Información de la revista
Case and Research Letter
Acceso a texto completo
Pruebas no corregidas. Disponible online el 7 de julio de 2025
[Translated article] Evaluation of Quality of Life in Patients With Chronic Dermatological Conditions Receiving Phototherapy
Evaluación de la calidad de vida en pacientes con enfermedad dermatológica crónica que han recibido fototerapia
Visitas
101
E. Rodríguez-Gabellaa,
, B. Martín-Gilb, N. Rivas-Gonzálezc, E. Fernández-Martínezd
a Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
b Sistemas de Información de Gestión de Cuidados, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
c Unidad de Formación Continuada, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
d Grupo de Investigación SALBIS, Facultad de Ciencias de la Salud, Universidad de León, León, Spain
Contenido relacionado
E. Rodríguez-Gabella, B. Martín-Gil, N. Rivas-González, E. Fernández-Martínez
Este artículo ha recibido
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Tablas (3)
Table 1. Mean pre- and post-intervention scores for DLQI questionnaire, NRS scale, PASI, and PAS.
Tablas
Table 2. Comparison of mean scores for the 10 items of the DLQI questionnaire, pre- and post-intervention.
Tablas
Table 3. Comparison of mean (SD) DLQI and NRS scores, pre- and post-intervention, by gender, age group, diagnosis (excluding atopic dermatitis due to only one case), and employment status.
Tablas
Mostrar másMostrar menos
Texto completo
To the Editor,

The quality of life of patients with chronic dermatological disease is compromised by symptoms that affect their emotional and social well-being.1 Identifying the most affected aspects of quality of life will allow the design of strategies to reduce stigma and symptoms associated with the disease.2 Therefore, this study was designed with the aim of identifying what changes in quality of life and in the intensity of pruritus occurred in patients with a chronic dermatological disease after treatment with phototherapy, during dermatology nursing consultations.

This quasi-experimental, pre-post intervention study included patients older than 18 years, selected through non-probabilistic sampling, who attended the dermatology service from May to October 2023, with a diagnosis of psoriasis or nodular prurigo, and were eligible for narrowband UVB (NB-UVB) phototherapy. Treatment was administered at a protocolized dose based on the patient's characteristics and disease progression, with a 3-month regimen in 2–3 weekly sessions, in the nurse-led dermatology consultation at a tertiary public referral center in the Castile and León public health system (Castile and León, Spain).

Sociodemographic, clinical, and outcome variables were included. Quality of life was measured using the Dermatology Life Quality Index (DLQI),3 and itching was assessed 24h prior to session #1 using the Numerical Rating Scale for Maximum Pruritus (NRS).4

A total of 39 patients were included (22 (56.4%) women and 17 (43.6%) men) with a mean age of 53.2 years (SD: 16.3). Twenty-two of these (56.4%) had psoriasis and 17 (43.6%), nodular prurigo; 19 (48.7%) were employed, and 20 (51.3%) were not.

Significant changes were observed in the mean values of quality of life, pruritus, and the severity of prurigo and psoriasis, pre- and post-intervention (Table 1).

Table 1.

Mean pre- and post-intervention scores for DLQI questionnaire, NRS scale, PASI, and PAS.

  Pre-interventionMean  Pre-interventionSD  Post-interventionMean  Post-interventionSD  p-Value 
Dermatology Life Quality Index (DLQI)  14.88  7.18  4.41  3.84  <0.001 
Numerical Rating Scale (NRS) for Maximum Pruritus  8.40  1.72  2.28  1.96  <0.001 
Prurigo Activity Score (PAS)  14.80  4.83  3.63  3.25  <0.001 
Psoriasis Area and Severity Index (PASI)  13.52  7.27  4.81  2.68  <0.001 

A detailed analysis of each DLQI item is shown in Table 2; the items where the worst quality of life was reported were: “feeling itchy, sore, painful, or stinging in the skin,” followed by “feeling uncomfortable due to skin problems” and “the burden of skin treatment.”

Table 2.

Comparison of mean scores for the 10 items of the DLQI questionnaire, pre- and post-intervention.

