Self-Esteem, Depression, Anxiety and Quality of Life in Patients with Melasma Living in a Sunny Mediterranean Area: Results from a Prospective Cross-Sectional Study.

INTRODUCTION: Melasma is a common acquired disorder of hyperpigmentation and has a significant effect on quality of life. The aim of this prospective cross-sectional study was to assess the effect of melasma on depression, social anxiety and self-esteem in the Greek population. METHODS: The study included a total of 254 participants: 127 patients with melasma and an equal sample of healthy controls. Both participant groups completed the following psychometric measures: the Hospital Anxiety and Depression Scale (HADS) to assess anxiety and depression and Rosenberg's Self-esteem Scale (RSES) for self-esteem. Furthermore, in patients with melasma, quality of life was assessed using Melasma Quality of Life (MELASQoL). RESULTS: Melasma patients (7.47 ± 4.53) presented statistically significantly higher anxiety compared to healthy controls (6.06 ± 3.59, p = 0.006), while no differences emerged with regard to depression or self-esteem. It is important to note that the difference regarding anxiety remained significant (b = 1.25, p = 0.003) even after adjusting for age, depression and self-esteem. A higher disease severity (MASI) correlated statistically significantly with longer disease duration (r = 0.24, p < 0.001), higher depression (r = 0.28, p = 0.002), and a more impaired health-related quality of life (MelasQol; r = 0.29, p < 0.001). Notably, a more impaired health-related quality of life was also correlated with higher depression (r = 0.19, p = 0.027) and lower self-esteem (r = - 0.31, p < 0.001). CONCLUSION: The results of this study highlight the importance of evaluating quality of life, anxiety and depression in patients with melasma. The therapeutic approach should not be based solely on clinical findings; it should also include an evaluation of the patient's psychological aspects. Dermatologists can further improve their patient care by being supportive or requesting psychological intervention when needed, resulting in better compliance with treatment and an improved social and psychological status.

Treatment of Axillary Bromhidrosis with Topical 2% Glycopyrronium Bromide Cream: A Prospective, Non-randomized, Open-label Study.

BACKGROUND: Topical glycopyrrolate is a well-established therapeutic option for focal hyperhidrosis; however, there are no data on its efficacy in the treatment of bromhidrosis. OBJECTIVES: The objective of this open-label, non-randomized study was to investigate the efficacy and safety of a galenic formulation of 2% glycopyrronium bromide cream, in the treatment of bromhidrosis. METHODS: Nineteen patients with bromhidrosis were prescribed a 2% glycopyrronium bromide cream, to apply in both axillae, every night, for 12 weeks. Malodor was assessed on a four-point scale. Scores for the Dermatology Life Quality Index (DLQI), Hyperhidrosis Disease Severity Scale (HDSS), and the Hospital Anxiety and Depression Scale (HADS) were recorded at baseline and after 12 weeks. RESULTS: Statistically significant improvements in malodor and HDSS, DLQI, and HADS scores, respectively, were observed after treatment. One patient reported irritation at the site of application and another reported mydriasis, which resolved spontaneously. All but one of the patients declared that they were either completely (52/6%) or partially (42.1%) satisfied regarding the treatment. CONCLUSION: Our results indicate that 2% glycopyrronium bromide cream is effective and safe for 12 weeks of application in patients with axillary bromhidrosis.

Comparative Study of Quality of Life and Psychological Aspects in Patients with Psoriasis and Hidradenitis Suppurativa.

