Servando E. Marron

The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study among Dermatological Out-Patients in 13 European Countries

The contribution of psychological disorders to the burden of skin disease has been poorly explored, and this is a large-scale study to ascertain the association between depression, anxiety, and suicidal ideation with various dermatological diagnoses. This international multicenter observational cross-sectional study was conducted in 13 European countries. In each dermatology clinic, 250 consecutive adult out-patients were recruited to complete a questionnaire, reporting socio-demographic information, negative life events, and suicidal ideation; depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. A clinical examination was performed. A control group was recruited among hospital employees. There were 4,994 participants––3,635 patients and 1,359 controls. Clinical depression was present in 10.1% patients (controls 4.3%, odds ratio (OR) 2.40 (1.67–3.47)). Clinical anxiety was present in 17.2% (controls 11.1%, OR 2.18 (1.68–2.82)). Suicidal ideation was reported by 12.7% of all patients (controls 8.3%, OR 1.94 (1.33–2.82)). For individual diagnoses, only patients with psoriasis had significant association with suicidal ideation. The association with depression and anxiety was highest for patients with psoriasis, atopic dermatitis, hand eczema, and leg ulcers. These results identify a major additional burden of skin disease and have important clinical implications.

Anxiety, Depression, Quality of Life and Patient Satisfaction in Acne Patients Treated with Oral Isotretinoin

Oral isotretinoin is effective in the clinical control of acne, but the relationship between this treatment and its psychosocial impact on the patient has not been completely clarified. The aim of this study was to determine if the use of oral isotretinoin in total accumulated doses of 120 mg/kg in a sample of 346 patients with moderate acne was useful in controlling symptoms of anxiety and/or depression and improving quality of life. A further objective was to ascertain the level of patient satisfaction with the treatment. After 30 weeks, there was a significant reduction in clinical symptoms (p < 0.001). The negative impact on quality of life, measured with the Dermatology Life Quality Index and the Health Survey Short-Form-36 (p < 0.001), showed a significant reduction, as did the Hospital Anxiety and Depression Scale scores for anxiety (p < 0.001) and depression (p < 0.005). At the end of the study, the mean level of patient satisfaction with improvement of symptoms was 84.4%.

The burden of common skin diseases assessed with the EQ5D: a European multicentre study in 13 countries

Generic instruments measuring health‐related quality of life (HRQoL), like EQ5D™, enable comparison of skin diseases with healthy populations and nondermatological medical conditions, as well as calculation of utility data.

Why quality of life measurement is important in dermatology clinical practice: An expert-based opinion statement by the EADV Task Force on Quality of Life.

The aim of this study was to describe the many ways in which quality of life (QoL) measurement may potentially be advantageous in routine clinical dermatology practice. Thirteen members of the EADV Task Force on Quality of Life, eight dermatologists, three health psychologists, one epidemiologist and one pharmacoepidemiologist, independently listed all of the ways they thought this may be advantageous. A total of 108 different ways of using QoL information in clinical practice were suggested (median per participant = 8, range = 4–15), and were classified into 20 descriptive groups. These were sorted into the following five categories: inform clinical decisions, clinician–patient communication, awareness of skin disease burden, informing the consultation and clinical service administration. The wide range of potential benefits identified may not only encourage clinicians to use these measures but also highlights many areas requiring evidence to establish the true value of routine use of QoL measures.

Quality of Life Measurement in Atopic Dermatitis. Position Paper of the European Academy of Dermatology and Venereology (EADV) Task Force on Quality of Life

There is a need for researchers to have easy reference to the wide spectrum of different types of quality of life (QoL) instruments that can be used in atopic dermatitis (AD). Previous reviews on QoL in AD do not cover the full spectrum of QoL measures used in studies on AD. This study, on behalf of the European Academy of Dermatology and Venereology (EADV) Task Force on QoL, contains information on instruments available for health‐related QoL and family QoL assessment in AD including information on validation, experience of QoL assessment in AD for different purposes, peculiarities of QoL assessment in different age groups, expert analysis of available instruments including data on limitations of their use and recommendations of the Task Force.

