Impact of contact dermatitis on health related quality of life assessed using the Dermatology Life Quality Index

Introduction

Dermatitis comprises a heterogeneous group of inflammatory skin disorders characterized by pruritus, erythema and a chronic or relapsing course. Contact dermatitis (CD), is among the most common causes of skin disease and represents a major reason for dermatology/allergist referrals. CD may lead to substantial impairment of health related quality of life (HRQoL).¹

In recent years, assessment of HRQoL has become an essential component, complementing traditional clinician reported severity measures. Patient reported outcome measures offer valuable insight into the subjective burden of disease, evaluating physical discomfort, emotional distress and social or occupational limitations not always reflected by clinical examination.² Among available specific instruments, the Dermatology Life Quality Index (DLQI) is the most widely used and extensively validated questionnaire for adult patients with DC.³

The DLQI has been applied across a broad range of cutaneous conditions and cultural settings and has demonstrated robust psychometric properties, including validity, reliability and responsiveness to change.^3,4 Recent systematic reviews confirm its extensive use not only in randomized clinical trials but also in routine clinical practice, supporting its relevance in real world patient management.⁴

Aims: To evaluate the impact of CD on HRQoL using the DLQI in a real world outpatient population and to describe the distribution of HRQoL impairment according to validated score banding.

Methods

A cross sectional observational study was conducted in Allergology with adult patients (≥18 years), with suspected CD.

HRQoL was assessed using the DLQI, a self administered questionnaire consisting of 10 items assessing the impact of CD during the previous week on symptoms and feelings, daily activities, leisure, work or school, personal relationships and treatment. Each item is scored from 0 (“not at all”) to 3 (“very much”), yielding a total score ranging from 0 to 30. DLQI scores were interpreted using the validated banding system (Table 1).

Table 1.

Impact on the quality of life of patients with contact dermatitis.

DLQI score range	Interpretation of impact on quality of life	Number of patients (%)
0–1	No effect	9 (18%)
2–5	Small effect	32 (64%)
6–10	Moderate effect	6 (12%)
11–20	Large effect	3 (6%)
21–30	Extremely large effect	0 (0%)
Total		50 (100%)

Results

Fifty patients were included. The analysis of DLQI scores showed that the majority of patients experienced minimal impairment of HRQoL (82% of patients reported absent or mild HRQoL impairment). No patients presented DLQI scores above 20, indicating that no patient had extremely large impairment (Table 1).

Discussion

This study demonstrates that, in a routine outpatient dermatology setting, most patients with CD report low levels of HRQoL impairment. These findings are in line with recent real world evidence showing that DLQI scores obtained in routine clinical practice are often lower than those reported in tertiary referral cohorts.⁴

Nevertheless, almost one fifth of patients in the present cohort experienced moderate to large impairment of HRQoL. This subgroup deserves particular attention, as previous research has shown that symptoms such as persistent pruritus, visibility of lesions and the burden of long term treatment may significantly affect emotional well being, social functioning and work productivity, especially in patients with allergic CD.¹

The absence of extremely high DLQI scores in this cohort contrasts with reports from specialized CD units, where severe HRQoL impairment is more frequently observed.¹ Such differences may be explained by variability in disease severity, chronicity, allergen exposure and referral patterns.

Recent literature emphasizes the clinical relevance of DLQI thresholds, particularly scores ≥6, as indicators warranting reassessment of disease management and potential treatment escalation, regardless of objective disease extent.^2,4 The DLQI remains the benchmark instrument, allowing comparability across dermatological diseases and facilitating integration into routine workflows.⁵

In conclusion, in this study with DC, HRQoL impairment assessed using the DLQI was predominantly mild. However, a relevant minority of patients experienced moderate to large impairment, hence the importance of incorporating patient measures into routine dermatological assessment. Systematic use of the DLQI may help identify patients who could benefit from optimized management strategies.

Authorship

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  Clar Castello: designed the study, evaluated each of the patients, and enrolled them in the study.

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  Palacios Cañas: searched the bibliography to carry out the study and drafted the first manuscript.

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  Iniesta Tejera: created the Excel table detailing study characteristics and performed the descriptive statistics.

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  Gomez Torrijos: revised the draft, translated the manuscript into English, and submitted it for publication.

All authors have approved the publication of this manuscript.

Patient consent

We have obtained patients consent to publish this work.

Informed consent

All patients in the study have signed informed consent and given us written permission to participate in the study and for the publication of their anonymized data. We have also obtained permission from the Ethics Committee of the University General Hospital of Ciudad Real to conduct the study.

Declaration of generative AI and AI-assisted technologies in the writing process

We used AI to correct the English language of the manuscript.

Funding

This work has not been funded by anything or anyone.

Conflict of interest

Every one of the authors who have contributed to this work declares that they have no conflicts of interest.

Acknowledgment

To Fatima Gomez Leon for all her support.