Psoriasis and hidradenitis suppurativa are two common dermatological diseases that affect physical, social, and psychological aspects of the patients' lives. The aim of this study was to compare quality of life, depression, anxiety, self-esteem, and loneliness in patients with psoriasis and hidradenitis suppurativa. One hundred and eight patients with psoriasis, 113 patients with hidradenitis suppurativa and 116 healthy controls were included in the study. The quality of life, depression, anxiety, and loneliness of the patients as well as their self-esteem were assessed using the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), the UCLA loneliness Scale (UCLA-Version 3) and the Rosenberg's Self-esteem Scale (RSES), respectively. Patients with psoriasis (12.77±4.43) reported a higher mean impairment in DLQI than patients with hidradenitis suppurativa (11.10±6.53, P=0.028), in the univariate comparisons. Patients with psoriasis presented statistically significantly higher levels of anxiety and depression than both patients with hidradenitis suppurativa and healthy controls, while patients with hidradenitis suppurativa also had higher anxiety and depression compared with healthy controls. Patients with psoriasis (46.31±6.36) reported statistically significantly higher loneliness than both patients with hidradenitis suppurativa (43.18±7.40) and controls (40.42±4.41), while the patients with hidradenitis suppurativa also presented higher loneliness in comparison with controls. Lower levels of self-esteem were found in patients with psoriasis (15.08±3.11) compared with both patients with hidradenitis suppurativa (18.89±1.69) and controls (20.25±2.60), while patients with hidradenitis suppurativa also had lower self-esteem than controls. Significant levels of depression, anxiety, and impaired quality of life were strongly associated with disease severity. When patients with mild disease were compared, those with psoriasis presented with both higher levers of loneliness and lower scores for quality of life. Although both psoriasis and hidradenitis suppurativa are associated with impaired quality of life and psychological aspects, significantly worse scores were recorded in patients with psoriasis.

Combination of 30% Salicylic Acid Peels and Mechanical Comedo Extraction for the Treatment of Favre-Racouchot Syndrome.

Dear Editor, Favre-Racouchot syndrome is a cutaneous disease characterized by cysts, comedones, and elastotic nodules in actinically damaged skin, typically on the face (1). It has been specifically connected to sun exposure and heavy smoking, which may act synergistically (2). Available medical and surgical therapies are of variable efficacy. We present a combined therapeutic approach: 30% salicylic acid peels followed by manual extraction of cystic and comedonal material in the same visit. Five male patients, aged between 60-75 years with the clinical diagnosis of Favre-Racouchot syndrome, were treated with salicylic acid peel 30% followed by cyst and mechanical comedo extraction. Local anesthesia was considered unnecessary. Patients were subjected to the above therapies every two weeks for a series of four treatments. Photographs were taken before the beginning of treatment, as well as before and after each session (Figures 1a, b and 2a, b). At the end of the study, physician and patient global assessment scale was used to evaluate the efficacy of the treatment (0-25% indicated poor response, 25-50% fair, 50-75% good, and 75-100% excellent response). We have previously used this assessment scale in published research. Safety was assessed by evaluating early and delayed adverse events. Physician assessment found a fair to good improvement in 80% of the patients based on the reduction of comedones and solar elastosis, as well as the improvement in overall skin appearance and texture. The numbers for each specific categories of improvement were as follows: 1 patient poor; 3 patients fair, and 1 patient good improvement. Based on the patients' self-assessment, all patients (100%) acknowledged an improvement. Three patients rated the improvement fair (60%) and two rated it good (40%). The treatment was well-tolerated and no side-effects were noted. No clinical progression was observed on 6-month follow-up visit. Favre-Racouchot syndrome was originally described in 1932 by Favre and later reviewed in detail by Favre and Racouchot in 1951. Lesions are usually distributed on the temporal and periorbital areas. However, there have been reports of similar findings in atypical locations such as the forearms and chest. The underlying skin is sun-damaged, diffusely thickened, and furrowed (1). The eruption is usually bilaterally symmetrical. The precise pathogenesis of Favre-Racouchot syndrome is not known. Nevertheless, it most commonly presents in patients with a history of long-term sun exposure, heavy smoking, and, although rare, a history of radiation exposure. Unilateral manifestation of the disease has been previously described and was attributed to prolonged occupational unilateral sun exposure or observed following radiation therapy (3). It is mostly reported in Caucasian men (with a prevalence of 6% in adults older than 50 years). Its incidence increases with age, although it has been reported in younger patients. Differential diagnosis includes dermatoses that present with lesions of similar morphologies, such as acne vulgaris, epidermoid cysts, sebaceous hyperplasia, and colloid milium (4). Diagnosis is primarily clinical. Although the histologic features of the disease are very characteristic, skin biopsy is rarely required. The comedones found are histologically indistinguishable from the primary comedones of acne vulgaris, with the exceptions of a lack of inflammation and the presence of a marked actinic elastosis in the surrounding dermis (epidermal atrophy and massive basophilic degeneration of the upper dermis). Measures to stop the progression of the disease include smoking cessation and sun protection. Treatment options include topical retinoids, excision, curettage, dermabrasion, comedo extraction, and carbon dioxide laser ablation. Daily oral isotretinoin (0.05-0.10 mg/kg/day) used in conjunction with topical tretinoin has also been found effective. Treatment results are usually unsatisfactory when these techniques are used independently, but when used in conjunction with one another they may provide a very favorable outcome (1). For the best therapeutic outcome, solar elastosis, the nodulocystic lesions, and the comedones that require mechanical removal should be targeted. Salicylic acid is a lipophilic beta-hydroxy acid possessing keratolytic, comedolytic, and anti-inflammatory properties. At concentrations between 20% and 30% it is used in the treatment of acne vulgaris and mild photodamage. It decreases sebum secretion and disrupts intercorneocyte cohesion, leading to desquamation (5). Its lipid solubility permits better penetration into the pilosebaceous unit. Salicylic acid extends up to the mid-portion of the follicular canal (upper dermis) where excessive keratinization, the initial event in comedo formation, takes place. Furthermore, it activates epidermal basal cells and underlying fibroblasts, resulting in reorganization of the epidermis and a rebuilding of the superficial dermal connective tissue. The above actions of salicylic acid may be responsible for the reduction in comedonal lesions and the improvement in solar elastosis and overall skin texture. Additionally, its keratolytic effect facilitates comedo extraction. On the basis of our results, we suggest an alternative therapeutic approach with salicylic acid peels followed by mechanical comedo extraction in patients suffering from Favre-Racouchot syndrome.

