Treatment Modality as a Key Predictor of Quality of Life Impairment in Chronic Dermatological Diseases

Treatment Modality as a Key Predictor of Quality of Life Impairment in Chronic Dermatological Diseases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Treatment Modality as a Key Predictor of Quality of Life Impairment in Chronic Dermatological Diseases Gunjan Bhutani, Dr. Naveen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9604902/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Skin diseases, also known as dermatological diseases are among the most common chronic inflammatory and auto-immune diseases in the general population. Its ramifications are seen to have an impact on the individual’s occupational, financial, as well as personal life. The aim of the current study is to assess the impact of dermatological diseases on the quality of life of the patients, to identify and explore the various factors associated with it. This study includes a sample of 103 patients with Acne Vulgaris, Psoriasis, Eczema, Vitiligo, Urticaria, Rosacea and others. The final analysis was conducted on 91 patients. Participants filled the online version of the Dermatological Life Quality Index (DLQI) and Sociodemographic and medical datasheet. Descriptive as well as inferential statistics were applied to analyze the data using SPSS. Among all the skin diseases included in this study, the highest prevalence was of Vitiligo (40.78%) followed by Acne Vulgaris (18.45%), Psoriasis (16.50%), Eczema (12.62%) and others (11.65%) including Urticaria, Rosacea and others. The condition that had the most influence on patients’ Quality of Life burden was Eczema. Different treatment modalities were explored as Predictors of Quality of Life Impairment in Chronic Dermatological Diseases. The present study recommends that psychophysical and social support should be provided to help patients improve their functioning of daily activities, along with psycho educating them regarding their subjective aggravating factors and possibility of inflammations. Psychology Psychiatry Dermatology Quality of Life Skin diseases India Dermatology Psychosocial support Introduction Dermatological diseases, better known as the diseases of the skin, are among the most common auto-immune diseases in the general population. Its ramifications are seen to have an impact on the individual’s occupational, financial, as well as personal life. Historically, not much research has been conducted to understand the level of impact it has on the functioning of the patient. More recently, health psychology as a field has emerged quite significantly in terms of research and applied therapy as well, understanding the impacts of different diseases on the patient’s functioning and vice-versa. The biopsychosocial model of illness has made understanding the evolution and progression of various diseases easier and comprehensive. Hence, health psychology plays a pivotal role in understanding how chronic conditions like dermatological diseases affect a patient’s mental health and Quality of Life. Quality of life (QoL) is a person’s standing in their life in terms of their aims, beliefs and values. There are different factors that affect this quality of life. These factors generally include happiness, security and safety, work satisfaction, financial stability etc. A few commonly found dermatological diseases in the Indian population include: Eczema- It is a condition that is characterized by the skin becoming red, itchy, bumpy and dry. Dryness may also cause flaking of the skin. Most commonly, eczema results into swelling of the skin. It is seen to effect areas which involve folding of the skin such as the neck, elbows, back of the knees etc. Severe itch may also lead to lesions that may even bleed. Acne Vulgaris- The disease characterized by pimples, spots, whiteheads and blackheads. It’s first eruptions are usually seen on the face but may also extend to other parts of the body like arms, neck etc. Eruptions occur when the hair follicles in the skin are blocked and the overproduction of the normal skin oil called sebum. In most cases it is seen that after the acne has been treated, the skin still produces some acne scars which are not painful. Vitiligo- The condition in which the skin becomes patchy due to loss of skin’s pigment cells. White patches tend to develop on the skin because of the lack of pigment cells of melanin, which give the color to the skin. Like eczema, vitiligo also starts developing in the regions which have creases, like the mouth, neck, arms, face etc. Psoriasis- Psoriasis develops when the skin becomes bumpy, scaly and itchy due to a systemic inflammation of the skin. First seen on the knees, elbows and scalp of the individual, psoriasis not only targets the skin but also makes the joints weak. The skin color turns redish purple because of the inflammation. Not only physical effects like inflammation, rashes and lesions, these diseases tend to also have a social impact on the individuals. Social impacts include changing major life decisions because of their condition. These decisions may include- job, career, married life etc [ 1 ]. The conditions not only affect those who experience it, but it also impacts the caregivers like parents, spouse, children etc. A study was conducted to understand the effect of Psoriasis on the family functioning, where the findings reported a positive association was found in the patient’s disease severity and family members’ dermatology life quality index which indicated that