Acne quality-of-life scores grow in importance

Vancouver, British Columbia - As the sophistication and the number of tools for measuring the impact of acne grow, so might the importance of quality-of-life scores to physicians, patients and policymakers.

No one disputes that acne can exact a significant toll upon patients. Cystic acne carries risks of leaving physical as well as emotional scars. In one recent case in the United Kingdom, a young male patient's depression over his severe acne reportedly drove him to suicide. Moreover, the occupational and social consequences of acne include a higher rate of unemployment among young male patients (Cunliffe WJ. Br J Dermatol. 1986 Sep;115(3):386).

"Among students with acne, the greater their acne severity, the more they are stressed during examinations," adds Andrew Y. Finlay, M.D., professor of dermatology, Wales College of Medicine, Cardiff University, Wales. "So there's a relationship between acne and examination stress among university students (Chiu et al. Arch Dermatol. 2003 Jul;139(7):897-900)."

As a result of such findings, there's growing support for establishing objective measurements of the severity of acne.

"We need to be able to measure quality of life for political reasons, in order to be able to demonstrate that acne is important when we're arguing for more resources for acne research and treatments," Dr. Finlay says. "We also need to be able to measure quality of life as a patient-oriented outcome measure in clinical research, as well as for National Health Service research to demonstrate whether or not different methods of managing patients within healthcare systems are of benefit. And for auditing purposes, quality of life measurements can be relevant outcome measures.

"Finally, and perhaps most controversially, I believe that having a formal measure of quality of life may be helpful to clinicians in guiding, and later justifying, certain clinical decisions relating to patients. If one were deciding to put a patient on oral isotretinoin for their severe acne, for example, it might be helpful to have a measure of (acne's) quality-of-life impact before starting."

Measuring quality of life Methods for measuring quality of life include general ones such as SF 36 and acne-specific tools such as the Acne Disability Index and the Acne Quality of Life (AQOL) scale. Dermatology-specific tools include the Dermatology Life Quality Index (DLQI), a 10-question assessment developed at Cardiff University that has been used in at least 11 acne studies worldwide, and Skindex, developed in the United States.

One study using Skindex found that older patients may experience more quality-of-life problems and less improvement post-treatment (Lasek RJ Chren MM. Arch Dermatol. 1998 Apr;134(4):454-458).

Somewhat similarly, the DLQI allows researchers to assess the impact of particular treatments and to gain insight into other aspects of acne. In the latter area, the more impact acne exerts on quality of life, the more depression and anxiety patients are likely to experience (Yazici K et al. J Eur Acad Dermatol Venereol. 2004 Jul;18(4):435-439).

An inexact science Interpreting quality-of-life scores, however, remains an inexact science.

"We all know that a blood pressure of 200/150 means a patient is in serious trouble. But nobody instinctively knows what a quality-of-life score means clinically. And we need to know what scores mean in order for these questionnaires to begin to be useful clinically," Dr. Finlay says. "So we need to know what the absolute meaning is, and what's the minimal important change, or how big a score change is required to achieve relevance to patients."