The Association of Various Metabolic Parameters with Multiple Skin Tags.

Background: Skin tags (STs) are benign skin lesions. Their definite etiology remains unknown. We aim to examine the association of obesity, diabetes mellitus, hyperlipidemia, thyroid abnormalities, acanthosis nigricans, and multiple STs in a Greek primary population. Methods: Phototype and body weight were recorded. Fasting serum blood samples were analyzed for cholesterol, low-density lipoprotein, high-density lipoprotein, triglycerides, glucose, and thyroid-stimulating hormone. Univariate ordinal logistic regression multivariate analysis was performed. Results: The univariate analysis showed that patients who were overweight with Fitzpatrick Skin Type III, acanthosis nigricans, and hypothyroidism were more likely to present with multiple skin tags as compared with patients at a normal weight with Skin Type I. Statistically significant associations were also found with the presence of cholesterol and triglycerides. In the multivariate analysis, a significant association between hypercholesterolemia and STs was demonstrated. Those with skin tags were more likely to have hypothyroidism. Conclusion: STs are often associated with obesity. An association between lipid profile and STs has been reported. Multiple STs have been independently associated with acanthosis nigricans. Although a possible relationship between STs and thyroid disease has not yet been proved, our review reveals a possible trend. Future investigations with larger sample sizes might clarify the association between skin tags and hypothyroidism.

Patients' self-esteem before and after chemical peeling procedure.

INTRODUCTION: Chemical peeling is a safe method, widely used to treat a variety of skin conditions and reduce the aging effects. This study aims to evaluate self-esteem among adolescents who undergo chemical peelings. MATERIAL AND METHODS: One hundred and twenty six patients constituted the study group. Sixty seven individuals had undergone chemical peeling for therapeutic reasons and 59 individuals for cosmetic reasons. To assess patients' self-esteem, the Rosenberg's Self-esteem Scale (RSES) was used before and after treatment. The control group included 71 healthy, age- and sex-matched volunteers from the general population. They were also asked to complete the RSES, after the same time interval as the patients. RESULTS: The healthy controls (23.01 ± 3.12) presented statistically significantly higher self-esteem than both the groups of individuals who would be submitted to chemical peeling. Furthermore, patients who would undergo peeling for therapeutic reasons (21.58 ± 3.20) had statistically significantly higher self-esteem than those who would undergo the procedure for cosmetic reasons (18.97 ± 3.36). After the chemical peeling sessions, the self-esteem of patients treated for therapeutic reasons (23.48 ± 2.43) and of patients treated for cosmetic reasons (22.83 ± 3.34) improved statistically significantly, while the self-esteem of the healthy controls remained stable, as expected. CONCLUSION: Patients who undergo chemical peelings tend to have low levels of self-esteem. Although facial lesions in skin diseases such as acne, acne scars, rosacea, and melasma seem to have negative effect on individuals' self-consciousness, patients who would be submitted to chemical peeling in order to treat wrinkles, loss of radiance, and skin tone clarity have even lower self-esteem. Chemical peelings were shown to favorably affect patient's self-esteem since all patients showed an increase in self-esteem after treatment, while the control group experienced no change.

