Quality of life in lupus erythematosus female patients with cutaneous lesions in Antananarivo, Madagascar

Abstract

Background: Lupus erythematosus (LE) is a chronic autoimmune disease that affects more women than men. The quality of life (QoL) of patients with lupus erythematosus and skin manifestations is impaired, but little is known about Malagasy patients. Objective: This study aimed to assess the impact of cutaneous lesions on the QoL of patients who present with LE. Methods: A transversal study, during 3 months, was conducted in patients who presented with LE and cutaneous lesions at the University Hospital Antananarivo. QoL was assessed using the Dermatology Life Quality Index (DLQI) scales. Results: The impact of cutaneous lesions on the QoL was assessed in 37 patients with LE, of whom 34 were women. The mean age of patients was 37.32 years. The mean DLQI was 5.43 ± 4.67 (range, 0–21). Of the patients, 2.7% had a very important effect (DLQI >21), 18.9% reported a great effect of skin symptoms of LE in their QoL (DLQI: 11–20), 18.9% had a moderate effect (DLQI: 6–10), 40.4% had a small effect (DLQI: 2–5), and 18.9% had no effect of cutaneous lesions on their QoL. Daily activities, symptoms, and feelings were the most altered dimensions. The alteration in patients’ QOL was influenced by high monthly income, severe medical history, and localization of the cutaneous lesions on the face and neckline. No correlation was found between sex and QoL. Conclusion: This study shows that significant impairment of QoL was found in patients with LE and cutaneous manifestations, which affected their sense of well-being.

Influence of Socio-Demographic Factors in Patients With Cutaneous Lupus Erythematosus

“…In contrast, existing literature has identified variable associations between income and health-related quality of life ( 7 , 30 , 33 , 35 ). An annual income < $10,000 was associated with a lower quality of life in the SKINDEX-29+3 functioning and symptom domains in three studies ( 7 , 30 , 35 ).…”

“…Hesselvig et al actually found that men with CLE had a higher risk of depression than women ( 27 ). However, a small cohort of LE patients in Madagascar did not find any significant correlations between gender and Dermatology Life Quality Index (DLQI) scales ( 33 ). Similarly, a CCLE cross-sectional cohort study in Georgia did not find significant differences in risk and severity of depression by gender ( 26 ).…”

“…Socio-demographic factors including income, education level, and geographic location can affect patients with CLE ( 7 , 19 , 28 , 30 , 33 , 35 ). CLE patients have been shown to experience significantly high healthcare expenditures, particularly if depression is present.…”

“…Although annual visits with a dermatologist or rheumatologist was not statistically significant, they also found that insured patients and those who visited a PCP in the last year were at lower risk of depression ( 26 ). However, Sendrasoa et al identified an inverse relationship between income and health-related quality of life, with high monthly income associated with increased impairment of quality of life ( 33 ). This difference may due to those with higher monthly income having different healthcare expectations than those with low monthly income in Madagascar.…”

“…Few studies examined educational attainment ( 15 , 23 , 33 ). Interestingly, CLE patients with at least one coexisting autoimmune condition were less likely to have high school level of education ( 23 ).…”