall objective of the study was to test the efficacy of Pennebaker's emotional writing intervention in patients with psoriasis treated with systemic therapy. METHODS: A randomized controlled trial was conducted in seven clinical centres in Italy, over a 2-year period. The main outcome measures were the psoriasis area and severity index and the Physician Global Assessment, as well as generic and dermatology-specific quality of life questionnaires. Such outcomes were measured at 4 weeks, and 6 and 12 months from baseline. The project recruitment time was 12 months, and the total follow-up time for each individual was also 12 months. RESULTS: In total, 202 patients were enrolled and assessed at baseline, 67 of whom completed all three follow-up visits. The writing exercise had little or no effect on patients with psoriasis who were undergoing systemic treatment. In the Generalized Estimating Equations models no statistically significant differences were observed in the Pennebaker intervention group vs. the control group. In subgroup analysis for health status, small effects in favour of patients assigned to the Pennebaker group were documented at the end of the study in women, in overweight individuals, in patients under treatment with biological drugs, and on the Physical Component Summary of the Short Form of the Medical Outcomes Study Questionnaire. CONCLUSIONS: The Pennebaker and control groups had similar changes over time for practically all the outcome variables, and also when considering all observations and adjusting for all the variables of interest. The longitudinal analysis confirmed that the intervention had little or no effect on the variables of interest. The implementation of writing exercises requires a careful and ad hoc organization, including dedicated spaces for the writing itself.

Quality of life in patients with pemphigus receiving adjuvant therapy.

BACKGROUND: Pemphigus has a strong effect on patients' quality of life (QOL). AIM: To analyze QOL and psychological well-being within patient groups, subdivided according to their different adjuvant treatments. METHODS: All adult patients with pemphigus enrolled in the study were assessed using the Short Form (SF)-36, the Skindex-29, and the General Health Questionnaire (GHQ)-12 for health status, effect of dermatology-specific aspects, and the presence of psychological comorbidity, respectively. The study population was subdivided into the following treatment groups: (i) those who were untreated or were treated only with corticosteroids (CS) at a dose of ≤ 5 mg/day (no adjuvant treatment, NAT); and patients receiving or not receiving CS ≤ 5 mg/day who also received either (ii) azathioprine (AZ), (iii) cyclophosphamide (CY), (iv) mycophenolate mofetil (MM) or (v) rituximab (RTX). RESULTS: In total, 113 patients were recruited. There were no significant differences between the treatment subgroups in either the SF-36 or Skindex-29 results. However, for the GHQ, there were large differences in QOL scores between patients scoring > 4 points (GHQ+) and those scoring < 4 points (GHQ-), especially for the more 'physical' components of QOL. The overall observed proportion of GHQ+ patients was 33.6%. CONCLUSIONS: We found no significant differences in QOL impairment between the treatment subgroups; however, we observed a strong association between psychiatric morbidity and poorer QOL within each of the treatment groups. This should be of concern for dermatologists, as psychiatric morbidity is associated with poor treatment adherence and dissatisfaction with care.

Disease severity evaluation among dermatological out-patients: a comparison between the assessments of patients and physicians.

BACKGROUND: The assessment of a patient's disease severity is an essential component in the formulation of treatment strategies. OBJECTIVES: To compare disease severity assessment by patients and by physicians, and to describe the possible discrepancies between them. METHODS: For each patient, we obtained the Physician Global Assessment (PhGA) and the Patient Global Assessment (PtGA). Data were completed for 2.578 patients. Sixty-one physicians participated in the study. We calculated the agreement between PtGA and PhGA scores using the weighted kappa statistics; a multinomial logistic regression was performed to assess the risk of disagreement considering both patient and physician variables. RESULTS: Differences in the percentages of severity level, identified by patients and by physicians, were always statistically significant (P < 0.05). Overall, the weighted Cohen's kappa was in the range of 0.09-0.34, depending on the diseases. Gender differences between patients and physicians did not influence the agreement. In the multinomial model female patients (OR = 1.38; 95% CI, 1.07-1.77), patients with higher educational levels (OR = 2.71; 95% CI, 2.12-3.46), and patients with impaired quality of life (OR = 1.56; 95% CI 1.23-1.97) had a higher risk to be underestimated for their disease severity by physicians, independently by physician gender and experience. CONCLUSIONS: Combining the subjective report with the objective severity assessment of the lesions, dermatologists may reach a better determination of how severity of disease is perceived by their patients and how they feel about the effectiveness of treatment. PtGA and PhGA might be considered in routine clinical assessments and not only for research activities.

Assessment of the health status of 2,499 dermatological outpatients using the 12-item Medical Outcomes Study Short Form (SF-12) questionnaire.

BACKGROUND: In dermatological research and clinical practice it is important to evaluate the burden of the disease. OBJECTIVE: To assess whether the 12-item Short Form of the Medical Outcomes Study (SF-12) could yield a valid description of the health status of a large number of dermatological outpatients. METHODS: The SF-12 and the 12-item General Health Questionnaire (GHQ-12) were utilized. Questionnaires were self-completed by the outpatients in the waiting rooms. At the end of the visit the dermatologists recorded the diagnosis and the evaluation of the clinical severity. RESULTS: Data were complete for 2499 patients. We observed a reduction in the Physical Component Summary score (PCS-12) with increasing age, while the Mental Component Summary score (MCS-12) was stable. PCS-12 and MCS-12 scores were worse in women. Twenty-three per cent of patients were identified as GHQ-12 positive. GHQ-12-positive patients ('cases') had lower PCS-12 and MCS-12 scores compared with GHQ-12-negative patients (mean ± SD, PCS-12: 47·9 ± 10·8 vs. 52·2 ± 6·6; MCS-12: 35·2 ± 10·2 vs. 50·9 ± 78·3, respectively). High correlations between the MCS-12 score and the GHQ-12 were documented overall (-0·690, P < 0·001) and for single skin diseases. CONCLUSIONS: The impact of dermatological diseases is high for the mental components of health status; the mean scores for MCS-12 were low, and lower in patients identified as GHQ-12 'cases'. The picture of the general health status of patients with skin diseases given by the SF-12 allows meaningful comparisons both within dermatological conditions and with diseases in other specialties, as well as within categories of clinical severity and psychological well-being in single skin conditions.