Bevacizumab-associated Sudden Onset of Multiple Monomorphic Comedones on the Scalp Successfully Treated with 30% Salicylic Acid Peels.

Bevacizumab is a humanized monoclonal antibody against vascular endothelial factor (VEGF) that targets tumor cell angiogenesis and proliferation. Although it is usually well tolerated, many side-effects have been reported. These include hypertension, bleeding, and thromboembolic events among others. Drug-associated cutaneous adverse effects are less common and include itching, exfoliative dermatitis, and acneiform eruptions. A man with bevacizumab-associated monomorphic skin eruption successfully was treated with 30% salicylic acid peels. To the author's knowledge, this is the first report of open comedones with no further inflammatory acne lesions that developed in a patient treated with bevacizumab. Complete remission of the rash was achieved after performing 30% salicylic peels, and the patient continued the chemotherapy as planned with no need of either dose reduction or discontinuation of bevacizumab.

Psychosocial Aspects in Patients With Chronic Leg Ulcers.

Chronic leg ulcers persist for > 6 weeks and show no tendency to heal after 3 or more months. They can be distressing to patients, both directly through physical symptoms caused by the disease and indirectly through limitations on work capacity, social activity, and personal hygiene. The quality of life (QoL) of patients with leg ulcers can be impaired by a complex set of aspects. Restrictions in their ability to perform paid employment, handle household duties, and engage in personal hygiene adversely affect patients' QoL. Patients with chronic leg ulcers frequently experience negative emotions such as shame, embarrassment, and loneliness, and they present higher levels of depression and anxiety compared with healthy individuals. When the expected healing results do not occur, these patients feel as if they have no control over their condition; this ongoing frustration leads them to feel depressed. The ulcers contribute to anxiety and psychological stress, creating a vicious, difficult-to-manage circle. This review aims to describe the negative psychosocial impacts on patients with chronic leg ulcers and emphasize their impaired QoL.

Psychopathology and alexithymia in patients with psoriasis.

BACKGROUND:: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. OBJECTIVE:: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. METHODS:: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. RESULTS:: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. STUDY LIMITATIONS:: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. CONCLUSIONS:: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

Psychopathology and alexithymia in patients with psoriasis

Abstract: Background: Psoriasis is a chronic, inflammatory, relapsing skin disease that has a psychosocial impact on the patients' life. Objective: This study aimed to investigate psychopathology in patients with psoriasis based on a valid psychometric instrument, as well as on the relationship between psychopathology and alexithymia. Methods: 108 patients with psoriasis were included in the study. Psychopathology was evaluated with the Symptom Checklist-90-Revised (SCL-90-R) and alexithymia with the Toronto Alexithymia Scale (TAS-20). Disease severity was clinically assessed using the Psoriasis Area and Severity Index. Results: As regards the psychopathological dimensions, female patients presented with statistically significant higher somatization, depression, anxiety, phobic anxiety, and psychoticism than males. Patients with alexithymia presented with statistically significant higher somatization, interpersonal sensitivity, anxiety, and phobic anxiety than non-alexithymic patients. Alexithymia positively correlated with somatization (r = 0.26, p < 0.01), interpersonal sensitivity (r = 0.24, p < 0.05), depression (r = 0.27, p < 0.01), anxiety (r = 0.26, p < 0.01), and phobic anxiety (r = 0.26, p < 0.01). In addition, alexithymia also contributed to the prediction of these conditions. Study Limitations: A larger study sample could yield safer generalized results. Nevertheless, to the best of our knowledge, this was the first study to investigate various psychopathological dimensions in patients with psoriasis. Conclusions: Our study results indicate that alexithymia and female sex were associated with several psychopathological dimensions in patients with psoriasis. It may be suggested that alexithymia constitutes an important factor in the development of mental disorders among patients with psoriasis.

Methotrexate: an effective monotherapy for refractory generalized morphea.

