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Measurement Tools| Volume 9, ISSUE 2, P169-180, March 2004

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10 Years Experience of the Dermatology Life Quality Index (DLQI)

Open ArchiveDOI:https://doi.org/10.1111/j.1087-0024.2004.09113.x
10 Years Experience of the Dermatology Life Quality Index (DLQI)
Previous ArticleA Catalog of Dermatology Utilities: A Measure of the Burden of Skin Diseases

      Keywords

      DLQI
      Dermatology Life Quality Index
      HRQoL
      health-related quality of life
      The Dermatology Life Quality Index, the first dermatology-specific health-related quality of life (HRQoL) questionnaire, was published in 1994 (
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ). There is now 10 years experience with over 85 peer reviewed research articles and 52 published abstracts describing its use: there are also many current studies worldwide using the DLQI as an outcome measure. The aim of this review article is to provide detailed information about where to find any published aspect of the DLQI so that the reader can readily decide whether the DLQI may be appropriate for their use. The DLQI was designed to be simple and easy to use in a busy clinical setting: wide experience of its use has confirmed the appropriateness of this concept.
      There are other well-validated similar outcome measures: these include Skindex (
      • Chren M-M.
      • Lasek R.J.
      • Quinn L.M.
      • Mostow E.N.
      • Zyzanski S.J.
      Skinned, a quality-of-life measure for patients with skin disease: Reliability, validity and responsiveness.
      J Invest Dermatol. 1996; 107: 707-713
      ), Dermatology Quality of Life Scales (
      • Morgan M.
      • McCreedy R.
      • Simpson J.
      • Hay R.J.
      Dermatology quality of life scales––a measure of the impact of skin diseases.
      Br J Dermatol. 1997; 136: 202-206
      ), and Dermatology-specific Quality of Life Instrument (Anderson and Rajagopalan, 1997).
      • De Korte J.
      • Mombers F.M.C.
      • Sprangers M.A.G.
      • Bos J.D.
      The suitability of quality-of-life questionnaires for psoriasis research.
      Arch Dermatol. 2002; 138: 1221-1227
      and
      • De Tiedra A.G.
      • Mercadal J.
      • Badia X.
      • Mascaro J.M.
      • Lozano R.
      A method to select an instrument for measurement of HR-QOL for cross-cultural adaptation applied to dermatology.
      Pharmacoeconomics. 1998; 14: 405-422
      have compared the characteristics of various HRQoL outcome measures used in dermatology. Many concepts to be considered when choosing quality of life measures in dermatology have been reviewed (
      • Finlay A.Y.
      Quality of life measurement in dermatology: A practical guide.
      Br J Dermatol. 1997; 136: 305-314
      ).

      DLQI Description

      The DLQI consists of 10 questions concerning symptoms and feelings, daily activities, leisure, work, and school, personal relationships and treatment.
      Each question is answered by a tick box: “not at all”, “a little”, “a lot” or “very much”. Each question is scored from 0 to 3 and the scores summed, giving a range from 0 (no impairment of life quality) to 30 (maximum impairment). All questions relate “to the last week”. The DLQI was designed to be used in adults over the age of 18 years.

      Methods

      The articles and abstracts in which the DLQI has been used have been identified by searching Medline, PubMed, and the Science Citation Index, and by a constant review of the major dermatology literature over the last 10 years up to December 2003.

      Validation

      Comparison with normal population

      The DLQI questions were designed to be specific to skin disease, with all 10 questions mentioning skin. There is a very high specificity of the DLQI when compared with the normal population, confirmed in seven studies (Table I). The mean DLQI scores (maximum 30) in normal populations ranged from 0 to 0.5.
      Table IDLQI used in the normal population
      Number of normal populationNumber of patientsDiseaseMean DLQI normal populationMean DLQI patientsReferences
      100237Eczema0.34.2
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      Psoriasis4.5
      100200All0.57.2
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      1419Operating room nurses03.3
      • Hachem J.P.
      • DePaepe K.
      • Sterckx G.
      • Kaufman L.
      • Rogiers V.
      • Roseeuw D.
      Evaluation of key biographical and clinical parameters of skin barrier function among hospital workers.
      Contact Dermatitis. 2002; 46: 220-223
      2232Atopic dermatitis––
      • Linnet J.
      • Jemec G.B.E.
      An assessment of anxiety and dermatology life quality in patients with atopic dermatitis.
      Brit J Dermatol. 1999; 140: 268-272
      100300Outpatients0.47.9
      • Zachariae R.
      • Zachariae C.
      • Ibsen H.
      • Mortensen J.T.
      • Wulf H.C.
      Dermatology Life Quality Index: Data from Danish inpatients and outpatients.
      Acta Derm Venereol. 2000; 80: 272-276
      Inpatients12.9
      100340All0.59.6
      Etemesi BA: Quality of life in Tanzanian adults with chronic skin disease. Ann Dermatol Venereol 129:1S253, 2002 (abstract).
      2848Psoriasis0.112.5
      Etemesi BA: Quality of life in Tanzanian adults with chronic skin disease. Ann Dermatol Venereol 129:1S253, 2002 (abstract).
      –––––
      Etemesi BA: Quality of life in Tanzanian adults with chronic skin disease. Ann Dermatol Venereol 129:1S253, 2002 (abstract).
      bUrbanowski S, Kosmowski W, Quality of life, psychological condition, depression and alexithymia in patients with psoriasis vulgaris. Ann Dermatol Venereol 129:1S798, 2002 (abstract).
      cFinlay AY, Myon E, Taieb C: Immoderate exposure to the sun: short-term impact on quality of life. JEADV 17:62, 2003 (abstract).
      a Etemesi BA: Quality of life in Tanzanian adults with chronic skin disease. Ann Dermatol Venereol 129:1S253, 2002 (abstract).

      Repeatability

      The ability of a questionnaire to give a closely similar score if repeated after a short time in a patient with stable disease is an important characteristic to be fulfilled. This has been confirmed for the DLQI in four studies (Table II).
      Table IITest-retest repeatability of the DLQI
      Number of patientsStatistical testReferences
      94Interclass correlation coefficient
      • Badia X.
      • Mascaro J.M.
      • Lozano R.
      Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensibility to change of the DLQI.
      Brit J Dermatol. 1999; 141: 698-702
       Eczema 0.77 (95% CI)
       Psoriasis 0.90 (95% CI)
      53Spearman's rank correlation
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
       Overall r=0.99
        p<0.0001
       Individual questions
        r=0.95–0.98
        p<0.001
      38Spearman's rank correlation coefficient 0.97
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      p<0.0001
      26Reliability
      • Zachariae R.
      • Zachariae C.
      • Ibsen H.
      • Mortensen J.T.
      • Wulf H.C.
      Dermatology Life Quality Index: Data from Danish inpatients and outpatients.
      Acta Derm Venereol. 2000; 80: 272-276
       General 0.93
        p<0.01
       Individual items 2–10
        Range 0.62–0.88
        p<0.001
       Item 1
        0.32 (not significant)

      Internal consistency

      Internal consistency for the DLQI has been examined in five studies (Table III). These have demonstrated Cronbach's α scores ranging from 0.83 to 0.93. Rank correlation has also been measured. This test determines the degree of consistency of responses between questions. The higher the rank correlation value the higher the consistency.
      Table IIIInternal consistency of the DLQI
      Number of patientsStatistical testReferences
      237Cronbach's alpha 0.83
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      200Rank correlation range 0.23–0.70
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      p=0.002
      607Cronbach's alpha 0.83
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Inter-item rank correlation coefficient range 0.04–0.54
      230Cronbach's alpha 0.9
      • Mork C.
      • Wahl A.
      • Moum T.
      The Norwegian version of the Dermatology Life Quality Index: A study of validity and reliability in psoriatics.
      Acta Derm Venereol. 2002; 82: 347-351
      ,
      • Mork C.
      • Wahl A.
      • Polit R.N.
      Improved quality of life among patients with psoriasis after supervised climate therapy at the Canary Islands.
      J Am Acad Dermatol. 2002; 47: 314-315
      )
      Paired correlation between items range 0.20–0.76
      p<0.01
      300Cronbach's alpha 0.88
      • Zachariae R.
      • Zachariae C.
      • Ibsen H.
      • Mortensen J.T.
      • Wulf H.C.
      Dermatology Life Quality Index: Data from Danish inpatients and outpatients.
      Acta Derm Venereol. 2000; 80: 272-276

