Indian Journal of Dermatology
CORRESPONDENCE COLUMN
Year
: 2006  |  Volume : 51  |  Issue : 2  |  Page : 155--157

Quality of life in chronic urticaria


KV Godse 
 Shree Skin Centre, 22, L Market, Sector 8, Nerul, Navi Mumbai - 400 706, India

Correspondence Address:
K V Godse
Shree Skin Centre, 22, L Market, Sector 8, Nerul, Navi Mumbai - 400 706
India




How to cite this article:
Godse K V. Quality of life in chronic urticaria.Indian J Dermatol 2006;51:155-157


How to cite this URL:
Godse K V. Quality of life in chronic urticaria. Indian J Dermatol [serial online] 2006 [cited 2019 Dec 10 ];51:155-157
Available from: http://www.e-ijd.org/text.asp?2006/51/2/155/26950


Full Text

Quality of life (QOL) indices assess the effects of disease on patients' well-being. Urticaria is a common problem in skin department and its impact on quality of life in India is not being studied.

Chronic urticaria is an often disabling condition which can prevent patient to perform daily activities. The Dermatology Life Quality Index questionnaire is designed for use in adults, i.e., patients over the age of 16. It is self-explanatory and can be simply handed to the patient who is asked to fill it in without the need for detailed exaplanation. It is usually completed in one to two minutes. The questions were classified to 6 headings items: symptoms and feelings (questions 1 and 2), daily activities (questions 3 and 4), leisure (questions 5 and 6) and personal relationships (questions 8 and 9) each item with maximum score 6; work and school (question 7), and treatment (question 10) each item with maximum score 3.[2] The DLQI is calculated by summing the score of each question resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired. The DLQI can also be expressed as a percentage of the maximum possible score of 30. This study was done to evaluate quality of lfie in patients with chronic urticaria in Indian population.

Fifty adult patients (age group 18-80, Mean age 43 years, Male to Female ratio 33:17) with chronic urticaria attending private skin centre of Navi Mumbai were asked to complete questionnaire which took them less than two minutes each. Trained staff was present to assist the patient in filling the form. Most patients filled up the form without any problem. Patients were excluded from the study if they could not read or if they were not willing to fill out the DLQI. Autologous serum skin test was performed in ten patients out of which three had positive result. Three patients had delayed pressure urticaria. We examined the association between DLQI and age by means of the Pearson correlation coefficient (0.03050) and we found no significant association to be present.

Of the 50 DLQI forms that were distributed a total of 45 patients (90%) answered all 10 questions; 5 patients (10%) answered 9 questions. We did show scoring of up to 23 of 30. More than 75% of our patients had a DLQI score of 10 or lower, out of a maximum score of 30. Three patients with delayed pressure urticaria (DPU) scored more than 16 score against average of 7.16. Similarly three patients with positive Autologous serum skin test showed score 21 out of 30 highest amongst all the patients. The mean age of our patient was 43 years (range, 18-80 years) and 66% were male, opposite to the sample of Finlay and Khan.[1]

Total scores for the 50 completed forms were calculated based on instructions obtained from Finlay and Khan,[1] which specify that questions with missing answers be scored as zero. The overall mean score was 6.5 in their study and 7.16 in ours. Although most skin conditions are not life threatening, they can strongly affect how patients perceive and interact with their environment, giving such diseases the potential to alter every aspect of a patient's life.

A comparison of physician and patient responses to surveys showed significant differences between physician and patient assessments of patient quality of life (QOL). Physicians tended to underestimate the impact of severe skin disease, and overestimate the impact of mild disease.[2] It has been argued that QOL assessment is the most important measure of disease severity because reductions in QOL define the patient's actual experience of living with the illness. The concept of "quality of life" attempts to account for several dimensions of well-being in an individual. The domains that are often assessed include physical, psychological, social, and general well-being, and cognitive functioning.[3] Chronic idiopathic urticaria (CIU) is a debilitating skin disease that affects patients' quality of life (QOL). The Dermatology Life Quality Index (DLQI) assesses QOL parameters across several types of dermatologic conditions. However, an evaluation of the validity of the DLQI for use in CIU patients has not been undertaken, because CIU, unlike other chronic skin conditions, is subject to daily or weekly symptom fluctuations.[4]

Few articles are available about chronic urticaia (CU) impact on patient's quality of life (QOL). There are no studies from India on this subject.[5] Using the QOL Nottingham Health Profile, O'Donnell and Greaves showed that the QOL handicap in CU and in patients with triple coronary heart disease was equivalent.[6] In further studies, Poon E et al showed that patients suffered serious impairment of sexual relationships due to CU, and its treatment.[7] Similarly patients with urticaria and angioedema did not report poorer quality of life than those with urticaria alone[9] Another survey demonstrated significantly poorer self-assessed quality of life among patients with chronic urticaria when compared with that patients with respiratory allergies.[8] We found patients with delayed pressure urticaria and with positive Autologous serum skin test reported serious impairment of quality of life. Quality of life in urticaria patients can be improved by using newer generation of non sedating antihistaminics and use of immunosuppressants like cyclosporine and Methotrexate[9] in patients with positive Autologous serum skin test in whom traditional anthihistaminics do not give adequate control of disease.

References

1Finlay AY, Khan G. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210-6.
2Mukhtar R, Choi J, Koo JY. Quality-of-life issues in psoriasis. Dermatol Clin 2004;22:389-95.
3McKenna KE, Stern RS. The outcomes movement and new measures of the severity of psoriasis. J Am Acad Dermatol 1996;34:534-7.
4Lennox RD. Validation of the Dermatology Life Quality Index as an outcome measure for urticaria-related quality of life. Ann Aller Asthma Immunol 2004;93:142-6.
5Hermansen SE, Helland CA, Finlay AY. Patients' and doctors' assessment of skin disease handicap. Clin Exp Dermatol 2002;27:249-50.
6O'Donnell BF, Lawlor F, Simpson J, Morgan M, Greaves MW. The impact of chronic urticaria on the quality of life. Br J Dermatol 1997;136:197-201.
7Poon E, Seed PT, Greaves MW, Kobza-Black A. The extent and nature of disability in different urticarial conditions. Br J Dermatol 1999;140:667-71.
8Baiardini I, Giardini A, Pasquali M, Dignetti P, Guerra L, Specchia C, et al . quality of life and patients' satisfaction in chronic urticaria and respiratory allergy. Allergy 2003;58:621-3.
9Godse KV. Methotrexate in autoimmune urticaria. Indian J Dermatol Venereol Leprol 2004;70:377.