Impact on quality of life in patients with dermatophytosis.

BACKGROUND/OBJECTIVES: Dermatophytosis can have a significant effect on patient's psychosocial and economic life. Despite this, knowledge on the quality of life (QoL) in patients with dermatophytosis is limited. The objective of the present study was to assess the quality of life in patients with dermatophytosis. METHODS: This was a cross-sectional study conducted in the Department of Dermatology at a tertiary care hospital from August 2018 to December 2018. All the patients with dermatophytosis aged ≥16 years were included and evaluated for impact on quality of life. The association of Dermatology Life Quality Index (DLQI) scores with disease characteristics was assessed using t-test, ANOVA and Pearson's correlation test, as applicable. RESULTS: A total of 348 patients were analysed. The mean ± SD DLQI score in our study was 13.4 ± 7.3. Dermatophytosis was found to have a very large effect on the QoL in majority (44.8%) of our patients. DLQI questions pertaining to symptoms and feelings and daily activity had the highest impact on patients. The DLQI score was significantly affected by the number of sites involved (P < 0.001), body surface area (P < 0.001) and the severity of symptoms (P = 0.007). CONCLUSION: Dermatophytosis was found to have a significant impact on the QoL of affected patients. The DLQI score was influenced by the severity of the disease. This study also underscores the feasibility of DLQI score based QoL assessment in dermatophytosis.

Quality of life and psychological morbidity in patients with superficial cutaneous dermatophytosis.

We are facing an onslaught of chronic and recurrent dermatophytosis in epidemic proportions never encountered previously. There is a dearth of studies assessing the quality of life (QoL) and psychological morbidity in patients with superficial dermatophytosis. Our aim was to assess QoL and psychological morbidity in a sample of Indian patients suffering from dermatophytosis by using Dermatology Life Quality Index (DLQI) questionnaire and General Health Questionnaire (GHQ), respectively. This was a single-centre, cross-sectional study where consecutive patients of first episode, chronic or recurrent dermatophytosis were invited to participate. In addition to DLQI and GHQ12, patients' demographic data, duration and symptoms of dermatophyte infection, were also documented and recorded in the case record form. We recruited 196 patients who satisfied the inclusion criteria. The mean total DLQI score was 13.41 ± 7.56 (range 0-30). The main items in the questionnaire influenced by the disease were "symptoms and feelings," followed by "daily activities," "leisure" and "personal relationships." Age of the patient and body surface area involved had a significant impact on the QoL in our study (P ≤ 0.05). The mean GHQ-12 score was 16.98; 84.9% of patients had a score higher than or equal to 12 indicating significant psychological distress. GHQ-12 was found to have significant correlation with the DLQI score. Quality of life issues and psychosocial aspect should be considered while managing dermatophytosis as education about the disease, its management and prognosis may go a long way in improving the adherence to treatment and overall outcome in these patients.

[Study of Home-based Ringworm Treatment and Follow-up by Visiting Nurses and Physicians: Interventional Effects].

　The aim of this study was to assess the effects of cooperation by visiting nurses and physicians experienced in general patient care, dermatology, and podiatry for the treatment of ringworm. Questionnaires were delivered to 1184 patients receiving home-based care by one of 14 participating visiting nursing establishments with a combined capacity of 3273 patients throughout five wards of the Tokyo metropolitan area. Responses were obtained from 691 patients (participation rate, 60.2%; average age, 80.2 years). The onychomycosis morbidity rate among home care patients was 22.7%. The results showed a significant reduction in the incidence of ringworm in the intervention group, from 79.5% to 54.5% (p=0.022), and in the incidence of "foot skin infection", from 100.0% to 31.6% (p<0.001). Although the level of care deteriorated in the control group (p=0.008), there was no significant change in the intervention group. The incidence of leg pain also remained unchanged in the control group (p=0.285) but decreased in the intervention group (p=0.003). While the "degree of satisfaction with foot cleanliness" did not change significantly in the control group (p=0.260), patients in the intervention group were generally satisfied with foot cleanliness. It is necessary to take into account foot care and the effect of onychomycosis treatment vearsusu no treatment and to ensure that visiting nurses and caregivers master foot care-related treatment regimens. We suggest the need to improve the maintenance of foot care and ringworm intervention/treatment performed by physicians, nurses, and caregivers.

Psychiatric profile of patients with neurodermatitis.

Fifty patients of neurodermatitis attending the dermatology clinic of a general hospital were screened for psychiatric morbidity. Fifty patients suffering from tinea from the same clinic were taken as a control group (age, sex and socio-economic class matched). A majority of neurodermatitis patients were between 21-30 years of age-group (52%), males (84%), married (90%), literate up to primary (42%) and belonged to socio-economic class V (44%). The common sites of neurodermatitis were legs (28%), arms (16%), scrotum (12%) or multiple sites (36%). The duration of symptoms ranged from 1 month to 2 years (average duration was 6 months). The study group also showed significantly higher occupational and psychosexual problems (p < 0.001). The neurodermatitis patients scored significantly higher on N-2 scale and Hamilton rating scale for depression.

Managing noncompliance in a schizophrenic patient with chronic skin disorders.

A schizophrenic-diagnosed woman with a long-term history of scratching and skin problems was referred for behavioral treatment because she was not responding well to medical care and was often described as noncompliant. The treatment of noncompliance consisted of four phases: (I) direct habit modification, (II) compliance training, (III) controlling anxiety precipitants and (IV) follow-up monitoring and evaluation. After several months of treatment, the maladaptive behaviors decreased and the skin condition improved. Follow-up at six month intervals for three years indicated no recurrence of skin problems.

Life events and psychological distress in dermatologic disorders: psoriasis, chronic urticaria and fungal infections.

A consecutive unselected series of 60 in-patients suffering from dermatologic disorders (psoriasis, chronic urticaria and fungal infections of the skin) was examined. Twenty patients with each illness were included. Stressful life events immediately before illness onset, levels of psychological distress, and alexithymic traits were investigated. Patients with psoriasis and chronic urticaria were exposed to stressful life situations before disease onset and suffered from psychological distress (anxiety, depression, inadequacy) significantly more than those with fungal infections. Implications for psychosomatic research and treatment are discussed.