      Sensitivity to change

      For any outcome measure to be of value in the assessment of intervention, the measure must be sensitive to change. This has been confirmed for the DLQI in 53 studies describing sensitivity to change in 11 diseases (Table IV), and interventions within seven different health service research settings (Table V). It should be noted that all the questions in the DLQI relate to “over the last week”. It is therefore not appropriate to administer the DLQI to an individual at an interval of less than 1 week.
      Table IVTreatments in which the DLQI has been used
      Mean DLQI
      Condition and treatmentNo. of studiesNo. of patients evaluated post-treatmentBeforeAfterReferencesAdditional references where DLQI score not stated
      Acne––adapalene287712.91.3
      • Grosshans E.
      • Marks R.
      • Marcard J.M.
      • et al.
      Evaluation of clinical efficacy and safety of adapelene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life.
      Brit J Dermatol. 1998; 139: 2633
      Samgin MA, Monakhov SA. Adapalene gel 0.1% in the treatment of acne in Moscow. JEADV 17(Suppl. 3):166, 2003.
      Blue light phototherapy1216.14
      Ammad S, Edwards C, Gonzalez M, Mills CM. The effect of blue light phototherapy on mild to moderate acne. Brit J Dermatol 147(Suppl 62):95, 2002 (abstract).
      Isotretinoin21046.72.8
      • Newton J.N.
      • Mallon E.
      • Klassen A.
      • Ryan T.J.
      • Finlay A.
      The effectiveness of acne treatment: An assessment by patients of the outcome of therapy.
      Brit J Dermatol. 1997; 137: 563-567
      ;
      • Grosshans E.
      • Marks R.
      • Marcard J.M.
      • et al.
      Evaluation of clinical efficacy and safety of adapelene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life.
      Brit J Dermatol. 1998; 139: 2633
      Amyotrophic lateral sclerosis––botox15––
      • Giess R.
      • Naumann M.
      • Werne E.
      • et al.
      Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis.
      J Neurol Neurosurg Psychiatry. 2000; 69: 121-123
      BCC––surgery1375.31.3
      • Blackford S.
      • Roberts D.L.
      • Salek M.S.
      • Finlay A.Y.
      Basal cell carcinomas cause little handicap.
      Qual Life Res. 1996; 5: 191-194
      Bullous pemphigoid––treatment115362.1
      • Rzany B.J.
      • Partscht K.
      • Kippes W.
      • et al.
      Quality of life in patients with Bullous pemphigoid.
      J Invest Dermatol. 2000; 114: 887
      Chronic urticaria––fexofenadine15711.610.3
      • Thompson A.K.
      • Finn A.F.
      • Schoenwetter W.F.
      Effect of 60 mg twice-daily Fexofenadine HCI on quality of life, work and classroom productivity, and regular activity in patients with chronic idiopathic urticaria.
      J Am Acad Dermatol. 2000; 43: 24-30
      Cosmetic camouflage31569.15.7
      • Holme S.A.
      • Beattie P.E.
      • Fleming C.J.
      Cosmetic camouflage advice improve quality of life.
      Br J Dermatol. 2002; 147: 946-949
      ;
      • Boehncke W.H.
      • Ochsendorf F.
      • Paeslack I.
      • Kaufmann R.
      • Zollner T.M.
      Decorative cosmetics improve the quality of life in patients with disfiguring skin diseases.
      Eur J Dermatol. 2002; 12: 577-580
      Feldman SR, McMichael A, Balkrishnan R, Rapp SR, Crambes O, Abella ML, Bouloc A. The effect of corrective cosmetics on quality of life of patients with facial disfigurements. JEADV 17(Suppl. 3):202, 2003.
      Eczema––autologous blood therapy1158.44.1
      • Pittler M.H.
      • Armstrong N.C.
      • Cox A.
      • Collier P.M.
      • Hart A.
      • Ernst E.
      Randomised, double-blind, placebo-controlled trial of autologous blood therapy for atopic dermatitis.
      Br J Dermatol. 2003; 148: 307-313
      Cyclosporin213715.76.3Czech et al (2000)
      Kochergin, NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      Pimecrolimus2353––
      • Reilly M.C.
      • Lavin P.T.
      • Kahler K.H.
      • Pariser D.M.
      Validation of the Dermatology Life Quality Index and the work productivity and activity impairment––Chronic Hand Dermatitis questionnaire in chronic hand dermatitis.
      J Am Acad Dermatol. 2003; 48: 128-130
      Meurer M, Folster-Holst R, Brautigam M. Primecrolimus (SDZ ASM 981) cream improves disease control and quality of life in the long-term management of atopic dermatitis in adults. Ann Dermatol Venereol 129:1S47, 2002 (abstract).
      Psychotropic medicines216321.36.9
      Kochergin, NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      ,
      Lvov AN, Ivanov OL, Ostrishko VV, et al. Psychoneurological parameters and quality of life in patients with severe forms of atopic dermatitis. JEADV 15(Suppl. 2):276, 2001 (abstract).
      Tacrolimus1985––
      • Drake L.
      • Prendergast M.
      • Maher R.
      • et al.
      The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis.
      J Am Acad Dermatol. 2001; 44: S65-S72
      Topical steroids11144.41.6
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      UVB11210.83.6
      • Piletta P.A.
      • Wirth S.
      • Hommele L.
      • et al.
      Circulating skin-homing T cells in atopic dermatitis.
      Arch Dermatol. 1996; 132: 1171-1176
      Hirsutism––ruby laser11512.87
      • Loo W-J.
      • Lanigan S.W.
      Laser treatment improves quality of life of hirsute females.
      Clin Exp Dermatol. 2002; 27: 439-441
      Hydrotherapy120010.25.7
      Segard C, Verriere F, Nocera T, Myon E, Taieb C. Impact of hydrotherapy care on the quality of life of patients' suffering from skin disease. Qual Life Res 12:777, 2003.
      Hyperhidrosis––botox19410.38.8
      • Swartling C.
      • Naver H.
      • Lindberg M.
      Botulinum A toxin improves life quality in severe primary focal hyperhidrosis.
      Eur J Neurol. 2001; 8: 247-252
      • Campanati A.
      • Penna L.
      • Guzzo T.
      • et al.
      Quality of life assessmentin patiens with hyperhidrosis before and after treatment with botulimum toxin: Results of an open-label study.
      Clin Ther. 2003; 25: 298-308
      Endoscopic transthoracic sympathectomy133––
      Nicolaou M, Swan MC, Paes T. Endoscopic transthoracic sympathectomy: the effect on the quality of life of patients with facial, palmar and axillary hyperhidrosis and facial blushing. JEADV 16(Suppl. 1):298, 2002 (abstract).
      Lymphoedema––skin hygiene11110.94.1
      • McPherson T.
      Impact on the quality of life of lymphoedema patients following introduction of a hygiene and skin care regimen in a Guyanese community endemic for lymphatic filariasis: A preliminary clinical intervention study.
      Filaria J. 2003; 2: 1
      Psoriasis––Alfacept631711.36.9
      • Finlay A.Y.
      • Salek M.S.
      • Haney J.
      Intramuscular Alefacept improves health-related quality of life in patients with chronic plaque psoriasis.
      Dermatology. 2003; 2006: 307-315
      • Ellis C.N.
      • Mordin M.M.
      • Adler E.Y.
      Effects of Alefacept on health-related quality of life in patients with psoriasis: Results from a randomised, placebo controlled phase II trial.
      Am J Clin Dermatol. 2003; 4: 131-139
      Christophers E, Bourcier M, Griffiths C, et al. Study design and demographics of a randomised, double-blind, placebo-controlled phase 3 dose-comparison study to evaluate weekly intramuscular administration of alefacept in chronic plaque psoriasis. JEADV 15(Suppl. 2):249, 2001 (abstract).
      ,
      Griffiths C, Langley R, Lebwohl M, et al. Alefacept improves psoriasis and quality of life: Results of an international trial. Ann Dermatol Venereol 129:1S280, 2002 (abstract).
      ,
      Papp K, Ellis C, Menter A, et al. Alefacept improves psoriasis and quality of life: Results of a multiple-course trial. Ann Dermatol Venereol 129:1S764, 2002 (abstract).
      ,
      Griffiths CEM, Humbert P, Koo J, Ortonne JP, Christophers E. Relationship between clinical response and quality of life in psoriasis patients treated with alefacept. JEADV 16(Suppl. 1):292, 2002 (abstract).
      ,
      Langley R. An improvement of 50% or more in psoriasis area severity index (PASI) represents substantial improvement for patients treated with alefacept. JEADV 17(Suppl. 3):139, 2003.
      ,
      Christopher E, Vanishnaw AK. A broad spectrum of patients with psoriasis benefit from alefacept therapy. JEADV 17(Suppl. 3):138, 2003.
      Clobetasol proprionate foam116––
      • Bergestrom K.G.
      • Arambula K.
      • Kimball A.B.
      Medication formulation affects quality of life: Randomised single blind study of clobetasol propionate foam 0.05% compared with a combined program of clobetasol cream 0.05% and solution 0.05% for the treatment of psoriasis cutis.
      . 2003; 72: 407-411
      Cyclosporin438810.91.3
      • Touw C.R.
      • Hakkaart-Van Roijen L.
      • Verboom P.
      • Paul C.
      • Rutten F.F.H.
      • Finlay A.Y.
      Quality of life and clinical outcome in psoriasis patients using intermittent cyclosporin.
      Br J Dermatol. 2001; 144: 967-972
      ;
      • Ho V.C.Y.
      • Griffiths C.E.M.
      • Berth-Jones J.
      • et al.
      Intermittent short courses of cyclosporin microemulsion for the long-term management of psoriasis: A 2 yr cohort study.
      J Am Acad Dermatol. 2001; 44: 643-651
      Kochergin NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      ,
      Chaidemenos C, Avgoustinaki N, Karakatsanis G, Chatzistylianos M, Papakonstantinou M, Mourellou O. Effect of intermittent and continuous cyclosporin therapy on the clinical and quality of life parameters of psoriasis. JEADV 17(Suppl. 3):381, 2003.
      DAB389IL-212910.85.9
      • Bagel J.
      • Garland W.T.
      • Breneman D.
      • et al.
      Administration of DAB 389 IL-2 to patients with recalcitrant psoriasis: A double-blind, phase II multicentre trial.
      J Am Acad Dermatol. 1998; 38: 938-944
      Efalizumab41008126.9
      • Gordon K.B.
      • Papp K.A.
      • Hamilton T.K.
      • et al.
      Efalizumab for patients with moderate to severe plaque psoriasis: A random controlled trial.
      JAMA. 2003; 290: 3073-3080
      ;
      • Shikiar R.
      • Bresnahan B.W.
      • Stone S.P.
      • Thompson C.
      • Koo J.
      • Revicki D.A.
      Validity and reliability of patient reported outcomes used in psoriasis: Results of two randomised clinical trials.
      Health Qual Life Outcomes. 2003; 1: 53
