DLQI SCORE IN VITILIGO PATIENTSIN RE-MEDIKA HOSPITAL

Cross-sectional study

M.Sc. Natasa Teovska Mitrevska MD

Macedonia –REMEDIKA general hospitalDepartment of dermatology

Vitiligo is a common acquired, idiopathic and often familiar depigmentation disorder that affects both

sexes equally worldwide.

Although not painful or life-threatening, this disfiguring disorder can have a devastating effect on a patient’s psychosocial wellbeing and social

life

Vitiligo

Patients often experience stigmatization, including curiosity, by other people, rejection and discrimination

at work, low self-esteem, embarrassment, impaired quality of life and a higher prevalence of sexual

difficulties, especially in women .Stigmatization is the most influential factor in the

variance of Dermatology Life Quality Index (DLQI) measurements.

Doctor/patients relationship

Additionally, many healthcare professionals still regard vitiligo as a harmless cosmetic skin problem, truly underestimating the importance of treating these patients. 

The emotional aspect of diseases vitiligo is gravely underestimated because clinicians fail to include the psychological and sociological components that are so closely tied to this disease

Quality of life-QL Definition

Quality of Life as individuals perception of their

position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.

It is a broad ranging concept affected in a complex way by the person's physical health, psychological state, level of independence, social relationships, personal beliefs and their relationship to salient features of their environment.

Quality of life at dermatology patients

• Dermatology-specific Quality of Life instruments• Skindex • DLQI • Dermatology Quality of Life Scales • Chronic Skin Disease on Daily Life).

DLQI Dermatology Life Quality Index

• First• The most used questionnaire • Simple questionnaire self administrated who used

to measure the health-related quality of life of adult patients suffering from a skin disease.

DLQI Dermatology Life Quality Index

DLQI (Dermatology Life Quality Index)

• It is a simple 10-question validated questionnaire which has been used in 33 different skin conditions in 32 countries and is available in 55 languages.

• Its use has been described in over 500 publications including 30 multinational studies.

DLQi scores for vitiligo patients -review the literature worldwide

-Porter et al. studied the effect of vitiligo on sexual relationships and found that embarrassment during sexual relationships was especially frequent for men with vitiligo

-Salzer and Schallreuter reported that 75% found their disfigurement moderately or severely intolerable

-Weiss et al compared the difficulties faced by patients with vitiligo with those with leprosy in India

-Al-Abadie et al. indicated that psychological stress increases levels of neuroendocrine hormones, affects the immune system and alters the level of neuropeptides, which may be the initial steps in pathogenesis of vitiligo

DLQi scores for vitiligo patients -review the literature worldwide

Sampogna, Patients older than 40 years old, have lower QoL. Patients with vitiligo reported a higher prevalence of both alexithymia (a state of deficiency in understanding, processing, or describing emotions) and depression or anxiety than the general population. In white populations, the prevalence's of depression and alexithymia are both estimated as approximately 10%, while in this study the prevalence was 39%, and of patients with alexithymia 24%

DLQi scores for vitiligo patients -review the literature worldwide

Papadopoulos et All.have shown that psychological counseling not only helps to improve body image, self-esteem and quality of life of patients with vitiligo, but also provides better control of disease.

Ongenae K, Quality of life in female patients has shown to be more impaired than men and was equal to the impairment caused by psoriasis.

Motivation

Motivation

• Knowledge: What is the knowledge of health information regarding his/her dermatology illness.

• Attitude: What is the attitude of the patient regarding his dermatology condition?

• Behaviors: What exactly the patient is doing regarding his dermatology condition?

• Group behaviors: What is the group behavior in accepting of patient with dermatology illness?

• Behavior of health system: What the health system is doing to change to change this factors?

Aim of the study

• To determine score od DLQI in patients with vitiligo in ReMedika general hospital, Skopje, R.Macedonia.

• To determine the dominate factors that affects on quality of life

• From the conclusion of this study to get the information's in order to start with interventions for improving and strength the quality of life in patients with vitiligo

Materials and Methods

• Study design: prospective research-(cross section) study for every new patient with vitiligo attending the clinic. Using a standard “forward-backward” translation procedure, the English language version of the questionnaire was translated into Macedonian.

• Place of study: Dermatology department, ReMedika general hospital. Skopje, Macedonia

DLQI questionnaire(Cardiff University's )

1. Questions about basic demographics characters

2. Symptoms and feelings (questions 1 and 2),

3. Daily activities (questions 3 and 4),

4. Leisure (questions 5 and 6),

5. Personal relationships (questions 8 and 9)

6. Work and school (question 7),

7. and treatment (question10) .

