Dermatology in-patient management greatly improves life quality

The aim of this study was to measure the effect of in-patient management on the quality of life of adult dermatology patients, and to identify the diagnostic categories which show the greatest improvement. Over a 6-month period, all 230 patients admitted to the dermatology ward of the University Hospital of Wales were invited to complete a Dermatology Life Quality Index (DLQI) questionnaire on admission, and again 4 weeks after discharge. Two hundred and seventeen (93%) of these patients entered the study, and 181 (83·4%) returned both questionnaires. The mean DLQI on admission was 13·2 (standard deviation [SD] 7·6; n= 181), and 4 weeks after discharge it was 7·7 (SD 6·8; P≤0·001). Seventy-three per cent of the 181 patients showed improvement. 5·5% remained unchanged, and 21·5% worsened. Patients with psoriasis improved from 13·7 (SD 6·5) to 6·7 (SD 5·6; n = 63; P ≤0·001), and those with eczema improved from 16·2 (SD 6·3) to 9·6 (SD 7·6; n = 56; P≤0·001). Patients with pruritus showed little improvement, as did those admitted for liver biopsy.

Patients with psoriasis and severe eczema showed, overall, a significant decrease in impairment of life quality following in-patient treatment. Severe eczema has a greater adverse impact on the quality of life than severe psoriasis. The parameters for which most improvement was seen were those which were of most concern to the patients, i.e. their symptoms (score after discharge = 1·2; SD 0·9; P≤0·001) and their embarrassment (0·9; SD 1·0; P≤0·001).