      Sterry W. Psoriasis––impact on QoL––efalizumab positive outcomes. JEADV 17(Suppl. 3):439, 2003.
      Etanercept15714–
      • Gottlieb A.B.
      • Matheson R.T.
      • Low N.
      • et al.
      A randomized trial of etanercept as monotherapy for psoriasis.
      Arch Dermatol. 2003; 139: 1627-1632
      Carey W, Gulliver WP. Efalizumab therapy improves and sustains health-related quality of life in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3):371, 2003.
      ,
      Ouellet JP, Toth D, Gratton D. Efalizumab provides rapid onset of clinical benefit in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3):371, 2003.
      Heliotherapy187––
      • Amir M.
      • Vardy D.
      • Narkiss T.
      • et al.
      Heliotherapy at the Dead Sea improves quality of life in psoriatic patients: A prospective study.
      Qual Life Res. 2001; 10: 236
      Hu1124Ab15211.95.7
      Bissonnette R, Papp KA, Garovoy M, Walicke P, Watrous W. Hu 1124 improves dermatological-specific quality of life in subjects with moderate-severe psoriasis. J Eur Acad Dermatol Venereol 14(Suppl. 1):255, 2000 (abstract).
      Infliximab17––
      • Chan J.J.
      • Gebauer K.
      Treatment of severe recalcitrant plaque psoriasis with single dose intravenous tumour necrosis factor-alpha antibody (infliximab).
      Aus J Dermatol. 2003; 44: 116
      Supervised climatotherapy14591.50.9
      • Mork C.
      • Wahl A.
      • Polit R.N.
      Improved quality of life among patients with psoriasis after supervised climate therapy at the Canary Islands.
      J Am Acad Dermatol. 2002; 47: 314-315
      Topical steroids11234.82.7
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      Vitiligo––pigmentary clinic114110.77.1
      • Parsad D.
      • Pandhi R.
      • Dogra S.
      • Kanwar A.J.
      • Kumar B.
      Dermatology Life Quality Index score in vitiligo and its impact on the treatment outcome.
      Br J Dermatol. 2003; 148: 373-374
      Cognitive behavioral therapy121155
      • Papadopoulos L.
      • Bor R.
      • Legge
      • et al.
      Coping with the disfiguring effects of vitiligo.
      Brit J Med Psychol. 1999; 72: 385-396
      Cosmetic camouflage1627.35.9
      Dierckxsen L, Ongenae K, van Geel N, Naeyaert J. Vitiligo and quality of life: impact of complexion corrector. JEADV 17(Suppl. 3):358, 2003.
      a Samgin MA, Monakhov SA. Adapalene gel 0.1% in the treatment of acne in Moscow. JEADV 17(Suppl. 3):166, 2003.
      b Ammad S, Edwards C, Gonzalez M, Mills CM. The effect of blue light phototherapy on mild to moderate acne. Brit J Dermatol 147(Suppl 62):95, 2002 (abstract).
      c Feldman SR, McMichael A, Balkrishnan R, Rapp SR, Crambes O, Abella ML, Bouloc A. The effect of corrective cosmetics on quality of life of patients with facial disfigurements. JEADV 17(Suppl. 3):202, 2003.
      d Kochergin, NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      e Meurer M, Folster-Holst R, Brautigam M. Primecrolimus (SDZ ASM 981) cream improves disease control and quality of life in the long-term management of atopic dermatitis in adults. Ann Dermatol Venereol 129:1S47, 2002 (abstract).
      f Kochergin, NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      g Lvov AN, Ivanov OL, Ostrishko VV, et al. Psychoneurological parameters and quality of life in patients with severe forms of atopic dermatitis. JEADV 15(Suppl. 2):276, 2001 (abstract).
      h Segard C, Verriere F, Nocera T, Myon E, Taieb C. Impact of hydrotherapy care on the quality of life of patients' suffering from skin disease. Qual Life Res 12:777, 2003.
      i Nicolaou M, Swan MC, Paes T. Endoscopic transthoracic sympathectomy: the effect on the quality of life of patients with facial, palmar and axillary hyperhidrosis and facial blushing. JEADV 16(Suppl. 1):298, 2002 (abstract).
      j Christophers E, Bourcier M, Griffiths C, et al. Study design and demographics of a randomised, double-blind, placebo-controlled phase 3 dose-comparison study to evaluate weekly intramuscular administration of alefacept in chronic plaque psoriasis. JEADV 15(Suppl. 2):249, 2001 (abstract).
      k Griffiths C, Langley R, Lebwohl M, et al. Alefacept improves psoriasis and quality of life: Results of an international trial. Ann Dermatol Venereol 129:1S280, 2002 (abstract).
      l Papp K, Ellis C, Menter A, et al. Alefacept improves psoriasis and quality of life: Results of a multiple-course trial. Ann Dermatol Venereol 129:1S764, 2002 (abstract).
      m Griffiths CEM, Humbert P, Koo J, Ortonne JP, Christophers E. Relationship between clinical response and quality of life in psoriasis patients treated with alefacept. JEADV 16(Suppl. 1):292, 2002 (abstract).
      n Langley R. An improvement of 50% or more in psoriasis area severity index (PASI) represents substantial improvement for patients treated with alefacept. JEADV 17(Suppl. 3):139, 2003.
      o Christopher E, Vanishnaw AK. A broad spectrum of patients with psoriasis benefit from alefacept therapy. JEADV 17(Suppl. 3):138, 2003.
      p Kochergin NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      q Chaidemenos C, Avgoustinaki N, Karakatsanis G, Chatzistylianos M, Papakonstantinou M, Mourellou O. Effect of intermittent and continuous cyclosporin therapy on the clinical and quality of life parameters of psoriasis. JEADV 17(Suppl. 3):381, 2003.
      r Sterry W. Psoriasis––impact on QoL––efalizumab positive outcomes. JEADV 17(Suppl. 3):439, 2003.
      s Carey W, Gulliver WP. Efalizumab therapy improves and sustains health-related quality of life in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3):371, 2003.
      t Ouellet JP, Toth D, Gratton D. Efalizumab provides rapid onset of clinical benefit in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3):371, 2003.
      u Bissonnette R, Papp KA, Garovoy M, Walicke P, Watrous W. Hu 1124 improves dermatological-specific quality of life in subjects with moderate-severe psoriasis. J Eur Acad Dermatol Venereol 14(Suppl. 1):255, 2000 (abstract).
      v Dierckxsen L, Ongenae K, van Geel N, Naeyaert J. Vitiligo and quality of life: impact of complexion corrector. JEADV 17(Suppl. 3):358, 2003.
      Table VHealth Service Research using the DLQI
      DLQI
      Type of CareRelevant diseaseNumber of patientsBeforeAfterReferencesReferences with insufficient data
      Day case treatmentPsoriasis3310.57.2
      • Haynes M.
      Examining day-case and in-patient psoriasis care.
      Prof Nurse. 2000; 16: 893-896
      Inpatient treatmentAll61912.36.7
      • Kurwa H.
      • Finlay A.Y.
      Dermatology inpatient management greatly improves life quality.
      Brit J Dermatol. 1995; 133: 575-578
      ;
      • Haynes M.
      Examining day-case and in-patient psoriasis care.
      Prof Nurse. 2000; 16: 893-896
      ;
      • Vensel E.
      • Hilley T.
      • Trent J.
      • et al.
      Sustained improvement of the quality of life of patients with psoriasis after hospitalisation.
      J Am Acad Dermatol. 2000; 43: 858-860
      ;
      • Helbling I.
      • Ferguson J.E.
      • McKenna M.
      • Muston H.L.
      Audit of admissions to dermatology beds in Greater Manchester.
      Clin Exp Derm. 2002; 27: 519-522
      • Ayyalaraju S.R.
      • Finlay A.Y.
      • Dykes P.J.
      • Trent J.
      • Kirsner R.S.
      • Kerdel F.A.
      Hospitalization for severe skin disease improves quality of life in the United Kingdom and the United States: A comparative study.
      J Am Acad Dematol. 2003; 49: 249-254
      Nurse follow-up clinicsEczema psoriasis38110.77.6
      • Gradwell C.
      • Thomas K.S.
      • English J.S.
      • Williams H.C.
      A randomised controlled trial of nurse follow-up clinics: Do they help patients and free up consultants' time?.
      Br J Dermatol. 2002; 147: 513-517
      Wong CSM, Sewell M, Yell J. Nurse practitioners compare favourably with doctors in the treatment of eczema and psoriasis. Brit J Dermatol 149(Suppl 64):4–5, 2003.
      Outpatient consultation with dermatologistAll24874.63.1
      Finlay AY, Coles EC, Lewis-Jones MS, et al. Quality of life improves after seeing a dermatologist. Brit J Dermatol 139(Suppl. 51):15, 1998 (abstract).
      • Shum R.W.
      • Lawton S.
      • Williams H.C.
      • Docherty G.
      • Jones J.
      The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 3: Audit of service outcome.
      Brit J Dermatol. 2000; 142: 721-727
      Berger K, Kugland B, Khlken B, Augustin M. Cost of chronic plaque psoriasis in Germany: An analysis from the patients and payer perspectives. J Eur Acad Dermatol Venereol 17(Suppl. 1):36, 2003 (abstract).
      Patch testingEczema1798.75.5
      • Thomson K.F.
      • Wilkinson S.M.
      • Sommer S.
      • Pollock B.
      Eczema: Quality of life by body site and the effect of patch testing.
      Br J Dermatol. 2002; 146: 627-630
      ;
      • Woo P.N.
      • Hay I.C.
      • Ormerod A.D.
      An audit of the value of patch testing and its effect on quality of life.
      Contact Dermatitis. 2003; 48: 244-247
      Primary careAll3417.4–
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Primary care dermatology liason nursesPsoriasis eczema356.14.6
      • Kernick D.
      • Cox A.
      • Powell R.
      • Reinhold D.
      • Sawkins J.
      • Warin A.
      A cost consequence study of the impact of a dermatology-trained practice nurse on the quality of life of primary care patients with eczema and psoriasis.
      Brit J Gen Pract. 2000; 50: 555-558
      Teledermatologytreament timeAllAll123536.310.8––
      • Williams T.L.
      • May C.R.
      • Esmail A.
      • et al.
      Patient satisfaction with teledermatology is related to perceived quality of life.
      Br J Dermatol. 2001; 145: 911-917
      ,
      • Jemec B.G.B.E.
      • Kynemund L.
      Time spent on treatment in dermatology––how much time do outpatients use and is it a measure of morbidity?.
      Acta Dermatoven APA. 2001; 10: 17-19
      a Wong CSM, Sewell M, Yell J. Nurse practitioners compare favourably with doctors in the treatment of eczema and psoriasis. Brit J Dermatol 149(Suppl 64):4–5, 2003.
      b Finlay AY, Coles EC, Lewis-Jones MS, et al. Quality of life improves after seeing a dermatologist. Brit J Dermatol 139(Suppl. 51):15, 1998 (abstract).
      c Berger K, Kugland B, Khlken B, Augustin M. Cost of chronic plaque psoriasis in Germany: An analysis from the patients and payer perspectives. J Eur Acad Dermatol Venereol 17(Suppl. 1):36, 2003 (abstract).