higher the severity, more impaired is the quality of life [ 2 ]. Most of the research performed by the researches in the field of psychodermatology has been conducted in the West. There are very limited researches conducted in India. Considering the weather and seasonal conditions in India, there should be more studies carried out to understand the effect of dermatological auto immune diseases that can be exacerbated by the seasonal changes and hence, have a detrimental effect on the social, occupational, academic functioning of a person. Most of the researches show how such auto-immune have hampered the quality of life but there is not much study on the therapy formulated especially for psychodermatological patients. The purpose of this study is to understand the prevalence of dermatological diseases in Indian population, the factors associated with the diseases and the affect they have on the quality of life of the patient. Physical as well as psychological interventions shall be employed to provide relief in the experience of the skin disease. Psychoeducation of the patients is necessary to control major flare ups by explaining them how their body actually functions and what triggers do they have. Methodology Aim To quantify the differential burden of common chronic dermatological diseases on dermatological quality of life, estimating the odds of increased impairment severity across diagnoses Eczema, Psoriasis, Acne Vulgaris. Objective The main objectives of the current study were to: a. To establish the prevalence and distribution of the dermatological diagnoses in the study cohort. b. To investigate the epidemiological disparities by assessing the association between diagnosis and patient gender. c. To assess the association between diagnosis and occupational environment within the cohort. d. To assess the association between diagnosis and socioeconomic status within the cohort. e. To assess the association between diagnosis and age within the cohort. f. To assess if there is a significant difference in the quality of life burden across the diagnostic groups. g. To investigate the role of gender on the perceived quality of life burden between men and women. h. To determine if having a family history of a dermatological disease is associated with a significant difference in the dermatological quality of life scores. i. To assess if the type of treatment a patient receives is associated with a difference in the dermatological quality of life scores. j. To assess if there is a significant difference in the quality of life burden across the illness duration groups. k. To identify the predictors of dermatological quality of life by modeling the odds of increased quality-of-life impairment across diagnoses. Hypotheses a. There will be no statistically significant association between diagnosis and patient gender. b. There will be no statistically significant association between diagnosis and occupational Environment within the cohort. c. There will be no statistically significant association between diagnosis and socioeconomic Status within the cohort. d. There will be no statistically significant association between diagnosis and age groups. e. There will be no statistically significant difference in the quality of life burden across the diagnostic groups. f. There will be no statistically significant role of gender on the perceived quality of life burden between men and women. g. There will be no statistically significant difference in the dermatological quality of life scores among those who with and without a family history of dermatological disease. h. There will be no statistically significant difference in the dermatological quality of life scores with different types of treatment a patient receives. i. There will be no statistically significant difference in the quality of life burden across the illness duration groups. j. There will be no statistically significant predictors of dermatological quality of life by modeling the odds of increased quality-of-life impairment. Design The study is based on a correlational research design. The impact of the dermatological disease on the Quality of life was analyzed through the sociodemographic variables that are: Gender Age Duration of disease Occupational Environment Family history Treatment type Socioeconomic Status Participants and sampling Eligibility criteria included patients above 18 years old who had the ability to understand and communicate in English language. These participants were technically sound which made it possible for them to fill the questionnaires online. They were recruited through the use of social media. The sampling method used was purposive sampling. All subjects were fully informed and gave their informed consent before participating in the study. 