Skin disease affects patientsi lives in many ways. It may be seen as trivial, or have a profound impact. Relationships, and the ability to study, work, play sport, or sleep may all be affected. Major life decisions are influenced: type of work, choice of partner, or even whether to have children. It can also affect the patientis family. Many of these effects will be apparent, but we may not be as good as we think at estimating the extent of this impact on patients.
Why measurement may help
Most clinical decisions relating to the care of skin disease involve consideration of its impact on the patientis life and take account of the patientis attitudes to possible risks and benefits.
Despite this, little quality of life information is explicitly raised during hospital dermatology clinic consultations.1 This may have a direct influence on the quality of care. For example, one study showed that although clinical decisions on psoriasis management related appropriately to patientis recorded quality of life, patients with great impairment were offered no change in therapy.2
The process of completing a quality of life questionnaire can encourage patients to raise issues that they see as important, but feel the doctor or nurse is not addressing.
Possible ways to measure quality of life
There are several questionnaires designed to measure the impact of skin disease on life quality. General health measures, such as Short-Form 36, can be used across all diseases, or there are disease-specific measures, such as the Psoriasis Disability Index. Dermatology-specific measures, such as the Dermatology Life Quality Index (DLQI),3 can be used in any skin disease.
What is the DLQI?
The DLQI is the most widely used quality of life questionnaire in dermatology.4 It consists of 10 simple questions (see box) relating to ways in which skin disease impairs lives. The questionnaire is designed to be used in a busy clinical setting. The patient completes it without assistance, usually in about two minutes.
What DLQI scores mean
Until recently, use of quality of life measures was confined to research, owing to difficulty with interpreting scores. A major advance in 2005 was a study of nearly 2,000 patients, establishing evidence-based descriptive bands that apply to DLQI scores.5
These bands make it possible to use the DLQI in a meaningful way in clinical practice. For example, if the score is more than 10, this indicates that skin disease is having a significant effect on the patientis life. Intervention is probably indicated.
The Rule of Tens
Now it is possible to interpret scores in a more meaningful way, new ways of defining disease severity can be proposed. The Rule of Tens6 defines current severe psoriasis as body surface area involved: >10 per cent, Psoriasis Area and Severity Index score: >10, or DLQI score: >10. British Association of Dermatologists guidelines for use of biologicals in psoriasis include the criterion that the DLQI score should be greater than 10.7
Where to obtain the questionnaire
The DLQI can be downloaded from www.dermatology.org.uk (click on Quality of Life) or from www.dlqi.com. As well as the original English version, 40 language translations are also available on this site. When the DLQI is used for routine clinical purposes, there is no need to seek permission and no charge. However, it is copyright and a charge is sometimes made for its use in funded research. Please note that the wording of the DLQI should not be altered, to ensure that scores remain comparable.
- Professor Andrew Y Finlay is professor of dermatology at the School of Medicine, Cardiff University, and joint copyright owner of the Dermatology Life Quality Index
1. David SE, Ahmed Z, Salek MS, Finlay AY. Does enough quality of life-related discussion occur during dermatology outpatient consultations? Br J Dermatol 2005; 153: 997-1000.
2. Katugampola RP, Hongbo Y, Finlay AY. Clinical management decisions are related to the impact of psoriasis on patient-rated quality of life. Br J Dermatol 2005; 152: 1256-62.
3. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19: 210-16.
4. Lewis V, Finlay AY. 10 years experience of the Dermatology Life Quality Index (DLQI). J Invest Dermatol Symp Proc 2004; 9: 169-80.
5. Hongbo Y, Thomas CL, Harrison MA et al. Translating the science of quality of life into practice: What do Dermatology Life Quality Index scores mean? J Invest Dermatol 2005; 125: 659-64.
6. Finlay AY. Current severe psoriasis and the Rule of Tens. Br J Dermatol 2005; 152: 861-7.
7. Smith CH, Anstey AV, Barker JNWN et al. British Association of Dermatologists guidelines for use of biological interventions in psoriasis 2005. Br J Dermatol 2005; 153: 486-97.
Subjects covered by the DLQI
- Itchy, sore, painful, stinging
- Embarrassed or self-conscious
- Interfered with going shopping or looking after home or garden
- Influenced choice of clothes
- Social or leisure activities and sports
- Working or studying
- Problems with partner or close friends or relatives
- Sexual difficulties
- Problems caused by treatment