      Validation with other HRQoL measures and other outcome measures

      The DLQI has been used in parallel with nine other dermatology specific measures (Table VI) and with seven general health measures (Table VII). Other general health measures that have been used in comparison with the DLQI are willingness to pay (
      • Lundberg L.
      • Johannesson M.
      • Silverdahl M.
      • Hermansson C.
      • Lindberg M.
      Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema.
      Brit J Dermatol. 1999; 141: 1067-1079
      ) and total illness burden (Fivenson D et al, 2002). An illustrated version of the DLQI (
      • Loo W-J.
      • Diba V.
      • Chawla M.
      • Finlay A.Y.
      Dermatology Life Quality Index: Influence of an illustrated version.
      Br J Dermatol. 2003; 148: 279-284
      ) has been evaluated, but it was not possible to demonstrate exact equivalence to the text only version.
      Table VIDermatology-specific HRQoL measures and other outcome measures used in parallel with the DLQI
      MeasureReferencesNumber of patientsCorrelation coefficient p-value
      Assessment of the Psychological and Social Effects of Acne (APSEA)
      Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social aspect of acne: a comparison study using three acne disability questionnaires. Brit J Dermatol 137(Suppl. 40):41, 1997 (abstract).
      		163r=0.65
      p<0.001
      Acne Quality of Life Scale (AQOLS)
      Ertam I. Acne and quality of life: Is there a correlation between them in university students. Ann Dermatol Venereol 129:1S374, 2002 (abstract).
      		108p<0.05
      Cardiff Acne Disability Index (CADI)
      Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social aspect of acne: a comparison study using three acne disability questionnaires. Brit J Dermatol 137(Suppl. 40):41, 1997 (abstract).
      		163r=0.65
      p<0.001
      Life Activity Impairment Score (LAIS)
      Al-Awadi R, Dykes PJ, Gonzalez M, Finlay AY. Life activity impairment by skin disease. J Eur Acad Dermatol Venereol 14(Suppl. 1):54, 2000 (abstract).
      		300r=0.86
      p=0.05
      Psoriasis Disability Index (PDI)
      • Nichol M.B.
      • Margoilies J.E.
      • Lippa E.
      • Rowe M.
      • Quell J.
      The application of multiple quality of life instruments in individuals with mild-to-moderate psoriasis.
      Pharmacoeconomics. 1996; 10: 644-653
      		644r=0.82
      p<0.001
      Physician's Disease Severity
      • Harris A.
      • Burge S.M.
      • Dykes P.J.
      • Finlay A.Y.
      Handicap in Darier's disease and Hailey–Hailey disease.
      Brit J Dermatol. 1996; 135: 959-963
      		279Darier's disease
      p=0.41
      Hailey–Hailey Disease
      p=0.08
      • Jayaprakasam A.
      • Darvey A.
      • Jsborne G.
      • McGibbon D.
      Comparisons of assessment of severity and quality of life in cutaneous disease.
      Clin Exp Dermatol. 2002; 27: 306-308
      		57r=0.56
      PSORIQoL
      • McKenna S.P.
      • Cook S.A.
      • Whalley D.
      • Doward L.C.
      • Richards H.L.
      • Griffiths C.E.M.
      • Van Assch D.
      Development of the PSORIQoL, a psoriasis-specific measure of quality of life designed for use in clinical practice and trials.
      Br J Dermatol. 2003; 149: 323-331
      		130r=0.7
      Psoriasis quality of life index (PQLI)
      Callis KP, Carlin CS, Krueger CG. Correlation of National Psoriasis Foundation score components with quality of life measures in psoriasis. J Invest Dermatol 121:0357, 2003.
      		50r=0.99
      Psoriasis Quality of Life Questionnaire (PQOL)
      • Koo J.
      • Menter A.
      • Lebwohl M.
      • Kozma C.
      • Slaton T.
      • Wojcik A.
      • Kowlaski J.
      The relationship between quality of life and disease severity: Results from a large cohort of mild, moderate and severe psoriasis patients.
      Br J Dermatol. 2002; 147: 1070-1171
      		474–
      a Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social aspect of acne: a comparison study using three acne disability questionnaires. Brit J Dermatol 137(Suppl. 40):41, 1997 (abstract).
      b Ertam I. Acne and quality of life: Is there a correlation between them in university students. Ann Dermatol Venereol 129:1S374, 2002 (abstract).
      c Al-Awadi R, Dykes PJ, Gonzalez M, Finlay AY. Life activity impairment by skin disease. J Eur Acad Dermatol Venereol 14(Suppl. 1):54, 2000 (abstract).
      d Callis KP, Carlin CS, Krueger CG. Correlation of National Psoriasis Foundation score components with quality of life measures in psoriasis. J Invest Dermatol 121:0357, 2003.
      Table VIIGeneral HRQoL measures used in parallel with the DLQI
      MeasureReferencesNumber of patientsr-value p-value
      Center for Epidemiological Studies Depression Scale (CESD-10)
      • Williamson D.
      • Gonzalez M.
      • Finlay A.Y.
      The effect of hair loss on quality of life.
      J Eur Acad Dermatol Venereol. 2001; 15: 137-139
      		70r=0.62
      p<0.0001
      Euroqol EQ-5D
      • Klassen A.F.
      • Newton J.N.
      • Mallon E.
      Measuring quality of life in people referred for specialist care of acne: Comparing generic and disease-specific measures.
      J Am Acad Dermatol. 2000; 43: 229-233
      		130
      General health Questionnaire (GHQ-28)
      • Kent G.
      • Al-Abadie M.
      Factors affecting responses on Dermatology Life Quality Index items among vitiligo sufferers.
      Clin Exp Dermatol. 1996; 21: 330-333
      		627r=0.39
      p<0.001
      Nottingham Health Profile (NHP)
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      		237r=0.32–0.12
      Patient Generated Index (PGI)
      • Herd R.M.
      • Tidman M.J.
      • Ruta D.A.
      • Hunter J.A.A.
      Measurement of quality of life in atopic dermatitis: Correlation and validation of two different methods.
      Brit J Dermatol. 1997; 136: 502-507
      		56r=-0.4
      p<0.001
      • Ruta D.
      • Allen S.
      • Herd R.
      • Tidman M.
      The patient generated index: A new approach to quality of life measurement in psoriasis.
      Qual Life Res. 1998; 7: 657
      		65–
      Rosenberg's self-esteem
      • Mallon E.
      • Newton J.N.
      • Klassen A.
      • Stewart-Brown S.L.
      • Ryan T.J.
      • Finlay A.Y.
      The quality of life in acne: A comparison with general medical conditions using generic questionnaires.
      Brit J Dermatol. 1999; 140: 672-676
      		111r=-0.4
      p<0.001
      • Kent G.
      • Al-Abadie M.
      Factors affecting responses on Dermatology Life Quality Index items among vitiligo sufferers.
      Clin Exp Dermatol. 1996; 21: 330-333
      		622r=-0.4
      p<0.001
      Short Form Health Survey Questionnaire (SF-36)
      • Nichol M.B.
      • Margoilies J.E.
      • Lippa E.
      • Rowe M.
      • Quell J.
      The application of multiple quality of life instruments in individuals with mild-to-moderate psoriasis.
      Pharmacoeconomics. 1996; 10: 644-653
      		644p=0.001
      • Mallon E.
      • Newton J.N.
      • Klassen A.
      • Stewart-Brown S.L.
      • Ryan T.J.
      • Finlay A.Y.
      The quality of life in acne: A comparison with general medical conditions using generic questionnaires.
      Brit J Dermatol. 1999; 140: 672-676
      		111r=-0.5
      p<0.001
      • Ruta D.
      • Allen S.
      • Herd R.
      • Tidman M.
      The patient generated index: A new approach to quality of life measurement in psoriasis.
      Qual Life Res. 1998; 7: 657
      		65–
      • Lundberg L.
      • Johannesson M.
      • Silverdahl M.
      • et al.
      Health-related quality of life in patients with psoriasis and atopic dermatitis measured with SF-36, DLQI and a subjective measure of disease activity.
      Acta Derm Venereol. 2000; 80: 430-434
      		366r=-0.27–0.41
      • Kiebert G.
      • Sorensen S.V.
      • Revicki D.
      • et al.
      Atopic dermatitis is associated with a decrement in health-related quality of life.
      Int J Dermatol. 2002; 41: 151-158
      		237r=-0.27–0.58
      p<0.05
      • Fivenson D.
      • Arnold R.J.G.
      • Kaniecki D.J.
      • Cohen J.L.
      • Frech F.
      • Finlay A.Y.
      The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organisation.
      J Managed Care Pharm. 2002; 8: 333-342
      		107r=-0.42–0.57
      UK Sickness Impact Profile (UKSIP)
      • Blackford S.
      • Roberts D.L.
      • Salek M.S.
      • Finlay A.Y.
      Basal cell carcinomas cause little handicap.
      Qual Life Res. 1996; 5: 191-194
      		44r=0.6
      p<0.01

      Time for completion

      The mean time for completion of the text only version of the DLQI is 124 s (
      • Loo W-J.
      • Diba V.
      • Chawla M.
      • Finlay A.Y.
      Dermatology Life Quality Index: Influence of an illustrated version.
      Br J Dermatol. 2003; 148: 279-284
      ). The mean time taken for a cartoon and text version was reduced to 88 s.
      • Hahn B.H.
      • Melfi C.A.
      • Chuang T.Y.
      • et al.
      Use of the Dermatology Life Quality Index (DLQI) in a Midwestern US Urban Clinic.
      J Am Acad Dermatol. 2001; 45: 44-48
      recorded that patients took between 1 and 3 min to complete the DLQI.

      Meaning of scores

      There has been very little published concerning the absolute meaning of dermatology HRQoL scores and the nature of the minimally important score change. The minimally important score change is the score change that is considered by a patient to be clinically relevant in contrast to a score change which might be statistically significant. Preliminary work concerning this has been carried out for the DLQI
      Khilji FA, Gonzalez M, Finlay AY: Clinical meaning of change in Dermatology Life Quality Index scores. Br J Dermatol 147(Suppl. 62):50, 2002 (abstract).
      ,
      Hongbo Y, Harrison MA, Salek MS, Finlay AY: Assessing the meaningfulness of Dermatology Life Quality Index (DLQI) scores. JEADV 17(Suppl. 3):113, 2003 (abstract).
      .

