DLQI scores underestimated during lockdowns?

Classic Dermatology Life Quality Index (DLQI) scores may not adequately reflect the status of patients during the pandemic. The increased numbers of ‘not-relevant’ responses (NRR) during this period could entail less reliable results.

The DLQI was introduced in 1994 and has since been used to determine the magnitude of effect that skin disease has on a patient’s life [1,2]. Items 3–10 of the DLQI questionnaire include an NRR option. These questions comprise the influence of shopping, social/leisure activities, sex, sports, and work/studying. In some countries, reaching a certain DLQI score is a prerequisite for health insurance to render a patient with psoriasis eligible for systemic treatment [1].

“Most European countries, Ireland included, went through a series of lockdowns and we hypothesised that because people were not able to access shops, gyms, and restaurants, more ‘non-relevant’ responses would be ticked on DLQI questionnaires,” Dr Ali Alsharqi (St. Vincent’s University Hospital, Ireland) explained the study’s aim [1]. Previous research had found that 38.8% of psoriasis patients generally choose an NRR at least once in their questionnaires. It was suggested that more than 1 NNR would decrease the DLQI score, and a formula was created that led to a score adjustment for NRR: the DLQI-R [3]. A second interest of the single centre, retrospective study was to evaluate potential differences in DLQI and DLQI-R during the lockdown phases of the pandemic [1].

The 52 participants all had stable disease, reflected by a Psoriasis Area Severity Index (PASI) score of ≤4. The mean age of the study subjects was 55.3 years, and 53.8% were women. Unsurprisingly in the setting of a specialist clinic, the vast majority was treated with biologics or other systemic drugs. Assessed were the most current DLQI scores obtained before lockdown restrictions and during the lockdown. The results showed similar mean disease activity before (PASI 2.16) and during lockdown (PASI 2.09). Looking at the DLQI in general, the mean scores slightly dropped with 3.13 pre-pandemic and 3.0 during the restrictions. However, mean values for NRRs increased during the lockdown (0.62 vs 1.27), and the picture changed when adjusted for these NRRs with the DLQI-R. “There was a statistically significant increase in the number of NNRs and that corresponded to a statistically significant increase in the DLQI-R,” Dr Alsharqi highlighted, pointing out that the numerical scores for interpersonal relationships, social/leisure, shopping/garden, and home were higher during lockdowns than in pre-pandemic research.

“We think it is important for clinicians to be aware of this, as they make decisions with respect to continuation or altering patient’s treatments and also when it comes to data collection in registries,” Dr Alsharqi summarised the findings.

1. 
   
   1. Alsharqi A. Are we underestimating Dermatology Life Quality Index Values in the Era of COVID-19? FC12, Psoriasis Gene to Clinic 2021, 9–11. December.
   2. Finlay AY, et al. Clin Exp Dermatol. 1994;19(3):210–216.
   3. Rencz F, et al. J Eur Acad Dermatol Venereol. 2018;32(5):783–790.

 

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Posted on 3 February 2022