110 participants filled the questionnaires of which 103 met the inclusion criteria. Inclusion criteria: a. Participant must be 18 years or older. b. Participant must have a diagnosed skin condition. c. Participant must have had experienced symptoms for at least a week. Tools The complete google form included a purpose designed datasheet form as well as the DLQI items. The google form assessed (a) socio-demographic characteristics (age, gender, occupational environment, duration of disease, family history of skin conditions, current treatment, diagnosis and education and occupation of the head of the family and total family income, and (b) data regarding skin conditions (diagnosis, DLQI), which was duly filled by the patients. Kuppuswamy’s Socioeconomic status scale 2022: This version of Kuppuswamy’s Socioeconomic status scale is widely used in Indian urban settings to categorize the socioeconomic status of an individual based on their education and occupation of the head of the family and the total family income. The total score ranges from 0 to 29. The lowest to highest socioeconomic status are Lower, Upper lower, Lower Middle, Upper Middle and Upper class respectively [3]. Dermatological Quality of Life Index (DLQI): It is the first dermatology-specific Quality of Life tool and is given by AY Finlay and GK Khan, in April 1992. It is a simple 10-item validated questionnaire that has been translated in over 90 languages and used in over 40 different skin conditions in over 80 countries. The tool is divided into six domains that are: symptoms and feelings, daily activities, leisure, working and schooling, personal relationships, and treatment. The total score ranges from 0 to 30 with the interpretation being that higher the score, the more Quality of Life of the patient is impaired [4]. For employing DLQI in this study, a prior written permission to avail the English version was obtained from the DLQI corresponding licensor through email. Procedure Firstly, an extensive research was conducted to select the most appropriate tool for assessing the Quality of Life in patients with dermatological concerns. Next, its permission was taken from the authors through the mail. After the permission to use the tool in an online form was granted, the next step was to add the necessary socio demographic characteristics within the tool selected (DLQI). Then, various dermatological support groups and organizations were approached through the social media. Purposive sampling was carried out and 200 dermatological patients were approached using support groups and NGOs. Out of the total, 110 patients filled the survey form. After the inclusion criteria were met by 103 participants, 91 of them had primary dermatological condition suggesting that statistical analysis was carried out on 91 of them and thereof the results were communicated. Statistical Analysis Clinical and Sociodemographic characteristics of patients and their QOL scores were explained using Descriptive statistics. Percentages and frequencies were used for the categorical variables, whereas means and standard deviations were calculated for the continuous variables. Following the descriptive analysis, the four most prevalent and clinically relevant diagnoses of: Vitiligo, Eczema, Psoriasis, and Acne Vulgaris were retained for all comparisons and modeling (Objectives b–k). This decision was made as these four conditions account for 88.35% of the total sample, and retaining the highly heterogeneous 'Other Diagnoses' group would introduce unacceptable heterogeneity and clinical non-specificity into the comparative statistical analyses. Hence, final analysis was conducted on 91 patients. As the data was not normally distributed, the association between sociodemographic variables and diagnoses was assessed using chi square test. The differences between patients’ sociodemographic characteristics and their QOL were then explained using MannWhitney and Kruskal–Wallis test. The standard Maximum Likelihood Estimation (MLE) for the final multivariate logistic regression model produced unstable estimates due to an occurrence of quasi-complete separation in the data. This issue was specifically seen with the “Topical steroids” variable. To address the data sparsity problem, the final model was executed using Firth's Bias-Reduced Penalized Likelihood Estimation. The effect size was explained using the categorization proposed by [5]. All analyses were performed using SPSS statistical software version 25. The significance level was set at p value<0.05. Results Disease Prevalence A total of 103 patients with mean age of 27.70 years (±10.35 years) were enrolled in this study. Most of the patients included in our study were women (63%). Majority of the patients were working in a combined form of outdoor and indoor environment (51.5%) and 48.54% patients belonged to the age group of 18-25. About 69.9% of the patients had their disease for more than 10 years. Most of patients (68.9%) did not have any family history of skin disease. Among total respondents, 38.8% were currently not on medication and were only applying creams. Among all the skin diseases included in this study, the highest prevalence was for vitiligo (40.78%) followed by Acne Vulgaris (18.45%), Psoriasis (16.5%), Eczema (12.62%) and others (11.65%) including urticaria, hyperpigmentation etc. Table 1 summarizes the patient and diagnostic characteristics of the current cohort. Epidemiological disparities in disease prevalence with respect to gender To investigate epidemiological disparities in disease prevalence with respect to gender, a Chi-Square test of independence was performed comparing the frequencies of the primary dermatological diagnoses that are Acne Vulgaris, Eczema, Psoriasis, and Vitiligo across patient gender. The analysis revealed a highly statistically significant association between the diagnosis and gender and a significant medium effect size as showed by Cramer’s V. This result also confirms that the distribution of these major skin conditions is not independent of gender in the cohort. The prevalence of Acne Vulgaris was disproportionately higher in women (30.9%) as compared to men (5.6%). While, Eczema also showed higher prevalence in women (18.2%), Psoriasis and Vitiligo were found to be more prevalent among