      Diseases Where DLQI Used

      The DLQI has been used in over 36 different skin conditions (Table VIII). It has been most widely used in psoriasis (30 studies), atopic eczema (21 studies), acne (10 studies), vitiligo (five studies) and chronic urticaria (four studies).
      Table VIIIDiseases and conditions in which the DLQI has been used
      DLQI
      ConditionTotal number from all studiesRange of meansMean of meansMedian of meansReferencesOther references with insufficient data
      Acne8384.3–17.711.96.1
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social aspect of acne: a comparison study using three acne disability questionnaires. Brit J Dermatol 137(Suppl. 40):41, 1997 (abstract).
      • Newton J.N.
      • Mallon E.
      • Klassen A.
      • Ryan T.J.
      • Finlay A.
      The effectiveness of acne treatment: An assessment by patients of the outcome of therapy.
      Brit J Dermatol. 1997; 137: 563-567
      ;
      • Grosshans E.
      • Marks R.
      • Marcard J.M.
      • et al.
      Evaluation of clinical efficacy and safety of adapelene 0.1% gel versus tretinoin 0.025% gel in the treatment of acne vulgaris, with particular reference to the onset of action and impact on quality of life.
      Brit J Dermatol. 1998; 139: 2633
      ;
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Zaghloul SS, Cunliffe WJ, Goodfield MJD. Compliance in acne is highly correlated to psychological well-being and self presentation. Brit J Dermatol 147(Suppl. 62):43, 2002 (abstract).
      ,
      Ammad S, Edwards C, Gonzalez M, Mills CM. The effect of blue light phototherapy on mild to moderate acne. Brit J Dermatol 147(Suppl. 62):95, 2002 (abstract).
      ,
      Kochergin NG, Samgin MA, Monakhow SA. Acne, adapalene and quality of life. JEADV 16(Suppl. 1):116, 2002 (abstract).
      • Poli F.
      • Dreno B.
      • Vershoores M.
      An epidemiological study of acne in female adults: Results of a survey conducted in France.
      JEADV. 2001; 15: 541-545
      Ertam I. Acne and quality of life: Is there a correlation between them in university students. Ann Dermatol Venereol 129:1S374, 2002 (abstract).
      Alopecia areata11–6.2–
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Atopic eczema14094.5–21.412.211
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      • Kurwa H.
      • Finlay A.Y.
      Dermatology inpatient management greatly improves life quality.
      Brit J Dermatol. 1995; 133: 575-578
      ;
      • Finlay A.Y.
      Measures of the effect of severe atopic eczema on quality of life.
      J Eur Acad Dermatol Venereol. 1996; 7: 149-154
      ;
      • Piletta P.A.
      • Wirth S.
      • Hommele L.
      • et al.
      Circulating skin-homing T cells in atopic dermatitis.
      Arch Dermatol. 1996; 132: 1171-1176
      ;
      • Herd R.M.
      • Tidman M.J.
      • Ruta D.A.
      • Hunter J.A.A.
      Measurement of quality of life in atopic dermatitis: Correlation and validation of two different methods.
      Brit J Dermatol. 1997; 136: 502-507
      ;
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      ;
      • Lundberg L.
      • Johannesson M.
      • Silverdahl M.
      • Hermansson C.
      • Lindberg M.
      Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema.
      Brit J Dermatol. 1999; 141: 1067-1079
      ;
      • Shum R.W.
      • Lawton S.
      • Williams H.C.
      • Docherty G.
      • Jones J.
      The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 3: Audit of service outcome.
      Brit J Dermatol. 2000; 142: 721-727
      ;
      • Czech W.
      • Brautigam M.
      • Weidinger G.
      • Schopt F.
      A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life.
      J Am Acad Dermatol. 2000; 42: 653-659
      ;
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      ;
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Kochergin, NG, Burova E P. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      ,
      Lvov AN, Ivanov OL, et al. Psychoneurological parameters and quality of life in patients with severe forms of atopic dermatitis. JEADV 15(Suppl. 2):276, 2001 (abstract).
      ,
      Taieb C, Nocera T, Verriere F, Myon E. Psoriasis and atopic dermatitis: cross-description of patients' quality of life. JEADV 17:38, 2003 (abstract).
      ,
      Holm EA, Jemec GBE. Why is assessment of health-related quality of life so important? JEADV 17(Suppl. 3):304, 2003.
      • Linnet J.
      • Jemec G.B.E.
      An assessment of anxiety and dermatology life quality in patients with atopic dermatitis.
      Brit J Dermatol. 1999; 140: 268-272
      ;
      • Kernick D.
      • Cox A.
      • Powell R.
      • Reinhold D.
      • Sawkins J.
      • Warin A.
      A cost consequence study of the impact of a dermatology-trained practice nurse on the quality of life of primary care patients with eczema and psoriasis.
      Brit J Gen Pract. 2000; 50: 555-558
      ;
      • Drake L.
      • Prendergast M.
      • Maher R.
      • et al.
      The impact of tacrolimus ointment on health-related quality of life of adult and pediatric patients with atopic dermatitis.
      J Am Acad Dermatol. 2001; 44: S65-S72
      ;
      Meurer M, Folster-Holst R, Brautigam M. Primecrolimus (SDZ ASM 981) cream improves disease control and quality of life in the long-term management of atopic dermatitis in adults. Ann Dermatol Venereol 129:1S47, 2002 (abstract).
      • Gradwell C.
      • Thomas K.S.
      • English J.S.
      • Williams H.C.
      A randomised controlled trial of nurse follow-up clinics: Do they help patients and free up consultants' time?.
      Br J Dermatol. 2002; 147: 513-517
      Basal cell carcinoma522–5.34.8–
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      • Blackford S.
      • Roberts D.L.
      • Salek M.S.
      • Finlay A.Y.
      Basal cell carcinomas cause little handicap.
      Qual Life Res. 1996; 5: 191-194
      Behcet's disease325–5.7–
      • Blackford S.
      • Finlay A.Y.
      • Roberts D.L.
      Quality of life in Behcets' syndrome: 335 patients surveyed.
      Brit J Dermatol. 1997; 136: 293
      Bullous pemphigoid25–6–
      • Rzany B.J.
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      Quality of life in patients with Bullous pemphigoid.
      J Invest Dermatol. 2000; 114: 887
      Chronic urticaria5183.9–10.99.9–
      • Poon E.
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      • Greaves M.W.
      • Kobza-Black A.
      The extent and nature of disability in different urticarial conditions.
      Brit J Dermatol. 1999; 140: 667-671
      ;
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      ;
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
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      • Thompson A.K.
      • Finn A.F.
      • Schoenwetter W.F.
      Effect of 60 mg twice-daily Fexofenadine HCI on quality of life, work and classroom productivity, and regular activity in patients with chronic idiopathic urticaria.
      J Am Acad Dermatol. 2000; 43: 24-30
      Darier's disease135–5.9–
      • Harris A.
      • Burge S.M.
      • Dykes P.J.
      • Finlay A.Y.
      Handicap in Darier's disease and Hailey–Hailey disease.
      Brit J Dermatol. 1996; 135: 959-963
      Discoid lupus erythematosus7–5–
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Dystrophic epidermolysis bullosa32–7.5–
      • Horn H.M.
      • Tidman M.J.
      Quality of life in epidermolysis bullosa.
      Clin Exp Dermatol. 2002; 27: 707-710
      Epidermolysis bullosa simplex57–10.7–
      • Horn H.M.
      • Tidman M.J.
      Quality of life in epidermolysis bullosa.
      Clin Exp Dermatol. 2002; 27: 707-710
      Hailey-Hailey disease66–6.1–
      • Harris A.
      • Burge S.M.
      • Dykes P.J.
      • Finlay A.Y.
      Handicap in Darier's disease and Hailey–Hailey disease.
      Brit J Dermatol. 1996; 135: 959-963
      Hair loss70–8.3–
      • Williamson D.
      • Gonzalez M.
      • Finlay A.Y.
      The effect of hair loss on quality of life.
      J Eur Acad Dermatol Venereol. 2001; 15: 137-139
      Hidradenitis suppurativa114–8.9–
      • Von Der Werth J.M.
      • Jemee G.B.E.
      Morbidity in patients with hidradenitis suppurativa.
      Br J Dermatol. 2001; 144: 809-813
      Hirsutism15–12.8–
      • Loo W-J.
      • Lanigan S.W.
      Laser treatment improves quality of life of hirsute females.
      Clin Exp Dermatol. 2002; 27: 439-441
      Immoderate sun exposure–––
      Finlay AY, Myon E, Taieb C. Immoderate exposure to the sun: short-term impact on quality of life. JEADV 17:62, 2003 (abstract).
      Latex allergy36–11–
      Lewis V, Statham B, Chowdhury M. How does the diagnosis of latex allergy affect people's lives? JEADV 17(Suppl. 3):124, 2003.
      Leg ulcers195.5–76.9–
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      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Lichen planus5–5.8–
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Lymphoedema68–10.9–
      • Boehncke W.H.
      • Ochsendorf F.
      • Paeslack I.
      • Kaufmann R.
      • Zollner T.M.
      Decorative cosmetics improve the quality of life in patients with disfiguring skin diseases.
      Eur J Dermatol. 2002; 12: 577-580
      McPherson T, Penzer. A comparison of quality of life and disease severity in 54 patients with lymphoedema in Guyana. Brit J Dermatol 149(Suppl. 64):34, 2003.
      Melasma1103.5–11.510.9–
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      • Bachmann M.
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      • Balkrishnan R.
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      • Camacho F.T.
      • et al.
      Development and validation of a health-related quality of life instrument for women with melasma.
      Br J Dermatol. 2003; 149: 572-577
      Moles171–2.72–
      • Finlay A.Y.
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      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      • Harlow D.
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      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Nodular prurigo6–8.7–
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      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Occuptional contact dermatitis906.6–10.87.5
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      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
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      • Hutchings C.V.
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      Occupational contact dermatitis has an appreciable impact on quality of life.
      Contact Dermatitis. 2001; 45: 17-20
      Primary focal hyperhidrosis58–10.3–
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      • Lindberg M.
      Botulinum A toxin improves life quality in severe primary focal hyperhidrosis.
      Eur J Neurol. 2001; 8: 247-252
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      Quality of life assessmentin patiens with hyperhidrosis before and after treatment with botulimum toxin: Results of an open-label study.
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      Pityriasis rosea7–6.6–
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      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Pruritus1510–10.510.3–
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Psoriasis24681.7–18.28.811.9
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      • Kurwa H.
      • Finlay A.Y.
      Dermatology inpatient management greatly improves life quality.
      Brit J Dermatol. 1995; 133: 575-578
      ;
      • Nichol M.B.
      • Margoilies J.E.
      • Lippa E.
      • Rowe M.
      • Quell J.
      The application of multiple quality of life instruments in individuals with mild-to-moderate psoriasis.
      Pharmacoeconomics. 1996; 10: 644-653
      ;
      Finlay AY, Coles EC, Lewis-Jones MS, et al. Quality of life improves after seeing a dermatologist. Brit J Dermatol 139(Suppl. 51)15, 1998 (abstract).
      • Bagel J.
      • Garland W.T.
      • Breneman D.
      • et al.
