The Dermatology life Quality Index (DLQI) is a ten-question questionnaire used to measure the impact of skin disease on the quality of life of an affected person. It is designed for people aged 16 years and above.
The DLQI was created by Andrew Y Finlay and Gul Karim Khan from 1990 to 1994 at the Department of Dermatology, University of Wales College of Medicine (now Cardiff University), Cardiff, UK. [1] 120 patients with a variety of skin diseases completed a questionnaire that asked them to write down all of the ways that their skin disease affected their lives. 49 different ways were identified, and these were used as the basis of the questions of the DLQI. [2]
The DLQI was first presented at the British Association of Dermatologists annual meeting in July 1993 [3] and described in an article published in 1994 in Clinical and Experimental Dermatology. [4] This article has become one of the most frequently cited articles in clinical dermatology. [5] The DLQI is the most frequently used method for evaluating quality of life for patients with different skin conditions. [6]
There are 10 questions, covering the following topics: symptoms, embarrassment, shopping and home care, clothes, social and leisure, sport, work or study, close relationships, sex, treatment. Each question refers to the impact of the skin disease on the patient’s life over the previous week. [7]
The DLQI has been translated into over 115 languages. The full translations are available at the Cardiff University Department of Dermatology website. [8]
Each question is scored from 0 to 3, giving a possible score range from 0 (meaning no impact of skin disease on quality of life) to 30 (meaning maximum impact on quality of life).
A series of validated “band descriptors” were described in 2005 to give meaning to the scores of the DLQI. [9]
These bands are as follows: 0-1 = No effect on patient’s life, 2-5 = Small effect, 6-10 = Moderate effect, 11-20 = Very large effect, 21-30 = Extremely large effect.
The Minimal Clinically Important Difference (MCID) is the score difference that is the minimum meaningful difference for a patient. Although previously considered to be 5, [10] the DLQI MCID for inflammatory skin diseases should be considered to be a score difference of 4. [11]
DLQI scores can be converted to EQ-5D utility values. [12]
The DLQI can provide clinicians with more accurate insight into the impairment of quality of life experienced by individual patients. This may lead to more appropriate clinical decisions. [13] The DLQI can also be used when required by national guidelines, for example in the management of psoriasis [14] or hand eczema. [15]
The DLQI is recommended for use in national treatment guidelines, and to assist management decisions, [16] in many countries, including: Australia, [17] Canada, [18] Bulgaria, [19] Croatia, [19] Czech Republic, [19] England and Wales, [20] Europe, [21] Germany, [22] Hungary, [19] Italy, [23] Japan, [24] Norway, [25] Poland, [19] Romania, [19] Saudi Arabia, [26] Scotland, [27] Singapore, [28] South Africa, [29] Spain, [30] Sweden, [31] Switzerland, [32] Taiwan, [33] Turkey [34] and Venezuela. [35]
The DLQI has been used as a patient reported outcome measure in many published clinical research studies. [36] For example, it has been used to assess novel drugs, [37] models of clinical care, in audit of clinical services and in assessment of teledermatology. [36] The DLQI is the most widely used quality of life outcome measure in randomised controlled trials of therapies for psoriasis. [38]
The Rule of Tens is a concept to aid clinicians in making the diagnosis of “severe psoriasis”. [39] It states that a patient is considered to have “severe psoriasis” if their body surface area affected is >10%, or if their Psoriasis Area and Severity Index (PASI) score is >10, or if the DLQI score is >10. [39] The Rule of Tens has influenced national guidelines concerning the criteria to be fulfilled before starting a patient on biological therapy. [14]
The DLQI is copyrighted but the originators allow it to be used for routine clinical purposes without seeking permission and without charge. [8]
The DLQI has been validated for use on tablets such as the iPad. [40]
Psoriasis is a long-lasting, noncontagious autoimmune disease characterized by raised areas of abnormal skin. These areas are red, or purple on some people with darker skin, dry, itchy, and scaly. Psoriasis varies in severity from small, localized patches to complete body coverage. Injury to the skin can trigger psoriatic skin changes at that spot, which is known as the Koebner phenomenon.
Pimecrolimus is an immunomodulating agent of the calcineurin inhibitor class used in the treatment of atopic dermatitis (eczema). It is available as a topical cream, once marketed by Novartis under the trade name Elidel.
Ammonium bituminosulfonate or ammonium bituminosulphonate is a product of natural origin obtained in the first step by dry distillation of sulfur-rich oil shale. By sulfonation of the resulting oil, and subsequent neutralization with ammonia, Ichthammol results as a viscous, water-soluble substance with a characteristic bitumen-like odor. It is used in medicine as a treatment for different skin diseases, including eczema and psoriasis. Ointments containing 10% or 20% Ichthammol are most common. They are sometimes called "black ointments" or "drawing salves". Ichthammol's dermatological action was promoted by German physician Paul Gerson Unna.