• The DLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0.

• The higher the score, the more quality of life is impaired.

• The DLQI can also be expressed as a percentage of the maximum possible score of 30.

DLQI questionnaire(Cardiff University's )

Materials and Methods

There were no restrictions on patient selection with regard to extension of lesions.

The patients were introduced to the subject of this study and informed about the personal nature of

the questionnaire, and all those who gave consent were given the DLQI questionnaire to complete.

Selection of patients

Criteria for participation

All the patients who are coming in dermatology department

Criteria for elimination

Children, babies.

Patients with other dermatology condition.

Defined time May-2011 to May 2012

Statistical analyses

Responses on the DLQI will be scored according to the guidelines of Finlay and Khan.

All statistical analyses is carried out using the Statistical Package for the Social Sciences (SPSS

11.0 for Windows). To test the reliability, the internal consistency of the

questionnaire will be assessed by Cronbach's α coefficient and α equal to or greater than 0.70 was

considered satisfactory.

Bias in Research Study

• Selection bias

-Only patients from Re-Medika hospital dermatology department is involved in this study

• Bias from nonresponse -refusing from patients• Reporting bias-lack of information regarding their

condition

Results

ResultsFrom May –October 2011

• Age of patients

25 - 85 (middle age 53). Most of them (49, 49%) were 45-65 years old.

Place of living:

½ of the patients (53, 53%) are from Skopje.

Demographics characteristics of patientsParameters Number

%

Gender 50 %

Male 16 32%

Female 34 68%

Age

25-34 11 22%

35-44 2 4%

45-54 15 30%

55-64 12 24%

65-74 10 20%

Над 75 1 2%

Place of living

Skopje 35 70,00%

Out side Skopje 15 30,00%

11

2

15

12

10

1

0

2

4

6

8

10

12

14

16

25-34

35-44

45-54

55-64

65-74

Над 75

Distribution of patients regarding the age

Comparison of mean DLQI scores and demographic variables

Sex Mean DLQI

Male 7,50

Female 9,53

Marital status

Single 8,23

Maried 7,25

Place of living

Skopje 9,25

Out side from Skopje 7,38

Comparison of mean DLQI scores and demographic variables

Educational levelDLQI

Illiterate 8,00

Under graduate 8,20

Graduate 8,38

Bachelor degree 9,56

Doctorate 7,00

Visibility of lesion

Exposed 9,45

Unexposed 8,23

As a conclusion

The chronic nature of disease, long term

treatment, lack of uniform effective therapy and

unpredictable prognosis of disease/therapy make

the patients suffer more from the disease.

DLQI score in vitiligo patients

Questions Parameters Mean DLQI

1. Symptoms 1,16

2 Feelings 2,22

3 Daily activities 1,56

4 Kind of clothes 2,22

5 Social or leisure activities 2,16

6 Physical exercise 2,11

7 Educational activities 2,02

8 Interpersonal relationships 2,88

9 Sexual activities 1,06

10 Treatment 1,86

• Pilot project first one in Macedonia• At the end of this study we will give the answer of

influence of demographics characteristics of patients in Macedonia regarding the quality of life

Review from literature is showing that DLQI not only can measure the quality of life but can also be used as a instrument of measuring the quality of doctors working.

Why is important in Macedonia?

Our study quantifies the burden on the quality of life caused by vitiligo and indicates specific areas of

patients' lives which are most affected by the disease..

These results should awake the interest of physicians in this ‘cosmetic’ disease, since appropriate treatment is likely to improve the quality of

life of vitiligo patients.

Conclusions

Suggestions activities

Holistic approaching is not only treatment of illness of the patients but it is treatment of a patient as human been and not only threatening illness.

So thinking about the DLQI at patient with dermatology illness is thinking about the factors who determinate the quality of life which are individual and changeable.

DLQI can help in identifying the dominant needs and searching of the patients the solution for those.

.

Conclusion

With more effective treatment options and a closer patient/ physician relationship, patients can improve their quality of life and overall well-being.

Before beginning on a specific treatment course, both patient and healthcare provider should be aware of patient's current QoL and monitor it closely throughout the course of a treatment regimen.

Conclusion

• Doctor must give the right and adequate information and education regarding the condition of the patient

• On this way educated patient will have more control of his disease and he will accept emotional more his condition.

• So with this DLQI will became a part of every clinical examinations of the patients, and with this we will increase the relationships between doctors and patient.

Greetings from Macedonia