      Administration of DAB 389 IL-2 to patients with recalcitrant psoriasis: A double-blind, phase II multicentre trial.
      J Am Acad Dermatol. 1998; 38: 938-944
      ;
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
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      • Lundberg L.
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      • Lindberg M.
      Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema.
      Brit J Dermatol. 1999; 141: 1067-1079
      ;
      Bissonnette R, Papp KA, Garovoy M, Walicke P, Watrous W. Hu 1124 improves dermatological-specific quality of life in subjects with moderate-severe psoriasis. J Eur Acad Dermatol Venereol 14(Suppl. 1):255, 2000 (abstract).
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      ;
      • Haynes M.
      Examining day-case and in-patient psoriasis care.
      Prof Nurse. 2000; 16: 893-896
      ;
      • Vensel E.
      • Hilley T.
      • Trent J.
      • et al.
      Sustained improvement of the quality of life of patients with psoriasis after hospitalisation.
      J Am Acad Dermatol. 2000; 43: 858-860
      ;
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      ;
      • Ho V.C.Y.
      • Griffiths C.E.M.
      • Berth-Jones J.
      • et al.
      Intermittent short courses of cyclosporin microemulsion for the long-term management of psoriasis: A 2 yr cohort study.
      J Am Acad Dermatol. 2001; 44: 643-651
      ;Touw et al (2002);
      Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social aspect of acne: a comparison study using three acne disability questionnaires. Brit J Dermatol 137(Suppl. 40):41, 1997 (abstract).
      ,
      Lowe N, Lebsack M Wande L. Psoriasis patients show improved quality of life when treated with Etanercept. Ann Dermatol Venereol 129:1S762, 2002 (abstract).
      ,
      Urbanowski S, Kosmowski. Quality of life, psychological condition, depression and alexithymia in patients with psoriasis vulgaris. Ann Dermatol Venereol 129:1S798, 2002 (abstract).
      ,
      Zaghloul SS, Goodfield MJD. Compliance in psoriasis: patients' self-reporting and factors affecting medication adherence. Brit J Dermatol 147(Suppl. 62):43–44, 2002 (abstract).
      ,
      Griffiths CEM, Humbert P, Koo J, Ortonne JP, Christophers E. Relationship between clinical response and quality of life in psoriasis patients treated with alefacept. JEADV 16(Suppl. 1):292, 2002 (abstract).
      • Mork C.
      • Wahl A.
      • Moum T.
      The Norwegian version of the Dermatology Life Quality Index: A study of validity and reliability in psoriatics.
      Acta Derm Venereol. 2002; 82: 347-351
      ,
      • Mork C.
      • Wahl A.
      • Polit R.N.
      Improved quality of life among patients with psoriasis after supervised climate therapy at the Canary Islands.
      J Am Acad Dermatol. 2002; 47: 314-315
      ;
      • Mork C.
      • Wahl A.
      • Polit R.N.
      Improved quality of life among patients with psoriasis after supervised climate therapy at the Canary Islands.
      J Am Acad Dermatol. 2002; 47: 314-315
      Taieb C, Nocera T, Verriere F, Myon E. Psoriasis and atopic dermatitis: cross-description of patients' quality of life. JEADV 17:38, 2003 (abstract).
      • Ruta D.
      • Allen S.
      • Herd R.
      • Tidman M.
      The patient generated index: A new approach to quality of life measurement in psoriasis.
      Qual Life Res. 1998; 7: 657
      ;
      Zaghloul S, Gonzalez M, Judodihardjo H, Finlay AY. In psoriasis, the greater the disability, the poorer the topical treatment compliance. Brit J Dermatol 141(Suppl. 55):48, 1999 (abstract).
      ,
      Christophers E, Bourcier M, Griffiths C, et al. Study design and demographics of a randomised, double-blind, placebo-controlled phase 3 dose-comparison study to evaluate weekly intramuscular administration of alefacept in chronic plaque psoriasis. JEADV 15(Suppl. 2):249, 2001 (abstract).
      • Amir M.
      • Vardy D.
      • Narkiss T.
      • et al.
      Heliotherapy at the Dead Sea improves quality of life in psoriatic patients: A prospective study.
      Qual Life Res. 2001; 10: 236
      Griffiths C, Langley R, Lebwohl M, et al. Alefacept improves psoriasis and quality of life: Results of an international trial. Ann Dermatol Venereol 129:1S280, 2002 (abstract).
      ,
      Papp K, Ellis C, Menter A, et al. Alefacept improves psoriasis and quality of life: Results of a multiple-course trial. Ann Dermatol Venereol 129:1S764, 2002 (abstract).
      • Ellis C.N.
      • Mordin M.M.
      • Adler E.Y.
      Effects of Alefacept on health-related quality of life in patients with psoriasis: Results from a randomised, placebo controlled phase II trial.
      Am J Clin Dermatol. 2003; 4: 131-139
      ,
      Öztap MO, Öztap P, Aslan S, Adypen H, Önder M. Comparison of the effects of PUVA and non PUVA treatment on the quality of life of patients with psoriasis vulgaris: a non-randomized, cross-sectional study. JEADV 17:59, 2003 (abstract).
      Rosacea/rhinophyma386.3–7.86.7–
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      ;
      • Hiltscher D.
      • Boslet W.T.
      • Fuchslocher M.
      • et al.
      Quality of life in patients with rosacea and rhinophyma.
      Akt Dermatol. 2001; 27: 391-394
      Scabies7–8.6–
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Seborrhoeic dermatitis50–5.9–
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      Calikoglu E, Oztas P, Cetin P. The evaluation of psychiatric tests in seborrhoeic dermatitis patients. JEADV 17(Suppl. 3):159, 2003.
      Seborrhoeic warts5–1.8–
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      Sialorrhoea in amyotrophic lateral sclerosis5–––
      • Giess R.
      • Naumann M.
      • Werne E.
      • et al.
      Injections of botulinum toxin A into the salivary glands improve sialorrhoea in amyotrophic lateral sclerosis.
      J Neurol Neurosurg Psychiatry. 2000; 69: 121-123
      Solar keratosis5–3.4–
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      Tinea10–5.5–
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Vitiligo8564.8–155.6–
      • Kent G.
      • Al-Abadie M.
      Factors affecting responses on Dermatology Life Quality Index items among vitiligo sufferers.
      Clin Exp Dermatol. 1996; 21: 330-333
      ;
      • Papadopoulos L.
      • Bor R.
      • Legge
      • et al.
      Coping with the disfiguring effects of vitiligo.
      Brit J Med Psychol. 1999; 72: 385-396
      ;
      Ongenae K, De Schepper S, van Geel N, et al. Impact of vitiligo on the quality of life in Belgium. JEADV 15(Suppl. 2):232, 2001 (abstract).
      • Parsad D.
      • Pandhi R.
      • Dogra S.
      • Kanwar A.J.
      • Kumar B.
      Dermatology Life Quality Index score in vitiligo and its impact on the treatment outcome.
      Br J Dermatol. 2003; 148: 373-374
      ;
      Dierckxsen L, Ongenae K, van Geel N, Naeyaert J. Vitiligo: Profile of a Belgian cohort. JEADV 17(Suppl. 3):359, 2003.
      Warts243.8–6.74.73.8
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ;
      • Harlow D.
      • Poyner T.
      • Finlay A.Y.
      • Dykes P.J.
      Impaired quality of life in adults with skin disease in primary care.
      Brit J Dermatol. 2000; 143: 979-982
      ;
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      a Clark SM, Goulden V, Finlay AY, Cunliffe WJ. The psychological and social aspect of acne: a comparison study using three acne disability questionnaires. Brit J Dermatol 137(Suppl. 40):41, 1997 (abstract).
      b Zaghloul SS, Cunliffe WJ, Goodfield MJD. Compliance in acne is highly correlated to psychological well-being and self presentation. Brit J Dermatol 147(Suppl. 62):43, 2002 (abstract).
      c Ammad S, Edwards C, Gonzalez M, Mills CM. The effect of blue light phototherapy on mild to moderate acne. Brit J Dermatol 147(Suppl. 62):95, 2002 (abstract).
      d Kochergin NG, Samgin MA, Monakhow SA. Acne, adapalene and quality of life. JEADV 16(Suppl. 1):116, 2002 (abstract).
      e Ertam I. Acne and quality of life: Is there a correlation between them in university students. Ann Dermatol Venereol 129:1S374, 2002 (abstract).
      f Kochergin, NG, Burova E P. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      g Lvov AN, Ivanov OL, et al. Psychoneurological parameters and quality of life in patients with severe forms of atopic dermatitis. JEADV 15(Suppl. 2):276, 2001 (abstract).
      h Taieb C, Nocera T, Verriere F, Myon E. Psoriasis and atopic dermatitis: cross-description of patients' quality of life. JEADV 17:38, 2003 (abstract).
      i Holm EA, Jemec GBE. Why is assessment of health-related quality of life so important? JEADV 17(Suppl. 3):304, 2003.
      j Meurer M, Folster-Holst R, Brautigam M. Primecrolimus (SDZ ASM 981) cream improves disease control and quality of life in the long-term management of atopic dermatitis in adults. Ann Dermatol Venereol 129:1S47, 2002 (abstract).
      k Finlay AY, Myon E, Taieb C. Immoderate exposure to the sun: short-term impact on quality of life. JEADV 17:62, 2003 (abstract).
      l Lewis V, Statham B, Chowdhury M. How does the diagnosis of latex allergy affect people's lives? JEADV 17(Suppl. 3):124, 2003.
      m McPherson T, Penzer. A comparison of quality of life and disease severity in 54 patients with lymphoedema in Guyana. Brit J Dermatol 149(Suppl. 64):34, 2003.
      n Finlay AY, Coles EC, Lewis-Jones MS, et al. Quality of life improves after seeing a dermatologist. Brit J Dermatol 139(Suppl. 51)15, 1998 (abstract).
      o Bissonnette R, Papp KA, Garovoy M, Walicke P, Watrous W. Hu 1124 improves dermatological-specific quality of life in subjects with moderate-severe psoriasis. J Eur Acad Dermatol Venereol 14(Suppl. 1):255, 2000 (abstract).
      p Lowe N, Lebsack M Wande L. Psoriasis patients show improved quality of life when treated with Etanercept. Ann Dermatol Venereol 129:1S762, 2002 (abstract).
      q Urbanowski S, Kosmowski. Quality of life, psychological condition, depression and alexithymia in patients with psoriasis vulgaris. Ann Dermatol Venereol 129:1S798, 2002 (abstract).
      r Zaghloul SS, Goodfield MJD. Compliance in psoriasis: patients' self-reporting and factors affecting medication adherence. Brit J Dermatol 147(Suppl. 62):43–44, 2002 (abstract).
      s Griffiths CEM, Humbert P, Koo J, Ortonne JP, Christophers E. Relationship between clinical response and quality of life in psoriasis patients treated with alefacept. JEADV 16(Suppl. 1):292, 2002 (abstract).
      t Taieb C, Nocera T, Verriere F, Myon E. Psoriasis and atopic dermatitis: cross-description of patients' quality of life. JEADV 17:38, 2003 (abstract).
      u Zaghloul S, Gonzalez M, Judodihardjo H, Finlay AY. In psoriasis, the greater the disability, the poorer the topical treatment compliance. Brit J Dermatol 141(Suppl. 55):48, 1999 (abstract).
      v Christophers E, Bourcier M, Griffiths C, et al. Study design and demographics of a randomised, double-blind, placebo-controlled phase 3 dose-comparison study to evaluate weekly intramuscular administration of alefacept in chronic plaque psoriasis. JEADV 15(Suppl. 2):249, 2001 (abstract).
      w Griffiths C, Langley R, Lebwohl M, et al. Alefacept improves psoriasis and quality of life: Results of an international trial. Ann Dermatol Venereol 129:1S280, 2002 (abstract).
      x Papp K, Ellis C, Menter A, et al. Alefacept improves psoriasis and quality of life: Results of a multiple-course trial. Ann Dermatol Venereol 129:1S764, 2002 (abstract).
      y Öztap MO, Öztap P, Aslan S, Adypen H, Önder M. Comparison of the effects of PUVA and non PUVA treatment on the quality of life of patients with psoriasis vulgaris: a non-randomized, cross-sectional study. JEADV 17:59, 2003 (abstract).
      z Calikoglu E, Oztas P, Cetin P. The evaluation of psychiatric tests in seborrhoeic dermatitis patients. JEADV 17(Suppl. 3):159, 2003.
      aa Ongenae K, De Schepper S, van Geel N, et al. Impact of vitiligo on the quality of life in Belgium. JEADV 15(Suppl. 2):232, 2001 (abstract).
      bb Dierckxsen L, Ongenae K, van Geel N, Naeyaert J. Vitiligo: Profile of a Belgian cohort. JEADV 17(Suppl. 3):359, 2003.