INTRODUCTION: Morphea is an inflammatory skin disorder characterized by excessive collagen deposition. Although treatment algorithms for morphea subtypes have been suggested, no consistent recommendations are available. This study attempts to evaluate the clinical efficacy of methotrexate (MTX) as monotherapy in refractory generalized morphea. METHODS: It is a retrospective study, including 20 patients who had already been treated with various topical and systemic therapies with minimal clinical improvement. Patients received orally MTX at a of dosage 15 mg once weekly. Duration of the use, dosage of MTX, and adverse events were recorded. Clinical assessment of skin lesions was performed and documented. RESULTS: The mean disease duration was 27 months before the initiation of MTX treatment. After 12 months of therapy, very good response was achieved in 6 patients (30%), good response in 10 patients (50%), and fair response in 2 patients (10%), while 2 patients (10%) had failed treatment. Patients were followed up for a mean time interval of 21 months. No serious adverse event was recorded. CONCLUSION: MTX has been already proved to be an effective and well-tolerated treatment in pediatric patients with morphea. The majority of the group of adult patients showed very good and good improvement when treated with MTX. Although this is an uncontrolled study, MTX monotherapy was considered a safe and effective treatment for the management of this specific clinical subset of morphea in adults.

Hidradenitis suppurativa treated with tetracycline in combination with colchicine: a prospective series of 20 patients.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder of the follicular epithelium. OBJECTIVES: The objective of the present study was to evaluate the effectiveness of the combination of tetracycline with colchicine in the treatment of HS. METHODS: Twenty patients (10 women and 10 men) with HS were included in an open, prospective, pilot study. All patients were treated with 100 mg minocycline administered orally once per day in combination with 0.5 mg colchicine administered twice per day for 6 months followed by a maintenance regimen of 0.5 mg colchicine administered orally twice per day for 3 months. Patients were examined at baseline and thereafter every 3 months for a total of 9 months. The efficacy of the treatment was evaluated using a physician's global assessment (PGA) scale, the Hurley scoring system, and the Dermatology Life Quality Index (DLQI). RESULTS: A significant improvement in clinical manifestation was reflected in scores on the Hurley scoring system and DLQI. According to the PGA, patients achieved substantial improvement or complete remission. Clinically, all patients started to show signs of improvement within the first 3 months of therapy and continued to improve over the next 6 months. CONCLUSIONS: This study indicates that the combination of the anti-inflammatory actions of colchicine and minocycline is effective in disease control in HS. Colchicine emerged as a safe option for the maintenance of the obtained result.

Quality of life, depression, anxiety and loneliness in patients with bullous pemphigoid. A case control study.

BACKGROUND:: Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. OBJECTIVE:: The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. METHODS:: Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. RESULTS:: The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). CONCLUSION:: BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity.

Periorbital Hyperpigmentation in Patients with Xanthelasma Palpebrarum: An Interesting Observation.

Background: Xanthelasma palpebrarum refers to xanthomas that occur more often near the inner canthus of the eyelid. Periorbital hyperpigmentation presents as a dark area surrounding the eyelids. Objective: In the present study, the authors examined the prevalence and the associated factors of periorbital hyperpigmentation among patients with xanthelasma. Methods: One hundred and fourteen patients with xanthelasma palpebrarum were examined for the presence of dark circles. Detailed questionnaires regarding the history of diabetes, hypothyroidism, smoking status, and weight were completed by all patients. They were also tested for serum lipids (cholesterol, low-density lipoprotein, triglycerides, apolipoprotein A and apolipoprotein B). Results: From the 114 patients with xanthelasma, 94 (82.4%) were diagnosed with periorbital hyperpigmentation. At the time of the survey, 46 patients were smokers (48.9%), 23 of them had hypothyroidism (24.4%), and 16 patients were obese (17%). Only four patients had a history of diabetes. Cholesterol levels were elevated in 65 patients (69.1%). In 52 patients (55.3%), low-density lipoprotein was increased and in 51 patients (54.2%), both cholesterol and low-density lipoprotein were elevated. Apolipoprotein A was increased in 35 patients (37.2%), whereas apolipoprotein B was increased in 23 patients (24.4%). Conclusions: This study showed that a significant number of patients with xanthelasma exhibited periorbital hyperpigmentation. Smoking, obesity, and hyperlipidemia were observed in these patients.