Quality of Life, Emotional Wellbeing and Family Repercussions in Dermatological Patients Experiencing Chronic Itching: A Pilot Study

A better understanding of the psychosocial impact of chronic itching could lead to improved intervention strategies. The aim of this study is to examine the prevalence and characteristics of chronic itching in dermatological patients. The Itch Severity Scale (ISS) was completed by a sample of 201 patients from a Dermatology Outpatient Clinic in Spain and 61.69% (n = 124) of participants recorded a positive score (X = 8.89, DT = 4.06). The results indicate that chronic itching has significant psychosocial repercussions. The Dermatology Life Quality Index (DLQI) showed that the negative impact on quality of life was significantly greater for the group that experienced chronic itching (p < 0.001). Scores on the Anxiety and Depression Scale (HADS) revealed that the group with chronic itching had more symptoms associated with anxiety (p = 0.001). The Family APGAR found no statistically significant differences between the groups with regards to repercussions on the family dynamic.

Body Image and Body Dysmorphic Concerns.

Most people would like to change something about their bodies and the way that they look, but for some it becomes an obsession. A healthy skin plays an important role in a persons physical and mental wellbeing, whereas a disfiguring appearance is associated with body image concerns. Skin diseases such as acne, psoriasis and vitiligo produce cosmetic disfigurement and patients suffering these and other visible skin conditions have an increased risk of depression, anxiety, feelings of stigmatization and self-harm ideation. Body image affects our emotions, thoughts, and behaviours in everyday life, but, above all, it influences our relationships. Furthermore, it has the potential to influence our quality of life. Promotion of positive body image is highly recommended, as it is important in improving peoples quality of life, physical health, and health-related behaviors. Dermatologists have a key role in identifying body image concerns and offering patients possible treatment options.

Measuring the impact of dermatological conditions on family and caregivers: a review of dermatology-specific instruments

The patient is the centre of a web of relationships, and the impact of his/her disease on family members and caregivers must be taken into account. The aim of this study was to identify the specific instruments that measure the impact of a dermatological disease on the quality of life (QoL) of family members, by performing a systematic search of the literature. Fifteen papers were identified, describing the creation and validation of nine instruments. Four of them concerned atopic dermatitis (Dermatitis Family Index, DFI; Parents’ Index QoL Atopic Dermatitis, PiQoL‐AD; QoL in primary caregivers of children with atopic dermatitis, QPCAD; Childhood Atopic Dermatitis Impact Scale, CADIS), two measured the impact of psoriasis in family members (Psoriasis Family Index, PFI; FamilyPso), one the impact of epidermolysis bullosa (Epidermolysis Bullosa Burden of Disease, EB‐BoD), one of ichthyosis (Family Burden Ichthyosis, FBI), and one was generic for dermatological conditions (Family Dermatology Life Quality Index, FDLQI). The European Academy of Dermatology and Venereology quality of life taskforce recommends that the impact of a skin disease on family and caregivers should be measured as part of any thorough evaluation of the burden of a disease. Guidelines are given to choose the most appropriate instruments.

Attachment styles of dermatological patients in europe : A multicentre study in 13 countries

Attachment styles of dermatological outpatients and satisfaction with their dermatologists were investigated within the framework of a multicentre study conducted in 13 European countries, organized by the European Society for Dermatology and Psychiatry. Attachment style was assessed with the Adult Attachment Scale. Patient satisfaction with the dermatologist was assessed with an 11-degree scale. A total of 3,635 adult outpatients and 1,359 controls participated in the study. Dermatological outpatients were less able to depend on others, were less comfortable with closeness and intimacy, and experienced similar rates of anxiety in relationships as did the controls. Participants who had secure attachment styles reported stressful life events during the last 6 months significantly less often than those who had insecure attachment styles. Patients with secure attachment styles tended to be more satisfied with their dermatologist than did insecure patients. These results suggest that secure attachment of dermatological outpatients may be a protective factor in the management of stress.

Quality of life measurement in acne. Position Paper of the European Academy of Dermatology and Venereology Task Forces on Quality of Life and Patient Oriented Outcomes and Acne, Rosacea and Hidradenitis Suppurativa

Acne causes profound negative psychological and social effects on the quality of life (QoL) of patients. The European Dermatology Forum S3‐Guideline for the Treatment of Acne recommended adopting a QoL measure as an integral part of acne management. Because of constantly growing interest in health‐related QoL assessment in acne and because of the high impact of acne on patients’ lives, the European Academy of Dermatology and Venereology Task Force on QoL and Patient Oriented Outcomes and the Task Force on Acne, Rosacea and Hidradenitis Suppurativa have documented the QoL instruments that have been used in acne patients, with information on validation, purposes of their usage, description of common limitations and mistakes in their usage and overall recommendations.