men (27.8% and 58.3% respectively) as compared to women counterparts. This suggests that gender is a critical demographic factor influencing which dermatological conditions affect patients in this population. Table 2 explains the specific nature of this disparity. Disease prevalence across Occupational Environment The overall model of association between the dermatological diagnoses and the patient's Occupational Environment was not statistically significant, and the observed association was weak, as indicated by Cramer's V = 0.15. This explains that the distribution of the diagnoses does not depend on the patient's occupational environment or setting such as Indoor, Outdoor, Both, or Not Working, suggesting that the prevalence of these diseases could possibly be driven more by factors such as genetic predisposition or non-occupational lifestyle factors, rather than environmental exposure to the skin. Table 3 explains the association between diagnosis and occupation environment. Disease prevalence across Socioeconomic Status The model revealed no statistically significant association between the patient’s primary diagnosis and their socioeconomic status as p>0.05. The strength of the association was calculated to be small-to-moderate, as indicated by Cramer's V = 0.29. This non-significant finding suggests that the distribution of these four specific dermatological conditions is independent of the broad Socioeconomic categorization utilized in this sample. Table 4 shows disease prevalence as per socioeconomic status. Disease prevalence across Age groups The analysis showed a highly statistically significant association between primary diagnosis and age groups, p < 0.001. The strength of this relationship was large, as indicated by Cramer's V = 0.56, confirming that the prevalence of specific dermatological condition differs across the patient lifespan in this cohort. Table 5 shows disease association with age groups. Quality of life burden across the diagnostic groups Kruskal Wallis H test was conducted to test for dermatological life quality differences across diagnostic groups. The results indicated a highly significant difference in Dermatological Life Quality Index scores across the diagnostic categories, H (3, N = 91) = 16.01, p = 0.001. This outcome confirms that quality of life impairment is significantly heterogeneous across the four skin diseases. The large gap in mean ranks between Eczema and the other groups suggests that Eczema patients experience the most severe impairment in quality of life compared to the rest of the cohort. The post hoc Dunn's test was conducted for pairwise comparisons. The findings indicate that the Eczema group reported significantly worse DLQI scores than the Vitiligo group ( p = 0.001) and the Acne Vulgaris group ( p = 0.018). The results between Psoriasis and all other groups were not statistically significant suggesting that its quality of life impairment is statistically similar to that of Eczema and the lower-ranked conditions. Table 6 shows difference in Dermatological life Quality as per diagnoses. Role of Gender on the perceived Quality of Life burden Mann Whitney U test was conducted to understand if there is a significant gender difference across dermatological life quality index scores across the Men and Women. It was found that men had a Mean Rank of 45.49 while women had a Mean Rank of 46.34. Hence, there was no significant difference in the scores, thereby suggesting that the functional impairment is equal across the genders and no one gender is more vulnerable to functional disability as compared to the other. Role of Family history on the perceived Quality of Life burden Mann Whitney U test was conducted to test for differences in DLQI scores in those who reported a family history of a dermatological disorder and those who did not report a prior family history of a dermatological disease. While the difference was not statistically significant, patients who reported a family history ("Yes") had a slightly higher mean rank (50.12) and patients who reported no family history ("No") had a slightly lower mean rank (43.98). Since a higher mean rank indicates greater quality-of-life impairment, this descriptive pattern suggests that patients with a family history of the condition tend to report a slightly higher, but not statistically verifiable, psychosocial burden. Differences in Dermatological Life Quality Index Scores among different treatment types For the analysis of this, the treatments were divided into 4 categories being: Only creams, Topical Steroids, Systemics and Alternatives. Kruskal Wallis was performed and results indicated a statistically significant difference in DLQI scores across the four treatment categories, H (3, N = 91) = 11.01, p = .012. The mean ranks indicated that the Topical steroids group reported the greatest psychosocial burden (Mean Rank = 76.75), significantly higher than the Only creams group (Mean Rank = 40.51). Dunn’s post-hoc test, with a Bonferroni correction, confirmed that the only statistically significant pairwise difference was found between the Topic steroids group and the Only creams group. This finding suggests that patients who only require minimal treatment report the lowest burden, while those engaged in topical regimens experience a significantly elevated DLQI impairment. Differences in Dermatological Life Quality Index Scores among different illness duration groups A Kruskal-Wallis H test was conducted to determine if Dermatological Quality of Life Index (DLQI) scores differed