Quality of life, depression, anxiety and loneliness in patients with bullous pemphigoid. A case control study

Abstract: Background: Bullous pemphigoid (BP) is a chronic, autoimmune blistering skin disease that affects patients' daily life and psychosocial well-being. Objective: The aim of the study was to evaluate the quality of life, anxiety, depression and loneliness in BP patients. Methods: Fifty-seven BP patients and fifty-seven healthy controls were recruited for the study. The quality of life of each patient was assessed using the Dermatology Life Quality Index (DLQI) scale. Moreover, they were evaluated for anxiety and depression according to the Hospital Anxiety Depression Scale (HADS-scale), while loneliness was measured through the Loneliness Scale-Version 3 (UCLA) scale. Results: The mean DLQI score was 9.45±3.34. Statistically significant differences on the HADS total scale and in HADS-depression subscale (p=0.015 and p=0.002, respectively) were documented. No statistically significant difference was found between the two groups on the HADS-anxiety subscale. Furthermore, significantly higher scores were recorded on the UCLA Scale compared with healthy volunteers (p=0.003). Conclusion: BP had a significant impact on quality of life and the psychological status of patients, probably due to the appearance of unattractive lesions on the skin, functional problems and disease chronicity.

Comparative Study of Quality of Life and Obsessive-Compulsive Tendencies in Patients With Chronic Hand Eczema and Lichen Simplex Chronicus.

BACKGROUND: Lichen simplex chronicus (LSC) and chronic hand eczema (CHE) are 2 common dermatological disorders that affect physical, social, and psychological aspects of life. The aim of this study was to compare quality of life and obsessive-compulsive tendencies between patients with LSC and patients with CHE. MATERIALS AND METHODS: Sixty patients with LSC, 60 patients with CHE, and 60 healthy controls were included in the study. Quality of life was evaluated according to the Dermatology Life Quality Index (DLQI). Patients were also assessed for compulsive behavior with the Leyton Trait Scale. RESULTS: Patients with LSC (13.00 [1.41]) had a statistically significant higher mean (SD) DLQI compared with patients with CHE (11.33 [1.53]). Patients with LSC (13.97 [2.14]) presented statistically significant higher levels of obsessive-compulsive personality traits than patients with CHE (12.48 [2.69]), whereas both groups also differed from the healthy controls (10.68 [3.87]). The DLQI was not correlated with the Leyton Trait Scale in either the patients with LSC (r = 0.10, P = 0.50, not significant [NS]) or in the CHE patients (r = 0.01, P = 0.92, NS). CONCLUSIONS: Although both LSC and CHE are associated with impaired quality of life and obsessive-compulsive tendencies, significantly higher scores were recorded in patients with LSC.

Improvement of health-related quality of life and adherence to treatment with calcipotriol-betamethasone dipropionate gel in patients with psoriasis vulgaris.

BACKGROUND: Psoriasis is a common, chronic, recurrent, immune-mediated disorder of the skin and joints. It can have a significant negative impact on the physical, emotional and psychosocial wellbeing of affected patients. OBJECTIVES: To measure improvement in health-related QoL (HRQoL) in Greek patients with psoriasis vulgaris after a month of treatment with calcipotriol-betamethasone dipropionate gel; and evaluate adherence to treatment parameters. METHODS: The study included 394 psoriasis vulgaris patients from 16 private dermatological practices in Greece, all treated with calcipotriol-betamethasone dipropionate gel. They were evaluated at the first visit and after 4 weeks. Moreover, they completed the Dermatology Life Quality Index (DLQI), while other data such as disease severity, subjective symptoms and adherence, were collected. RESULTS: At week 4, the DLQI median was reduced by 3.5 points from the baseline (p<0.001; baseline and week 4 median: 4.5 and 1.0 respectively). Pruritus and sleep disorders also improved (p<0.001). Furthermore, 90.1% of the subjects fully adhered to treatment, with a 97.1% mean level of compliance. CONCLUSIONS: The convincing clinical results, with a distinct improvement in HRQoL, plus the high level of adherence due to its advantageous physical properties, make the calcipotriol-betamethasone dipropionate gel formulation an important, effective and well-tolerated topical therapy to treat psoriasis.