      Health Service Research

      The use of HRQoL measures is particularly appropriate as an outcome measure in health service research, as the data generated give insight into the “consumer's” viewpoint. The DLQI can be rapidly and accurately completed by patients unaided and be administered by post with minimal instructions, characteristics of benefit in large-scale studies. Fourteen studies are summarized in Table V.

      Countries In Which DLQI Used

      Although the DLQI was created in the United Kingdom, it has been used in at least 20 countries (Table IX) and it is currently being used in several others. The concepts described in the 10 questions are very simple and ask about very basic human concerns. The questions have consequently been found to be appropriate across many different cultures. One should not, however, assume that the questions are necessarily universally appropriate: for example, the question about sexual difficulties may not be acceptable in some cultures.
      Table IXCountries where the DLQI has been used in published research
      CountryReferences
      Australia
      • Chan J.J.
      • Gebauer K.
      Treatment of severe recalcitrant plaque psoriasis with single dose intravenous tumour necrosis factor-alpha antibody (infliximab).
      Aus J Dermatol. 2003; 44: 116
      ;
      • Marks R.
      • Plunkett A.
      • Merlin K.
      • Jenner N.
      Atlas of Common Skin Diseases in Australia. Melbourne, University of Melbourne2000: 9-19
      Belgium
      • Hachem J.P.
      • DePaepe K.
      • Sterckx G.
      • Kaufman L.
      • Rogiers V.
      • Roseeuw D.
      Evaluation of key biographical and clinical parameters of skin barrier function among hospital workers.
      Contact Dermatitis. 2002; 46: 220-223
      Dierckxsen L, Ongenae K, van Geel N, Naeyaert J. Vitiligo: Profile of a Belgian cohort. JEADV 17(Suppl. 3)359: 2003.
      Canada
      Carey W, Gulliver WP. Efalizumab therapy improves and sustains health-related quality of life in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3):371, 2003.
      ,
      Ouellet JP, Toth D, Gratton D. Efalizumab provides rapid onset of clinical benefit in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3)371, 2003.
      ,
      Langley R. An improvement of 50% or more in psoriasis area severity index (PASI) represents substantial improvement for patients treated with alefacept. JEADV 17(Suppl. 3):139, 2003.
      Denmark
      • Jemec G.B.
      • Wulf H.C.
      Patient–physician consensus on quality of life in dermatology.
      Clin Exp Dermatol. 1996; 21: 177-179
      ;
      • Zachariae R.
      • Zachariae C.
      • Ibsen H.
      • Mortensen J.T.
      • Wulf H.C.
      Dermatology Life Quality Index: Data from Danish inpatients and outpatients.
      Acta Derm Venereol. 2000; 80: 272-276
      Holm EA, Jemec GBE. Why is assessment of health-related quality of life so important? JEADV 17(Suppl. 3):304, 2003.
      ;
      • Jemec B.G.B.E.
      • Kynemund L.
      Time spent on treatment in dermatology––how much time do outpatients use and is it a measure of morbidity?.
      Acta Dermatoven APA. 2001; 10: 17-19
      France
      • Poli F.
      • Dreno B.
      • Vershoores M.
      An epidemiological study of acne in female adults: Results of a survey conducted in France.
      JEADV. 2001; 15: 541-545
      Taieb C, Nocera T, Verriere F, Myon E. Psoriasis and atopic dermatitis: cross-description of patients' quality of life. JEADV 17:38, 2003 (abstract).
      ,
      Feldman SR, McMichael A, Balkrishnan R, Rapp SR, Crambes O, Abella ML, Bouloc A. The effect of corrective cosmetics on quality of life of patients with facial disfigurements. JEADV 17(Suppl. 3):202, 2003.
      ,
      Segard C, Verriere F, Nocera T, Myon E, Taieb C. Impact of hydrotherapy care on the quality of life of patients' suffering from skin disease. Qual Life Res 12:777, 2003.
      Germany
      • Augustin M.
      • Zschocke I.
      • Lange S.
      • Seidenglanz K.
      • Amon U.
      Quality of life in skin diseases: Methodological and practical comparison of different quality of life questionnaires in psoriasis and atopic dermatitis.
      Hautarzt. 1999; 50: 715-722
      ;
      • Czech W.
      • Brautigam M.
      • Weidinger G.
      • Schopt F.
      A body-weight-independent dosing regimen of cyclosporine microemulsion is effective in severe atopic dermatitis and improves the quality of life.
      J Am Acad Dermatol. 2000; 42: 653-659
      ;
      • Schafer T.
      • Staudt A.
      • Ring J.
      German instrument for the assessment of quality of life in skin diseases (DIELH). Internal consistency, reliability, convergent and discriminant validity and responsiveness.
      Hautarzt. 2001; 52: 624-628
      ;
      • Hiltscher D.
      • Boslet W.T.
      • Fuchslocher M.
      • et al.
      Quality of life in patients with rosacea and rhinophyma.
      Akt Dermatol. 2001; 27: 391-394
      ;
      • Boehncke W.H.
      • Ochsendorf F.
      • Paeslack I.
      • Kaufmann R.
      • Zollner T.M.
      Decorative cosmetics improve the quality of life in patients with disfiguring skin diseases.
      Eur J Dermatol. 2002; 12: 577-580
      ;
      • Rzany B.J.
      • Partscht K.
      • Kippes W.
      • et al.
      Quality of life in patients with Bullous pemphigoid.
      J Invest Dermatol. 2000; 114: 887
      ;
      • Schmid-ott G.
      • Burchard R.
      • Niederauer H.H.
      • Lamprecht F.
      • Kunsebeck H.W.
      Stigmatization and quality of life of patients with psoriasis and atopic dermatitis.
      Hautarzt. 2003; 54: 852-857
      Meurer M, Folster-Holst R, Brautigam M. Primecrolimus (SDZ ASM 981) cream improves disease control and quality of life in the long-term management of atopic dermatitis in adults. Ann Dermatol Venereol 129:1S47, 2002 (abstract).
      ,
      Berger K, Kugland B, Khlken B, Augustin M. Cost of chronic plaque psoriasis in Germany: an analysis from the patients and payer perspectives. JEADV 17:36, 2003 (abstract).
      ,
      Sterry W. Psoriasis––impact on QoL––efalizumab positive outcomes. JEADV 17(Suppl. 3):439, 2003.
      Greece
      Chaidemenos C, Avgoustinaki N, Karakatsanis G, Chatzistylianos M, Papakonstantinou M, Mourellou O. Effect of intermittent and continuous cyclosporin therapy on the clinical and quality of life parameters of psoriasis. JEADV 17(Suppl. 3):381, 2003.
      Guyana
      • McPherson T.
      Impact on the quality of life of lymphoedema patients following introduction of a hygiene and skin care regimen in a Guyanese community endemic for lymphatic filariasis: A preliminary clinical intervention study.
      Filaria J. 2003; 2: 1
      India
      • Parsad D.
      • Pandhi R.
      • Dogra S.
      • Kanwar A.J.
      • Kumar B.
      Dermatology Life Quality Index score in vitiligo and its impact on the treatment outcome.
      Br J Dermatol. 2003; 148: 373-374
      Italy
      • Mazzotti E.
      • Picardi A.
      • Sampogna F.
      • Sera F.
      • Pasqunini P.
      • Abeni D.
      The Idi multipurpose psoriasis research on vital experiences (improve) study group. Sensitivity of the Dermatology Life Quality Index to clinical change in patients with psoriasis.
      Br J Dermatol. 2003; 149: 318-322
      Norway
      • Mork C.
      • Wahl A.
      • Moum T.
      The Norwegian version of the Dermatology Life Quality Index: A study of validity and reliability in psoriatics.
      Acta Derm Venereol. 2002; 82: 347-351
      Russia
      Kochergin NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      ,
      Kochergin NG, Samgin MA, Monakhow SA. Acne, adapalene and quality of life. JEADV 16(Suppl. 1):116, 2002 (abstract).
      ,
      Lvov AN, Ivanov OL, et al. Psychoneurological parameters and quality of life in patients with severe forms of atopic dermatitis. JEADV 15(Suppl. 2):276, 2001 (abstract).
      ,
      Kochergin NG, Yutanova NS. Mometasone furoate 0.1% with salicylic acid 5% ointment in psoriasis and atopic dermatitis. JEADV 17(Suppl. 3):350, 2003.
      South Africa
      • Jobanputra R.
      • Bachmann M.
      The effect of skin diseases on quality of life in patients from different social and ethnic groups in Cape Town, South Africa.
      Int J Dermatol. 2000; 39: 826-831
      Spain
      • Badia X.
      • Mascaro J.M.
      • Lozaro R.
      On behalf of the Cavide research group Measuring health-related quality of life in patients with mild to moderate eczema and psoriasis: Clinical validity, reliability and sensitivity to change of the DLQI.
      Br J Dermatol. 1999; 141: 698-702
      Sweden
      • Lundberg L.
      • Johannesson M.
      • Silverdahl M.
      • Hermansson C.
      • Lindberg M.
      Quality of life, health-state utilities and willingness to pay in patients with psoriasis and atopic eczema.
      Brit J Dermatol. 1999; 141: 1067-1079
      ,
      • Lundberg L.
      • Johannesson M.
      • Silverdahl M.
      • et al.
      Health-related quality of life in patients with psoriasis and atopic dermatitis measured with SF-36, DLQI and a subjective measure of disease activity.
      Acta Derm Venereol. 2000; 80: 430-434
      Tanzania
      Etemesi BA. Impact of chronic skin disease on the quality of life of Tanzanian adults. Brit J Dermatol 149(Suppl. 64):31–32, 2003.
      Turkey
      Öztap MO, Öztap P, Aslan S, Adypen H, Önder M. Comparison of the effects of PUVA and non PUVA treatment on the quality of life of patients with psoriasis vulgaris: A non-randomized, cross-sectional study. JEADV 17:59, 2003 (abstract).
      ,
      Calikoglu E, Oztas P, Cetin P. The evaluation of psychiatric tests in seborrhoeic dermatitis patients. JEADV 17(Suppl. 3):159, 2003.
      United Kingdom
      USA
      • Ayyalaraju S.R.
      • Finlay A.Y.
      • Dykes P.J.
      • Trent J.
      • Kirsner R.S.
      • Kerdel F.A.
      Hospitalization for severe skin disease improves quality of life in the United Kingdom and the United States: A comparative study.
      J Am Acad Dematol. 2003; 49: 249-254
      ;
      • Vensel E.
      • Hilley T.
      • Trent J.
      • et al.
      Sustained improvement of the quality of life of patients with psoriasis after hospitalisation.
      J Am Acad Dermatol. 2000; 43: 858-860
      ;
      • Hahn B.H.
      • Melfi C.A.
      • Chuang T.Y.
      • et al.
      Use of the Dermatology Life Quality Index (DLQI) in a Midwestern US Urban Clinic.
      J Am Acad Dermatol. 2001; 45: 44-48
      ;
      Callis KP, Carlin CS, Krueger CG. Correlation of National Psoriasis Foundation score components with quality of life measures in psoriasis. J Invest Dermatol 121:0357, 2003.
      ,
      Christopher E, Vanishnaw AK. A broad spectrum of patients with psoriasis benefit from alefacept therapy. JEADV 17(Suppl. 3):138, 2003.
      • Kiebert G.
      • Sorensen S.V.
      • Revicki D.
      • et al.
      Atopic dermatitis is associated with a decrement in health-related quality of life.
      Int J Dermatol. 2002; 41: 151-158
      ;
      • Fivenson D.
      • Arnold R.J.G.
      • Kaniecki D.J.
      • Cohen J.L.
      • Frech F.
      • Finlay A.Y.
      The effect of atopic dermatitis on total burden of illness and quality of life on adults and children in a large managed care organisation.
      J Managed Care Pharm. 2002; 8: 333-342
      ;
      • Koo J.
      • Menter A.
      • Lebwohl M.
      • Kozma C.
      • Slaton T.
      • Wojcik A.
      • Kowlaski J.
      The relationship between quality of life and disease severity: Results from a large cohort of mild, moderate and severe psoriasis patients.
      Br J Dermatol. 2002; 147: 1070-1171
      ;
      • Balkrishnan R.
      • McMichael A.J.
      • Camacho F.T.
      • et al.
      Development and validation of a health-related quality of life instrument for women with melasma.
      Br J Dermatol. 2003; 149: 572-577
      ;
      • Bergestrom K.G.
      • Arambula K.
      • Kimball A.B.
      Medication formulation affects quality of life: Randomised single blind study of clobetasol propionate foam 0.05% compared with a combined program of clobetasol cream 0.05% and solution 0.05% for the treatment of psoriasis cutis.
      . 2003; 72: 407-411
      ;
      • Gordon K.B.
      • Papp K.A.
      • Hamilton T.K.
      • et al.
      Efalizumab for patients with moderate to severe plaque psoriasis: A random controlled trial.
      JAMA. 2003; 290: 3073-3080
      ;
      • Shikiar R.
      • Bresnahan B.W.
      • Stone S.P.
      • Thompson C.
      • Koo J.
      • Revicki D.A.
      Validity and reliability of patient reported outcomes used in psoriasis: Results of two randomised clinical trials.
      Health Qual Life Outcomes. 2003; 1: 53
      ;
      • Weisman S.
      • Pollack C.R.
      • Gottschalk R.W.
      Psoriasis disease severity measures: Comparing efficacy of treatments for severe psoriasis.
      J Dermatol Treat. 2003; 14: 158-165
      Yugoslavia
      Paravina M, Stanojevic M, Poljacki M, Ljubisavljevic D. Quality of life in dermatological patients. J Eur Acad Dermatol Venereol 14(Suppl. 1):274–275, 2000 (abstract).
      a Dierckxsen L, Ongenae K, van Geel N, Naeyaert J. Vitiligo: Profile of a Belgian cohort. JEADV 17(Suppl. 3)359: 2003.
      b Carey W, Gulliver WP. Efalizumab therapy improves and sustains health-related quality of life in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3):371, 2003.
      c Ouellet JP, Toth D, Gratton D. Efalizumab provides rapid onset of clinical benefit in patients with moderate to severe plaque psoriasis. JEADV 17(Suppl. 3)371, 2003.
      d Langley R. An improvement of 50% or more in psoriasis area severity index (PASI) represents substantial improvement for patients treated with alefacept. JEADV 17(Suppl. 3):139, 2003.
      e Holm EA, Jemec GBE. Why is assessment of health-related quality of life so important? JEADV 17(Suppl. 3):304, 2003.
      f Taieb C, Nocera T, Verriere F, Myon E. Psoriasis and atopic dermatitis: cross-description of patients' quality of life. JEADV 17:38, 2003 (abstract).
      g Feldman SR, McMichael A, Balkrishnan R, Rapp SR, Crambes O, Abella ML, Bouloc A. The effect of corrective cosmetics on quality of life of patients with facial disfigurements. JEADV 17(Suppl. 3):202, 2003.
      h Segard C, Verriere F, Nocera T, Myon E, Taieb C. Impact of hydrotherapy care on the quality of life of patients' suffering from skin disease. Qual Life Res 12:777, 2003.
      i Meurer M, Folster-Holst R, Brautigam M. Primecrolimus (SDZ ASM 981) cream improves disease control and quality of life in the long-term management of atopic dermatitis in adults. Ann Dermatol Venereol 129:1S47, 2002 (abstract).
      j Berger K, Kugland B, Khlken B, Augustin M. Cost of chronic plaque psoriasis in Germany: an analysis from the patients and payer perspectives. JEADV 17:36, 2003 (abstract).
      k Sterry W. Psoriasis––impact on QoL––efalizumab positive outcomes. JEADV 17(Suppl. 3):439, 2003.
      l Chaidemenos C, Avgoustinaki N, Karakatsanis G, Chatzistylianos M, Papakonstantinou M, Mourellou O. Effect of intermittent and continuous cyclosporin therapy on the clinical and quality of life parameters of psoriasis. JEADV 17(Suppl. 3):381, 2003.
      m Kochergin NG, Burova EP. Life quality assessment in psoriasis and atopic dermatitis. JEADV 15(Suppl. 2):186, 2001 (abstract).
      n Kochergin NG, Samgin MA, Monakhow SA. Acne, adapalene and quality of life. JEADV 16(Suppl. 1):116, 2002 (abstract).
      o Lvov AN, Ivanov OL, et al. Psychoneurological parameters and quality of life in patients with severe forms of atopic dermatitis. JEADV 15(Suppl. 2):276, 2001 (abstract).
      p Kochergin NG, Yutanova NS. Mometasone furoate 0.1% with salicylic acid 5% ointment in psoriasis and atopic dermatitis. JEADV 17(Suppl. 3):350, 2003.
      q Etemesi BA. Impact of chronic skin disease on the quality of life of Tanzanian adults. Brit J Dermatol 149(Suppl. 64):31–32, 2003.
      r Öztap MO, Öztap P, Aslan S, Adypen H, Önder M. Comparison of the effects of PUVA and non PUVA treatment on the quality of life of patients with psoriasis vulgaris: A non-randomized, cross-sectional study. JEADV 17:59, 2003 (abstract).
      s Calikoglu E, Oztas P, Cetin P. The evaluation of psychiatric tests in seborrhoeic dermatitis patients. JEADV 17(Suppl. 3):159, 2003.
      t Callis KP, Carlin CS, Krueger CG. Correlation of National Psoriasis Foundation score components with quality of life measures in psoriasis. J Invest Dermatol 121:0357, 2003.
      u Christopher E, Vanishnaw AK. A broad spectrum of patients with psoriasis benefit from alefacept therapy. JEADV 17(Suppl. 3):138, 2003.
      v Paravina M, Stanojevic M, Poljacki M, Ljubisavljevic D. Quality of life in dermatological patients. J Eur Acad Dermatol Venereol 14(Suppl. 1):274–275, 2000 (abstract).