significantly across the five categories of illness duration. The overall model was not statistically significant , H (4, N = 91) = 2.76, p = .599. This indicates that the duration of the dermatological condition, as defined in categories (0–2 years, 2–5 years, 5–7 years, 7–10 years, and 10+ years), does not have a measurable impact on the patients' psychosocial and functional burden. However, the shortest duration group (5–7 years) showed the lowest descriptive mean rank (35.30), the lack of statistical significance suggests that these variations in quality of life are not large enough to be considered a true difference based on how long a patient has lived with the condition. Predictors of dermatological quality of life A Firth Logistic Regression was conducted to identify predictors of elevated dermatological quality of life (DLQI) impairment which was defined as a binary outcome based on the DLQI score (cutoff was a score of 6 and above for DLQI impairment). This method was necessary due to an occurrence of quasi-complete separation observed with the Topical Steroids variable. The final model included gender, occupational environment, socioeconomic status, and treatment type as predictors. The analysis indicated that most sociodemographic factors were not significant predictors of DLQI impact: Gender (Reference Group: Men): In our cohort, women did not show a statistically significant difference in the odds of experiencing DLQI impairment ( p = 0.50). Occupational Environment (Reference Group: Not working): The environment in which a patient worked was not a significant predictor of DLQI impairment. None of the environments Indoor only (OR = 0.84, p = 0.81), Outdoor only (OR = 1.82, p = 0.52), nor Indoor and outdoor both (OR = 0.61, p = 0.47) demonstrated significantly different odds of high DLQI burden compared to patients who were not working. Socioeconomic Status (Reference Group: Lower): The socioeconomic status of a patient was not a significant predictor of DLQI impairment. None of the groups Upper Lower (OR = 0.87, p = 0.89), Lower Middle (OR = 0.70, p = 0.71), and Upper Middle (OR = 1.06, p = 0.94) demonstrated significantly different odds of high DLQI burden as compared to those in the Lower SES group. Treatment Type demonstrated a significant association with the odds of DLQI impairment (Reference Group: Only Creams ). Two categories were found to be statistically significant: Topical Steroids: Patients currently using topical steroids showed significantly higher odds of experiencing DLQI impairment compared to the group using only non-steroid creams (B = 2.54, Wald Z = 1.72, p = 0.03 ). The estimated odds ratio was substantial, suggesting that these patients are 12.68 times more likely to report a high DLQI burden (95% CI: 1.22–1722.36). Alternatives: Patients using alternative treatments also indicated significantly higher odds of DLQI impairment compared to the only creams group (B = 1.24, Wald Z = 1.89, p = 0.03 ). These patients had 3.48 times the odds of high DLQI burden (95% CI: 1.11–12.71). However, patients currently on systemic treatments did not show a statistically significant difference in DLQI impairment compared to the "Only Creams" reference group (OR = 1.78, p = 0.38). Table 11 shows the predictors of DLQI impairment Discussion Dermatological conditions have seen to significantly impair the functioning of patients as the conditions exert debilitating effects on the emotional, occupational and social functioning of the patients. Several studies are being conducted across the globe to find preventive and intervention factors that can ease the experience of a skin condition, particularly in those countries where weather conditions are extreme throughout the year. India has a seasonal pattern of longer summers and shorter winters with majority of the states experiencing very harsh summers where the temperature goes above 52 degrees Celsius or 125 Fahrenheit. Therefore it is important to study the cultural and physical impact of these diseases. An important aspect was that even though skin diseases do not contribute significantly to the years of life lost and disability-adjusted life years due to skin diseases are less, their impact on disability or years lived with disability is more significant [ 6 ]. The central objective of the current study was to assess current epidemiological trends and the factors contributing to the patients’ burden of chronic dermatological diseases, a critical area within public health. The findings challenge several notions about health disparities, instead highlighting the often underestimated role of treatment modality in Quality of life burden. Epidemiological Trends and Diagnostic Disparities The initial phase of the study provided a demographic view of the cohort, showing the high prevalence of Vitiligo (40.78%), Acne Vulgaris (18.45%), Psoriasis (16.5%), and Eczema (12.62%). This distribution itself is a critical epidemiological finding, suggesting that conditions with high psycho-social impact such as Vitiligo and Acne Vulgaris dominate, beside chronic inflammatory conditions such as Psoriasis and Eczema. Diagnostic Vulnerability and Health Disparities The investigation into sociodemographic associations revealed specific vulnerabilities within the patient population: Gender and Diagnosis We rejected the null hypothesis that there is no association between gender and diagnosis. The results indicate a meaningful relationship, likely reflecting the higher prevalence of certain conditions in female patients