Quality of Life in a Population of Patients With Hand Eczema: A Six-month Follow-up Study

Abstract

Hand eczema is a disease with a potentially profound effect on an individual's life in terms of daily ftmctioning and interpersonal relationships. Accordingly, methods for measuring health-related quality of life (QoL) are increasingly used to evaluate the effect of various treatments.In studies of skin diseases the most widely used dermatology-specific questionnaire is the Dermatology Life Quality Index (DLQI) (1). The various scales applied, in the context of skin diseases, were evaluated by Both et al.(2). Their paper, which evaluated the interpretability of the DLQI, revealed a need for reports concerning the minimal change of score that is relevant to the patients. A similar need was expressed in a review by Basra et al. (3).The aim of the present study was to explore potential factors related to a low health-related QoL among patients with hand eczema and to examine the responsiveness of the DLQI score to clinical changes. MATERIALS AND METHODSThe study involved six private clinics and three outpatient clinics at university hospitals. The study population comprised consecutive hand eczema patients, aged 18 years or older, referred with present hand eczema to one of the clinics and enrolled during the period January 2006 to February 2007. At the first consultation the clinical severity of hand eczema was assessed by the patients using a self-administered photographic guide (4). All patients were patch-tested with the European Baseline Series (5). In the case of exposure to other known allergens, additional patch tests were applied, for example the hairdressing series in hairdressers. Patients completed a self-administered questionnaire at the time of patch testing.Approximately 6 months later (median 7 months; range 4-15 months) patients received a questionnaire package by post, which included a follow-up questionnaire and a selfadministered photographic guide. The DLQI questions were included in both the baseline and the follow-up questionnaire (permission granted). A detailed description of the study cohort including a dropout analysis of the non-respondents has been published previously (6).The DLQI is a 10-item questionnaire covering six aspects of daily life experienced during the past week. It is calculated by summing the score, of each question, with a maximum score of 30 and a minimum score of 0; the higher the score, the greater the impairment in QoL (1). In this study cut-off points were made dichotomizing the DLQI total score into low QoL corresponding to the one-third of the cohort with the highest score (score 7-30) and a score < 7 identifying those with moderate to high QoL at baseline. By subtracting the DLQI score, the course from baseline to follow-up was defined as improved or unchanged/diminished QoL.The data from the DLQI questionnaires were analysed by non-parametric statistics, as the DLQI score of the cohort was not normally distributed (Kolmogorov-Smimov test, p < 0.001 ).The Wilcoxon signed-rank test was used to compare paired data, and the Mann-Whitney test or Kruskal-Wallis test wa...

Self-Reported Skin Morbidities and Health-Related Quality of Life: A Population-Based Nested Case-Control Study

“…Studies based on cases from hospital settings or private practices show higher scores in patients with HS [8,33,34], acne [34,35], psoriasis [35], AE [34] or dermatitis [36] and hand rash [37]. However, these studies may have included a higher proportion of more severe cases, in contrast to the population level where mild cases are more likely to be included.…”

Self-reported Skin Diseases, Quality of Life and Medication Use: A Nationwide Pharmaco-epidemiological Survey in Sweden

“…psoriasis (42)(43)(44), hand eczema (14,33,(45)(46)(47)(48), atopic dermatitis (44,49) and acne (50,51). SF-36 has also previously been used in postal-based population studies focused on skin problems (4,52).…”

“…In a more recent Swedish crosssectional population survey it was shown that the use of dermatological pharmaceuticals among persons with hand eczema increased if the eczema was reported to be severe (13). Hald et al (14) found that 25% of patients with hand eczema used prescription pharmaceuticals.…”

Chronic hand eczema: A prospective analysis of the Swiss CARPE registry focusing on factors associated with clinical and quality of life improvement

“…In a cohort of 799 HE patients, predictors of poor prognosis after 6 months included being an unskilled worker and the presence of frequent symptoms associated with severe initial disease . Moreover, these patients had an impaired quality of life (QoL), which, during follow‐up, improved in 55.7% in parallel with clinical amelioration . In young adults, childhood eczema was the most important risk factor for HE .…”