      Languages

      The DLQI has been translated into at least 21 different languages (Table X). Other translation processes are currently underway. The majority of these translations are fully validated with appropriate independent forward and back translation, appropriate correction and further forward and backward translation. This is to ensure that the scores gained from the use of the DLQI in different languages can be compared.
      Table XLanguages in which DLQI has been translated
      AfrikaansFinnishPolish
      Canadian/FrenchFrenchRomanian
      CzechGermanSpanish
      CantoneseGreekSwedish
      ChineseItalianTurkish
      DanishHungarianUrdu
      DutchNorwegianUS/Spanish

      Children's Version

      There is a children's version of the DLQI (
      • Lewis-Jones M.S.
      • Finlay A.Y.
      The Children's Dermatology Life Quality Index (CDLQI): Initial validation and practical use.
      Br J Dermatol. 1995; 132: 942-949
      ), the Children's Dermatology Life Quality Index (CDLQI). A text and cartoon version of this has been described (
      • Holme S.A.
      • Mann I.
      • Sharpe J.L.
      • Dykes P.J.
      • Lewis-Jones M.S.
      • Finlay A.Y.
      The Childrens' Dermatology Life Quality Index: Validation of the cartoon version.
      Br J Dermatol. 2003; 148: 285-290
      ): the cartoon version is more quickly completed by children than the text-only version and is preferred by them.

      Discussion

      There are several reasons for trying to measure the impact of skin disease on patients' lives. HRQoL measures provide a patient orientated and relevant outcome measure in the assessment of new therapies and in comparing different ways of delivering health care. They provide a way of being able to compare the impact of different skin diseases, and compare the impact of skin diseases to diseases affecting other organs. This information may be important to inform decision taking concerning resource allocation in health care systems and for political purposes in emphasizing the importance of skin disease. The DLQI has been used for all of these purposes. In the direct clinical consultation allowing patients to express the issues in their lives caused by their skin disease can enhance the quality of care provided. HRQoL measures may in the future be helpful in informing clinical decision taking where consideration is being given to using expensive or potentially harmful therapies.
      As the planning of health care is becoming increasingly patient-orientated, quality of life measurements will continue to be a vital means of assessing how individual patients are affected by skin conditions (
      • Tulloch I.K.
      • Ormerod A.D.
      Quality of life measurements.
      Br J Dermatol. 2003; 148: 193-194
      ). There are a variety of HRQoL measures that can be used in dermatology, including disease-specific, dermatology-specific and general health measures (
      • Finlay A.Y.
      Quality of life measurement in dermatology: A practical guide.
      Br J Dermatol. 1997; 136: 305-314
      ). This survey of published information relating to the DLQI is not intended to indicate whether or not the DLQI should be used in individual circumstances, but rather to make it easier for potential users to access information about the various strengths and weaknesses of this instrument. It is important that validity of outcome measures should be demonstrated and that data related to this be easily accessible. In addition to the published experience reviewed in this survey, the DLQI is currently being used in many studies worldwide and this survey should be informative to current users.
      Perhaps the biggest challenge to the development of our understanding of HRQoL measures is for research to be focused on giving HRQoL scores some direct meaning for clinicians. Before the DLQI is likely to be used widely in the direct clinical setting however, it will be necessary to know how score ranges of the DLQI relate to patients' overall view of their HRQoL; an initial banding proposal2 is likely to be altered based on a much larger study. The size of change in scores that are of relevance to patients will also have to be more clearly established. As the DLQI is a simple measure which is accurately and rapidly completed by patients with no supervision, it does have the potential, as originally intended (
      • Finlay A.Y.
      • Khan G.K.
      Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use.
      Clin Exp Dermatol. 1994; 19: 210-216
      ), to be of direct help to clinicians.

      Further Information

      Further information about the DLQI is available from [email protected] and at http://www.ukdermatology.co.uk The DLQI is copyright: Library of Congress United States copyright office registration number TXu 608 406, date of registration December 6, 1993. Permission is usually given for the use of the DLQI for academic purposes or by individual clinicians without charge. Under some circumstances a small charge is made.

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      Article info

      Publication history

      Accepted: October 6, 2003
      Received in revised form: August 19, 2003
      Received: May 29, 2003

      Footnotes

      Declaration of interest: Prof. Andrew Y Finlay is joint copyright holder of the DLQI and the CDLQI.

      Identification

      DOI: https://doi.org/10.1111/j.1087-0024.2004.09113.x

      Copyright

      © 2004 The Society for Investigative Dermatology, Inc. Published by Elsevier Inc.

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