within this cohort. This finding underscores the need for gender-specific epidemiological modeling and clinical resource allocation, particularly in young adult populations where women have a significant majority, as seen in the descriptive results (60.44% female). This result is supported by a study conducted that showed 2.5 times higher prevalence of acne vulgaris in adult women as compared to men [ 7 ]. Occupation environment and Diagnosis : There was no significant association between diagnosis and occupational environment within the cohort, hence the null hypothesis was accepted. Thus, dermatological diseases are independent of the patient’s occupational environment. This suggests that the distribution of these diseases is not being significantly skewed by exposure factors related to the workplace among the patients. However, occupational dermatoses are an important part of dermatology but these certainly include contact dermatitis and certain bacterial and viral infections [ 8 ]. Thus, presenting provide contradictory evidence to our finding. Age and Diagnosis We rejected the null hypothesis as a significant association was found between age group and diagnosis. The association between dermatological diagnoses and age groups was highly significant reflecting an established important epidemiological trend, where diagnoses like Acne Vulgaris cluster in younger age groups (18–25 years, representing 48.54% of the cohort), while other conditions may become more prevalent in older cohorts. This outcome shows the urgent need of public health strategies that are specifically for the early detection and prevention efforts to specific age-diagnostic profiles. Another study explained that as individuals reach puberty, their chances of being diagnosed with atopic dermatitis which is a form of eczema, increases significantly [ 9 ]. However, in the later years, atopic dermatitis seems to be less prevalent. One important study shows the average age of vitiligo patients being between 40–50 years [ 10 ]. Socioeconomic Status and Diagnosis We failed to reject the null hypothesis for the association between diagnosis and Occupational Environment and Socioeconomic Status. This finding suggests that the distribution of these four dermatological diagnoses is largely independent of socioeconomic class the patient belongs to. This is an important finding for health equity as it emphasizes that patients across different SES levels are equally vulnerable to developing these chronic skin conditions and that no particular strata of patients is at a higher risk of developing them. An epidemiological study on skin disorders was performed and it was found that most of the conditions were prevalent across lower and middle class groups; however the study did not test for significant differences in this case [ 11 ]. DLQI across Diagnoses We rejected the null hypothesis of no difference in DLQI scores across the four diagnostic groups. This states that the average QOL burden is not uniform and that specific diagnoses inherently have a greater impairment than others. This finding is essential in prioritizing and allocating resources in healthcare systems, signaling that clinical pathways must move beyond simple diagnostic codes to incorporate patient-reported burden. Among all the diseases, eczema was found to deteriorate the life quality the most. A researchstudy on dermatological severity was conducted on Saudi Arabic dermatological patients. Results reported that the effect of atopic dermatitis(eczema) was the most severe on quality of life in the group[ 12 ]. Moreover, A colombian study reported that patients with psoriasis, urticaria, atopic dermatitis had the worst quality of life and daily functioning as compared to other skin diseases [ 13 ]. An Indian study assessed quality of life of patients having a diagnosis of vitiligo. They found that 44% of the patients had mild effect on their quality of life and 46% patients had a moderate effect. [ 14 ]. Gender and DLQI We failed to reject the null hypothesis of no difference in DLQI scores between genders. Despite the significant gender disparity in diagnostic prevalence as we quoted, the severity of the impact on DLQI, appears to be equalized between men and women after the diagnosis of the patient is established. This challenges traditional findings about women reporting higher psychological distress, indicating that the clinical visibility and severity of skin disease generate a high burden irrespective the gender. Along the same findings, a study assessed sex differences in dermatological quality of life of psoriasis patients and found that on the baseline visit, men and women had no significant differences in their total DLQI indicating equal burden of psoriasis on overall functioning across the genders [ 15 ]. An Indian study on Acne vulgaris patients also showed no significant differences in the quality of life scores of men and women samples [ 16 ]. Family History and DLQI We failed to reject the null hypothesis in DLQI scores of those who had and those who did not have a family history of a dermatological disorder. This shows that functional impairment of a patient with dermatological disorder is equal across patients that report a prior family history of a skin condition and patients who report not having a family history of the same. On the contrary, a study assessed the family dermatological quality of life index of vitiligo patients in India and reported that 13% of the participants reported a positive family history of vitiligo