Onychomycosis, also known as tinea unguium, is a fungal infection of the nail. Symptoms may include white or yellow nail discoloration, thickening of the nail, and separation of the nail from the nail bed. Toenails or fingernails may be affected, but it is more common for toenails. Complications may include cellulitis of the lower leg. A number of different types of fungus can cause onychomycosis, including dermatophytes and Fusarium. Risk factors include athlete's foot, other nail diseases, exposure to someone with the condition, peripheral vascular disease, and poor immune function. The diagnosis is generally suspected based on the appearance and confirmed by laboratory testing.
Erythroderma is an inflammatory skin disease with redness and scaling that affects nearly the entire cutaneous surface. This term applies when 90% or more of the skin is affected.
Natural skin care uses topical creams and lotions made of ingredients available in nature. Much of the recent literature reviews plant-derived ingredients, which may include herbs, roots, flowers and essential oils, but natural substances in skin care products include animal-derived products such as beeswax, and minerals. These substances may be combined with various carrier agents, preservatives, surfactants, humectants and emulsifiers.
Heinrich Koebner ; was a German-Jewish dermatologist born in Breslau.
Psoriasis Area and Severity Index (PASI) is the most widely used tool for the measurement of severity of psoriasis. PASI combines the assessment of the severity of lesions and the area affected into a single score in the range 0 to 72.
In medicine, a finger tip unit (FTU) is defined as the amount of ointment, cream or other semi-solid dosage form expressed from a tube with a 5 mm diameter nozzle, applied from the distal skin-crease to the tip of the index finger of an adult. The "distal skin-crease" is the skin crease over the joint nearest the end of the finger. One FTU is enough to treat an area of skin twice the size of the flat of an adult's hand with the fingers together, i.e. a "handprint". Two FTUs are approximately equivalent to 1 g of topical steroid.
Psoriatic onychodystrophy or psoriatic nails is a nail disease. It is common in those suffering from psoriasis, with reported incidences varying from 10% to 78%. Elderly patients and those with psoriatic arthritis are more likely to have psoriatic nails.
Guttate psoriasis is a type of psoriasis that presents as small lesions over the upper trunk and proximal extremities; it is found frequently in young adults.
Psoriatic erythroderma represents a form of psoriasis that affects all body sites, including the face, hands, feet, nails, trunk, and extremities. This specific form of psoriasis affects 3 percent of persons diagnosed with psoriasis. First-line treatments for psoriatic erythroderma include immunosuppressive medications such as methotrexate, acitretin, or ciclosporin.
Generalized pustular psoriasis (GPP) is an extremely rare type of psoriasis that can present in a variety of forms. Unlike the most general and common forms of psoriasis, GPP usually covers the entire body and with pus-filled blisters rather than plaques. GPP can present at any age, but is rarer in young children. It can appear with or without previous psoriasis conditions or history, and can reoccur in periodic episodes.
Lidia Rudnicka is a Polish-American dermatologist with contributions to the field of scleroderma research, hair diseases and melanoma prevention.
The American Board of Dermatology (ABD), located in Newton, Massachusetts, United States, certifies physicians in dermatology, dermatopathology, and pediatric dermatology. Board-certified physicians are known as diplomates. Since its inception in 1932, the ABD has certified over 15,000 physicians. The ABD was one of the original four sponsoring organizations of the American Board of Medical Specialties (ABMS). Dermatologists possess expertise in all aspects of healthy and diseased skin through basic scientific research and clinical care. In addition to the wide range of medical diseases, dermatologists have practices devoted to skin surgery, care of children with skin disease, immunologic diseases of the skin and pathology of the skin. Dermatologists play an important role in the maintenance of the general public health in educating people about sun avoidance, sun protection and the signs of skin cancer.
Goeckerman therapy is a regimen for treatment of moderate to severe plaque psoriasis using a combination of crude coal tar and artificial ultraviolet radiation. It is a specialized form of light therapy.
Mark G. Lebwohl, M.D., is an American dermatologist and author and the Waldman Professor and Chairman of the Kimberly and Eric J. Waldman Department of and Chairman of the Department of Dermatology at the Mount Sinai Hospital in New York City.
Louis Dubertret was born on 18 June 1943 in Douai, France. He had a distinctive career as an associate professor specializing in dermatology and cutaneous biology, is now a Professor Emeritus, and currently serves as the president of the René Touraine Foundation.
The Psoriasis Index of Quality of Life (PSORIQoL) is a patient-reported outcome measure which determines the quality of life of patients with psoriasis. It is based on a needs-based approach to quality of life.
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