P. Duller

The Impact of Chronic Skin Disease on Daily Life (ISDL): a generic and dermatology-specific health instrument

Background  In dermatological research and clinical practice, there is a need for comprehensive self‐report instruments that assess a broad spectrum of health implications of chronic skin diseases, including generic and skin‐specific aspects of disease‐related quality of life. The advantages of dermatology‐specific, multidimensional instruments over generic instruments or single‐dimensional quality‐of‐life measures are in the detailed and specific information they provide about health areas that are affected by the skin condition and that may change through therapeutic intervention.

Prevalence of physical symptoms of itch, pain and fatigue in patients with skin diseases in general practice

Background  Physical symptoms of skin diseases have been shown to negatively affect patients’ wellbeing. Although insight into physical symptoms accompanying skin diseases is relevant for the management and treatment of skin diseases, the prevalence of physical symptoms among patients with skin diseases is a rather unexplored territory.

Effectiveness of a multidisciplinary itch-coping training programme in adults with atopic dermatitis.

The short- and longer-term effectiveness of a brief, multidisciplinary itch-coping group training scheme in adults with atopic dermatitis was evaluated. Clinical severity scores (Eczema Area and Severity Index) and validated self-report measures were obtained in a waiting-list control condition (n=30) and a treatment condition (n=61) at pre- and post-treatment and in the treatment condition at 3- and 12-month follow-ups. Relative to the control condition, all post-treatment measures showed improvements in terms of enhanced skin status, reduced itching and scratching and improved itch-coping patterns. In the treatment condition, the changes were sustained or further improved at both follow-ups. Also, the dermatological healthcare use was significantly reduced during the follow-up periods, in terms of fewer visits to the dermatologist and decreased use of topical corticosteroids and itch-relieving medication (histamine antagonists). The brief multidisciplinary itch-coping programme in adults with atopic dermatitis considerably reduced itch-scratching patterns, improved their skin status and reduced the use of dermatological care, both in the short and longer term.

Helplessness as Predictor of Perceived Stigmatization in Patients with Psoriasis and Atopic Dermatitis

Background: The experience of stigmatization is a problem frequently recognized in chronic skin diseases such as psoriasis and atopic dermatitis. The purpose of the study was to investigate a broad spectrum of physical, psychological and social predictors for perceived stigmatization in patients with psoriasis and atopic dermatitis. Patients and Methods: Stigmatization experience, demographic variables, age of onset, clinical status, physical symptoms of itch and fatigue, the impact of the disease on daily life, illness cognitions of helplessness and acceptance, and social support were recorded using self-report instruments in 131 patients with psoriasis and in 139 patients with atopic dermatitis. Results: For both skin diseases, lower age, not being married, a worse clinical status, physical symptoms of itch and fatigue, the impact of the disease on daily life, heightened helplessness and less acceptance as well as less social support were all significantly related to the experience of stigmatization. In patients with psoriasis, stigmatization was also related to lower education and earlier age of onset. However, when comparing the predictors in multiple regression analyses, perceived helplessness proved the strongest predictor of the experience of stigmatization in both patients groups. Conclusion: Our results indicate that perceived helplessness acts as a common major predictor of stigmatization in both skin diseases, suggesting that helplessness should be the focus in the study and treatment of stigmatization in patients with psoriasis and atopic dermatitis.

Skin diseases in family medicine: prevalence and health care use.

PURPOSE Ongoing care for patients with skin diseases can be optimized by understanding the incidence and population prevalence of various skin diseases and the patient-related factors related to the use of primary, specialty, and alternative health care for these conditions. We examined the recent prevalence of skin diseases in a defined population of family medicine patients, self-reported disease-related quality of life, extent and duration of skin disease, and the use of health care by patients with skin diseases. METHODS We undertook a morbidity registry-based epidemiological study to determine the prevalence of various skin diseases, using a patient questionnaire to inquire about health care use, within a network of family practices in the Netherlands with a practice population of approximately 12,000 citizens. RESULTS Skin diseases accounted for 12.4% of all diseases seen by the participating family physicians. Of the 857 questionnaires sent to patients registered with a skin disease, 583 (68.0%) were returned, and 501 were suitable for analysis. In the previous year, 83.4% of the patients had contacted their family physician for their skin disease, 17.0% had contacted a medical specialist, and 5.2% had consulted an alternative health care practitioner. Overall, 65.1% contacted only their family physician. Patients who reported more severe disease and lower quality of life made more use of all forms of health care. CONCLUSION This practice population-based study found that skin diseases account for 12.4% of diseases seen by family physicians, and that some skin problems may be seen more frequently. Although patients with more extensive skin diseases also obtain care from dermatologists, most patients have their skin diseases treated mainly by their family physician. Overall, patients with more severe disease and a lower quality of life seek more treatment.

Psychosocial well-being of patients with skin diseases in general practice

Background  Skin diseases are a substantial part of the problems dealt with by general practitioners. Although the psychosocial consequences of skin diseases in secondary care has been extensively studied, little is known about the psychosocial well‐being of patients with skin diseases in primary care.

Out-Patient Treatment of Atopic Dermatitis with Crude Coal Tar

BACKGROUND Patients with atopic dermatitis benefit from treatment with crude coal tar. We started a program for the treatment of patients with atopic dermatitis in an out-patient facility using intermittent applications of crude coal tar. OBJECTIVE To study the efficacy and feasibility of an out-patient regimen using crude coal tar in atopic dermatitis. METHODS We treated 18 patients in the out-patient setting. A trained nurse and after thorough instruction the patients themselves at home applied crude coal tar in a zinc paste 2 or 3 times a week. We studied the improvement by visual scoring and compared the results with patients treated with daily applications at the in-patient department. RESULTS The improvement was comparable at the end of the treatment period for both settings. The treatment period, however, was longer for the patients treated in the out-patient setting. CONCLUSION The out-patient programme proved to be an efficacious and a well-appreciated approach.