and they had a slightly more impaired quality of life as compared to those who did not report a family history [ 17 ]. Illness Duration and DLQI The failure to reject the null hypothesis for and illness duration is significant. This implies that the duration of adapting the disease mitigates the daily QOL impact. The burden remains constant regardless of the patient’s long term or short term experience with the condition. A study was conducted on 551 Psoriasis patients and to assess their DLQI. It was found that patients with illness duration of more than 10 years showed a higher DLQI score as compared to lesser durations [ 18 ]. Treatment Modality and DLQI The most clinically and public health-relevant findings emerged from the analysis of treatment type, which resulted in the rejection of the null hypothesis for both models. Topical Steroid The Odds Ratio of 12.68 for topical steroid use is very high. This finding explains that patients requiring topical steroids invariably have severe disease. However, the finding also addresses the burden of treatment such as the physical and psychological demands of such topical regimens. This complex regimen often involve daily application, staining, greasing of skin due to the topical and fear of side effects. All of these contribute to the medical compliance fatigue and distress inturn increasing the burden beyond the disease itself. Alternative Treatment Seeking The Odds Ratio of 3.48 for alternative treatment such as Homeopathy and Ayurveda suggests these patients face severe functional impairment. When a patient shifts to non-conventional treatments, it is often an indicator of treatment dissatisfaction and refractory disease indicating the patient’s last effort after exhausting all of their standard medical options. This finding signals a major rift in health system capacity to effectively manage chronic inflammatory cases for different people from different socioeconomic backgrounds. The key public health implications derived from these findings include: Given the findings across key sociodemographics, Quality of Life screening across dermatological settings should be mandatory and universal, not restricted to perceived "high-risk" groups, to assess the nature of the psychosocial burden on the patient. Health systems and patient care models must actively work on mitigating the burden of treatments such as topical steroids. It must be ensured that medical professionals simply the treatments and conduct psychoeducation of patients regarding their triggers and side effects, that will ultimately help them manage their condition effectively. Patients seeking alternative treatment options represent a highly vulnerable, high-burden group. Health policies must ensure timely access to specialist care, novel treatments, and increased specialty clinics such as for Eczema and Psoriasis. Public health initiatives must recognize the burden of treatment adherence as a crucial factor. Limitation The study limits the generalizability of conclusions as the sample size of the study is considerably small for all four skin diseases. Future studies could employ a larger sample and explore the level of awareness patients have regarding their skin being able to develop infections and its relationship with quality of life. Conclusion This study presented that dermatological diseases significantly lead to functional impairment of the affected patient. For our population, symptoms/feelings and daily activities were the most affected where individuals have difficulty performing activities of daily living and have worse feelings which may lead to additional problems like anxiety, depression etc. Moreover, eczema was found to be the most significant contributor to the burden in patients’ quality of life followed by psoriasis, acne vulgaris and vitiligo. Lastly, significant predictors of quality of life were the use of topical steroids and alternative therapies. The current study recommended that not only physical but psychological support as well, should be given to help patients improve their daily lives along with psychoeducating them regarding aggravating factors and awareness of possible skin infections. Declarations We confirm that this manuscript is original, has not been published previously, and is not under consideration for publication elsewhere. Ethical consideration: All necessary ethical guidelines were followed and consents were taken from the participants. Clinical Trial: Not Applicable Conflicts of Interest: We confirm that there are no conflicts of interest related to the authorship or publication of this article. Funding: We received no financial support for this work. Data Availability Statement: The datasets generated and analyzed during the current study are not publicly available due to confidentiality and privacy issues but are available from the corresponding author Gunjan Bhutani ( [email protected] ) at a reasonable request. Ethics Statement: The data collection was conducted in 2022 and the protocol was reviewed and approved by the Faculty for the Master’s thesis. Formal ethical oversight was provided by the Amity Institute of Psychology and Allied Sciences (AIPS), Amity University, Noida ensuring standards of institution and Declaration of Helsinki. Informed Consent was obtained electronically from all the participants prior to data collection and the data was anonymized to maintain confidentiality. References Bhatti ZU, Salek MS, Finlay AY. Chronic diseases influence major life changing decisions: a new domain in quality of life research. J R Soc Med . 