Skin diseases such as acne are sometimes thought of as unimportant, even trivial, when compared with diseases of other organ systems. To address this point directly, validated generic questionnaires were used to assess morbidity in acne patients and compare it with morbidity in patients with other chronic diseases. For 111 acne patients referred to a dermatologist, quality of life was measured using the Dermatology Life Quality Index, Rosenberg's measure of self-esteem, a version of the General Health Questionnaire (GHQ-28) and the Short Form 36 (SF-36). Clinical severity was measured using the Leeds Acne Grade. Population quality of life data for the SF-36 instrument were available from a random sample of adult local residents (n = 9334) some of whom reported a variety of long-standing disabling diseases. All quality of life instruments showed substantial deficits for acne patients that correlated with each other but not with clinically assessed acne severity. The acne patients (a relatively severely affected group) reported levels of social, psychological and emotional problems that were as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain or arthritis. Acne is not a trivial disease in comparison with other chronic conditions. This should be recognized in the allocation of health care resources.
Context: It is well recognized that the presence of a foreskin predisposes to penile carcinoma and sexually transmitted infections. We have investigated the relationship between the presence or absence of the foreskin and penile dermatoses. Objective: To determine whether there is an association between circumcision and penile dermatoses. Design: A retrospective case control study of patients attending the department of dermatology with genital skin conditions. Subjects: The study population consisted of 357 male patients referred for diagnosis and management of genital skin disease. The control population consisted of 305 male patients without genital skin disease attending the general dermatology clinics over a 4-month period. Main Outcome Measures: The relationship between circumcision and the presence or absence of skin disease involving the penis was investigated. The rate of circumcision in the general male dermatology population was determined. Results: The most common diagnoses were psoriasis (n = 94), penile infections (n = 58), lichen sclerosus
The impact of acne on quality of life can be profound. Although treatment improves the clinical features of acne, there is little information on its benefit from the patients' point of view. In this study, patients with acne referred to a dermatology clinic were sent questionnaires before being seen, and 4 and 12 months afterwards. Clinical severity was assessed by a dermatologist at baseline and at 4 months. Quality of life was assessed by patients using the Short Form 36 instrument (SF-36), the Dermatology Life Quality Index (DLQI), Rosenberg's measure of self-esteem and the General Health Questionnaire (GHQ-28). Of 90 available patients, 79 (89%) returned at least one follow-up questionnaire. The clinical acne grade improved substantially with treatment. There were also significant improvements either at 4 or 12 months in the DLQI, self-esteem. GHQ-28 and all five dimensions of the SF-36 that were impaired at baseline. Quality of life continued to improve between the 4- and 12-month follow-up questionnaires. Clinical and patient-assessed outcomes were significantly better in patients treated with isotretinoin. The study showed that disability caused by acne can be largely reversed by effective treatment. It also showed that patient-assessed measures of outcome can respond to changes over time and discriminate between treatments differing in effectiveness.
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