Quality-of-Life: Patients with Common Dermatological Disease

Quality-of-Life: Patients with Common Dermatological Disease Skin diseases are frequent in all over the world. Approximately 30% of Americans had at least one skin condition that leads to further medical examination (1). Patients with skin disease have experienced various problems including emotional, financial, psychological and social issues which can affect their quality of life (QoL) (2). Skin diseases are responsible for the majority of morbidity due to the presence of physical symptoms. Some studies reported that itching and fatigue are the main complaint in patients with skin diseases; moreover, compared with the normal people, these patients had a lower psychosocial wellbeing which it depended on disease-severity and duration, disease-related quality of life, and presence of physical symptoms such as itch, pain and fatigue (3-4). It also reported that some skin diseases can cause higher degree of disability in comparison with many chronic diseases (5). For instance patients who suffered from psoriasis reported fatigue, stigmatization, and loss of physical function, lack of self confidence, impaired daily and social function and limitations in social contacts (6). Some studies suggested that that eczema and psoriasis have a lower mental health compare patients with cardiovascular diseases (CVD) and psychiatric patients had better functioning compared to patients with skin disorders, also the harmful effects of psoriasis on QOL were comparable to that seen in breast cancer, arthritis, hypertension, diabetes, and mood disorders (7-8). The World Health Organization defines QOL as â€Å"individuals’ expectation of their position in life, in the context of the cultural and value system in which they live and in relation to their goals, expectations, standards and concerns† (9). It is very difficult to achieve QOL in patients with skin diseases. This may be due to the patients worrying about their unhandsome appearance in confronting people and so, what they think about their skin. Therefore, it is very important for clinicians or dermatologists to improve the QOL in these patients by concentrating on patients symptoms and appearance. Assessing QOL provides more accurate information about patients needs and helps dermatologist to decide better about patients treatment. So, it improves better patients service and QOL (10). Because QOL shows a very important aspect in physical and mental health, this review was aimed on evaluating the impacts of QOL of patients on various skin diseases including psoriasis, vitiligo, acne vulgaris, atopic dermatitis and seborrheic dermatitis and also, how much these diseases affected QOL and what factors may be associated with a worse QOL. ACNE VULGARIS: Acne vulgaris is the probably most prevalent skin disease in adolescents and especially during puberty. Approximately all of men and women experienced at least one acne lesions during their lifetime (11). In some studies has reported that this skin disorder, affecting almost 80% of individuals who aged from 11 to 30 years. 17However, this rate varied between 41.7% -93.3% in different countries with populations aged 12 to 18 years (12-13). Also, it has reported that acne and actinic keratosis represented the two most common presentations in dermatologists office visits, with both conditions resulting in 5.2 million visits and 15% of total visits yearly in United States (14). QoL issues have been well-known in acne vulgaris. One of the most important in adolescence is a good appearance. It affected self-worth and self confidence. Acne vulgaris may cause some morbidity in many teenage patients such as low self-esteem, social isolation, and depression and suicidal ideation (15-18). There are some validated criteria for evaluating and identifying individuals with acne vulgaris include the Acne Disability Index (ADI), Cardiff Acne Disability Index (CADI), and the Acne-QoL index (19). It is worth mentioning that CADI and acne-Qol were Simpler and more rapidly used than the ADI index (19). Of note, physical morbidity and decreased social functioning in adulthood may be the complications of acne vulgaris that had happened in adolescents (20). Verhoeven et al.(3) suggested in his study that patients with skin diseases in experienced a lower psychosocial well-being compare to the normal population and several of these patients was at risk of developing severe mood disorders such as depression. Also, the psychosocial problems were more frequent in patient with chronic skin disease. Also, Patients who suffered from acne vulgaris have worse mental health and anxiety and depression status than individuals with asthma, epilepsy, diabetes, CVD, back pain, or arthritis (2, 21). About the half of adolescent patients accepted acne as a disease, but 86% think that treatment is necessary to improve their appearance (12). This is the reason that subjects with worse symptoms and QoL condition should be treated by the physician or dermatologist with more aggressive or systemic treatments such as corticosteroids(22). In some cases, referral for further evaluation by a psychologist is recommended (23). Effective treatments may be useful to reach the optimum QoL burden of this common disease. ATOPIC DERMATITIS: It is reported that the atopic dermatitis causes most physician office visit and outpatient hospital visits in United States (14). Atopic dermatitis (AD) describes an inflammatory, chronically relapsing skin condition that, along with asthma and allergic rhinitis, is part of the atopic triad (24). The condition gives rise to itching and severely dry skin, and is characterized by an allergic predisposition, pruritus, erythema, oozing, crusting, excoriations, lichenification, sensitivity to allergens/ irritants and susceptibility to secondary infections (24) Atopic dermatitis typically appears in early childhood, and patients may experience periodic flare-ups throughout adulthood (25). A worldwide study found that AD affects approximately 5% to 20% of children at ages 6 – 7 and 13–14 years, with the prevalence being highest in developed countries (26). Other estimates of prevalence in children fall within this range. The prevalence of AD in Canada was estimated to be 8.5% for children aged 6 – 7 years, and 9.4% for children aged 13–14 years (26). Approximately 10% of cases are considered to be severe, with approximately half the remaining cases being considered moderate and half being considered mild. Incidence and severity are approximately equal among males and females (24). Evidence suggests that the prevalence of AD in Western nations is increasing. Parents report that their children with AD experience sleep disturbance, and are more clingy, frustrated, and irritable (27-29). Studies have found a correlation between AD and attention-deficit/ hyperactivity disorder (30-32). Infants with AD are also found to be at greater risk for development of mental health problems by age 10 years. The prevalence and burden of AD in teenagers is less well understood. Adolescents with AD are at significant risk of impaired QoL similar to that of acne vulgaris, including predisposition to depression, impaired social interaction with members of the opposite sex, and sexual functioning.54 Using Skindex-Teen, adolescents with AD generally experienced similar impairment in QoL as those with acne (33). Indices to accurately measure QoL in pediatric patients with AD are highly relevant to clinical practice and research. To more completely gauge the comprehensive burden of disease, the clinician should aim to objectively review QoL and physical impairment (34-35). Patients with severe QoL impairment caused by AD may be in greater need of aggressive treatment strategies to minimize comorbidities and the longterm psychosocial effects of their disease. It is critical to involve both the caregiver and patient in these treatment strategies. . 1.Johnson M-LT. Defining the Burden of Skin Disease in the United States[mdash]A Historical Perspective. 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