Item  Pre-interventionMean  Pre-interventionSD  Post-interventionMean  Post-interventionSD  95% CI lower  95% CI upper  p-Value 
Have you felt itching, inflammation, pain, or burning in your skin?  2.50  0.68  0.80  0.56  1.45  1.95  <0.001 
Have you felt uncomfortable or self-conscious because of your skin problems?  2.38  0.84  0.73  0.64  1.38  1.92  <0.001 
Have your skin problems interfered with shopping or taking care of your home or garden?  1.60  1.03  0.30  0.52  1.00  1.60  <0.001 
Have your skin problems influenced the clothes you wear?  1.63  1.03  0.48  0.68  0.84  1.46  <0.001 
Have your skin problems affected any social or leisure activity?  1.33  1.00  0.38  0.63  0.66  1.24  <0.001 
Has it been difficult to play sports because of your skin problems?  1.18  1.01  0.35  0.58  0.55  1.10  <0.001 
Has your skin caused you any problems at work or school?  0.98  0.97  0.20  0.46  0.52  1.03  <0.001 
Has your skin caused problems with your partner, close friend, or relative?  0.65  0.80  0.15  0.43  0.28  0.72  <0.001 
Have your skin problems made your sex life difficult?  0.63  0.90  0.13  0.40  0.27  0.73  <0.001 
Has your skin treatment been a problem, for example by making a mess at home or taking up your time?  2.13  0.72  0.88  0.69  1.01  1.49  <0.001 

Table 3 illustrates the results compared by gender, age group, dermatological diagnosis, and employment status.

Table 3.

Comparison of mean (SD) DLQI and NRS scores, pre- and post-intervention, by gender, age group, diagnosis (excluding atopic dermatitis due to only one case), and employment status.

  DLQI questionnaire  p  NRS scale  p 
Female
Preintervention
Mean  15.78  <0.001  8.78  <0.001 
SD  6.80    1.53   
Postintervention
Mean  4.30    2.39   
SD  3.40    2.29   
Male
Preintervention
Mean  13.71  <0.001  7.82  <0.001 
SD  7.69    1.77   
Postintervention
Mean  4.47    2.06   
SD  4.30    1.63   
Age<50
Preintervention
Mean  14.92  0.002  8.17  0.002 
SD  9.13    1.89   
Postintervention
Mean  4.17    2.17   
SD  4.91    2.03   
Age between 50 and 60 (included)
Preintervention
Mean  16.91  0.003  8.73  0.003 
SD  7.48    0.64   
Postintervention
Mean  6.00    2.73   
SD  3.79    2.53   
Age>60
Preintervention
Mean  13.59  <0.001  8.29  <0.001 
SD  5.35    2.02   
Postintervention
Mean  3.47    2.00   
SD  2.47    1.69   
Nodular prurigo
Preintervention
Mean  16.71  <0.001  8.82  <0.001 
SD  7.65    0.88   
Postintervention
Mean  4.59    1.76   
SD  4.47    1.56   
Psoriasis
Preintervention
Mean  12.91  <0.001  7.95  <0.001 
SD  6.02    2.06   
Postintervention
Mean  4.32    2.68   
SD  3.27    2.30   
Works/studies
Preintervention
Mean  14.00  <0.001  7.95  <0.001 
SD  7.61    1.85   
Postintervention
Mean  3.80    1.45   
SD  3.55    1.28   
Unemployed/retired
Preintervention
Mean  15.80  <0.001  8.80  <0.001 
SD  6.80    1.44   
Postintervention
Mean  4.95    3.05   
SD  3.97    2.33   

Literature agrees that phototherapy is an appropriate therapeutic option for patients with pruritus and that the impact of symptoms must be addressed individually.4,5

These results are similar to those from studies conducted with systemic treatments, suggesting that it may be beneficial to consider the use of combined therapies in patients with room for improvement.6

The most affected aspects after treatment were the difficult-to-treat symptoms typical of chronicity, which may improve with additional treatments or interventions.5 The discomfort caused by the disease may stem from its visual impact, both personally and socially. The relevance of how skin disease affects overall appearance has been highlighted, as it may trigger psychiatric comorbidities.4 The lowest-rated item was “the burden of skin treatment.” These chronic conditions require continuous self-care to avoid worsening, which involves time and dedication.7

Female patients reported greater impairment in quality of life and pruritus prior to treatment. This may be due to women experiencing a greater emotional impact because of social expectations, which worsens their overall distress before receiving appropriate treatment. These differences in perceived disease burden suggest that therapy optimization may require gender-specific considerations and confirm the need to increase the number of studies assessing the impact of disease and treatment by gender.8

