Objective severity does not capture the impact of rosacea, acne scarring and photoaging in patients seeking laser therapy.

BACKGROUND: Measures of quality of life (QOL) and patient satisfaction are of great importance in dermatology, as both impact upon treatment adherence and health outcomes. Patients' assessment of QOL often differs from their doctors' predictions and their assessments of skin disease severity do not correlate with patients' own perceptions. The development of laser technology has facilitated successful treatment of many skin conditions, but studies on patient satisfaction are lacking. OBJECTIVES: Our aim was to determine the extent of discordance between patient and dermatologist-assessed disease severity and assess the impact of acne scarring, rosacea and photoaging on QOL. Our secondary aim was to assess patient satisfaction with laser therapy. METHODS: A prospective study of patients undergoing laser treatment for acne scarring, rosacea and photoaging was conducted over 1 year at the Skin & Cancer Foundation Australia. Subjective disease severity was determined using a visual analogue scale (VAS). Two dermatologists determined objective severity using validated grading scales to score photographs. QOL impact was measured by Skindex-16, satisfaction was measured using an amended Comprehensive Satisfaction Questionnaire (PSQ-18). RESULTS: A total of 147 individuals sought laser therapy for acne scarring, rosacea and photoaging. Dermatologists' subjective disease severity correlated weakly with patient-reported severity. All conditions negatively impacted upon QOL. Patients with rosacea had the most symptomatic impact; acne scarring was associated with the greatest self-esteem and social functioning issues; photoaging patients were the least affected. There were significant correlations between subjective severity assessment and Skindex-16 scores. There was notable discordance between dermatologist's skin severity assessment and patient's self-reported QOL impact. CONCLUSION: Skin conditions can have a profound impact on patient QOL, which is affected by patients' perception of disease severity and not fully appreciated by dermatologists' own severity assessments. Laser therapy is associated with high patient satisfaction.

Practical procedures in dermatology.

Most small skin lesions can be treated by simple office procedures. The key to effective treatment is accurate diagnosis and selecting the most appropriate treatment modality. Sometimes more than one modality may be appropriate for a specific lesion.