Work performance is also affected. Job choice, absenteeism, and clothing selection, among others, are factors identified in studies as having a significant impact on work life or its absence.9

Some studies conclude that younger patients experience a greater decline in quality of life due to social stigma and social relationships; whereas in patients aged 30–50 years, this is linked to greater knowledge of the disease and stronger social relationships, which positively influence quality of life. Therefore, age range should be taken into consideration when planning treatment.10

The study limitations are inherent to its design. As a self-administered questionnaire was used, desirability bias may exist. The study setting is specific, which limits the generalizability of the results.

In conclusion, the influence of chronic dermatological conditions on quality of life was evident. Phototherapy treatment improved patients’ perception of their quality of life and reduced pruritus. However, we saw that some patients still had suboptimal quality of life scores after the intervention. Being a woman, aged 50–60 years, with nodular prurigo and not currently employed was associated with a greater impact on quality of life and pruritus intensity.

Conflicts of interest

None declared.

References
[1]
A.H. Musters, S. Mashayekhi, J. Harvey, E. Axon, S.J. Lax, C. Flohr, et al.
Phototherapy for atopic eczema.
Cochrane Database Syst Rev, 10 (2021), pp. CD013870
[2]
S.H. Ko, C.C. Chi, M.L. Yeh, S.H. Wang, Y.S. Tsai, M.Y. Hsu.
Lifestyle changes for treating psoriasis.
Cochrane Database Syst Rev, 7 (2019), pp. CD011972
[3]
A.G. De Tiedra, J. Mercadal, X. Badía, J.M. Mascaró, M. Herdman, R. Lozano.
Adaptación transcultural al español del cuestionario Dermatology Life Quality Index (DLQI): El Índice de Calidad de Vida en Dermatología.
Actas Dermosifiliogr, 89 (1998), pp. 692-700
[4]
C. Boehlke, L. Joos, B. Coune, C. Becker, J.J. Meerpohl, S. Buroh, et al.
Pharmacological interventions for pruritus in adult palliative care patients.
Cochrane Database Syst Rev, 4 (2023), pp. CD008320
[5]
A. Arrieta, A. Jaka, E. del Alcázar, M. Blanco, J.M. Carrascosa.
Phototherapy for prurigo nodularis: our experience and a review of literature.
Actas Dermosifiliogr (Engl Ed), 112 (2021), pp. 339-344
[6]
F.M. Ramos, A.M. Puchades, J. Matáix-Díaz, L. Schneller-Pavelescu, I. Belinchón-Romero, S.S. Alarcón.
[Artículo traducido] Eficacia a medio plazo (52 semanas) de tildrakizumab en el tratamiento de la psoriasis moderada a severa: un estudio multicéntrico de práctica clínica.
Actas Dermosifiliogr, 115 (2024), pp. T722-T726
[7]
L. Puig, J.M. Carrascosa, I. Belinchón, V. Fernández-Redondo, G. Carretero, J.C. Ruiz-Carrascosa, et al.
Adherencia y satisfacción del paciente y características organolépticas y de uso de los tratamientos tópicos utilizados para la psoriasis: Consenso Delphi del panel de expertos y miembros del Grupo de Psoriasis de la Academia Española de Dermatología y Venereología.
Actas Dermosifiliogr, 104 (2013), pp. 488-496
[8]
Do anti-psoriatic drugs work better in women than men?.
Br J Dermatol, 185 (2021), pp. e200-e213
[9]
M. Sanchez-Diaz, P. Díaz-Calvillo, A. Soto-Moreno, A. Molina-Leyva, S. Arias-Santiago.
Factors influencing major life-changing decisions in patients with psoriasis: a cross-sectional study.
Acta Derm Venereol, 103 (2023), pp. adv11640
[10]
L. Decean, M. Badea, V. Rus, G. Buicu, A. Sasu, C.N. Pilut, et al.
The implication of misinformation and stigma in age-related quality of life, depression, and coping mechanisms of adult patients with psoriasis.
Medicina (Kaunas, Lithuania), 58 (2022), pp. 1420
Copyright © 2025. AEDV
Descargar PDF
Idiomas
Actas Dermo-Sifiliográficas
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?