2011; 104 :241–50. Eghlileb AM, Basra MK, Finlay AY. The psoriasis family index: preliminary results of validation of a quality of life instrument for family members of patients with psoriasis. Dermatology (Basel) . 2009; 219 (1):63–70. doi: 10.1159/000209234. Sood P, Bindra S. Modified Kuppuswamy socioeconomic scale: 2022 update of India. Int J Community Med Public Health . 2022; 9 :3841-4. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clin Exp Dermatol . 1994; 19 (3):210–6. doi: 10.1111/j.1365-2230.1994.tb01167.x. Cohen J. Statistical Power Analysis for the Behavioral Sciences . 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers; 1988. Murray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. Bull World Health Organ . 1994; 72 (3):429–45. Chang J, Nock MR, Cohen JM, Bunick CG. Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States: A study of the national ambulatory medical care survey from 2002-2016. PLoS One . 2023; 18 (9):e0290763. doi: 10.1371/journal.pone.0290763. Srinivas CR, Sethy M. Occupational Dermatoses. Indian Dermatol Online J . 2022; 14 (1):21–31. doi: 10.4103/idoj.idoj_332_22. Kanwar AJ. Adult-onset Atopic Dermatitis. Indian J Dermatol . 2016; 61 (6):662–3. doi: 10.4103/0019-5154.193679. Mohr N, Petersen J, Kirsten N, Augustin M. Epidemiology of Vitiligo - A Dual Population-Based Approach. Clin Epidemiol . 2021; 13 :373–82. doi: 10.2147/CLEP.S304155. Kumar TP, Shivani S. Epidemiological study of various skin diseases and prescription pattern of drugs in dermatological OPD in Khammam Region. Indian J Pharm Pract . 2020; 13 (1):42–9. Alhoqail I. Impairment of quality of life among adults with skin disease in King Fahad Medical City, Saudi Arabia. J Fam Community Med . 2009; 16 :105-9. Sanclemente C, Burgos J, Nova F, Hernández C, González MI, Reyes N, et al. The impact of skin diseases on quality of life: A multicenter study. Actas Dermosifiliogr (Engl Ed) . 2017; 108 (3):244-52. Bhuptani NV, Parmar PJ, Selot NK, Patel BK. Quality of life in patients with vitiligo. Int J Res Dermatol . 2020; 6 (3):388–91. doi: 10.18203/issn.2455-4529.IntJResDermatol20201586. Jensen MB, Loft N, Zacheriae C, Skov L. Sex Differences in Dermatology Life Quality Index (DLQI) among Patients with Psoriasis. Acta Derm Venereol . 2024; 104 :adv42441. doi: 10.2340/actadv.v104.42441. Kanagala Chowdary N, Prabhu SS, Shenoi SD, Nayak SU. Quality of life in acne patients: A clinical and Dermatology Life Quality Index (DLQI) based cross-sectional study. J Pak Assoc Dermatol . 2018; 28 (4):415–9. Saxena A, Dey VK, Chaudhary N, Shrivastava P, Sharma S. Impact on quality of life in family members of patients suffering from vitiligo. IP Indian J Clin Exp Dermatol . 2020; 6 (1):5-9. doi: 10.18231/j.ijced.2020.002. Ma X, Xu Q, Kuai L, Shen F, Duan Z, Gao X, et al. Beyond Skin Clearance: Personalized Strategies for DLQI Improvement in Psoriasis -Insights From a Shanghai Prospective Cohort. Psoriasis (Auckl) . 2025; 15 :373–87. doi: 10.2147/PTT.S534881. Tables Tables 1 to 11 are available in the supplementary files section Additional Declarations The authors declare no competing interests. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9604902","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633899016,"identity":"b4295940-5931-4e5a-a521-60f1014b9601","order_by":0,"name":"Gunjan Bhutani","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9ElEQVRIiWNgGAWjYJACAyBOMIAwbaAMBglitDCDmGnEaWFAaGE4DNOCG8hH5B4o+LmDIc9cIv/g54KC80BGAuOHHwwWebi0GN7ISzDsPcNQbDkjmVl6hsFtICOBWbKHQaIYp5YZOQYGvG0MiRtuJDNI8xjcBjISGKSBfklswKPF8C9EC/NvHoNzIC3Mv/FpkZfIMTCG2sIGtOUASAsbXlsMeN4YGMu2SRQbnHlsZs1jkAxkPGyz7DHAY0t7jpnh2zabPIPjiY9v8/yxAzKSD9/4UVGH25YDDGwGaBHH2ACJXly2NDAwP8AtPQpGwSgYBaMACADanFRy2EEP5wAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0001-5008-9339","institution":"Banaras Hindu University","correspondingAuthor":true,"prefix":"","firstName":"Gunjan","middleName":"","lastName":"Bhutani","suffix":""},{"id":633900965,"identity":"05684b8d-c1db-4d17-8e65-1b6c244d4542","order_by":1,"name":"Dr. Naveen","email":"","orcid":"https://orcid.org/0000-0001-9558-9396","institution":"Banaras Hindu University","correspondingAuthor":false,"prefix":"Dr.","firstName":"","middleName":"","lastName":"Naveen","suffix":""}],"badges":[],"createdAt":"2026-05-04 06:52:23","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9604902/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9604902/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108806525,"identity":"fa99cdf1-c2c4-43d6-8e86-d173a986f7dc","added_by":"auto","created_at":"2026-05-08 15:28:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":274078,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9604902/v1/5284d5cf-cec1-4b1e-af28-cb0432cf5f67.pdf"},{"id":108674011,"identity":"883d26db-b537-4fe4-98a2-2b476f3fab25","added_by":"auto","created_at":"2026-05-07 08:13:03","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":43693,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-9604902/v1/15419dfb98a0471b89afc8bf.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eTreatment Modality as a Key Predictor of Quality of Life Impairment in Chronic Dermatological Diseases\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDermatological diseases, better known as the diseases of the skin, are among the most common auto-immune diseases in the general population. Its ramifications are seen to have an impact on the individual\u0026rsquo;s occupational, financial, as well as personal life. Historically, not much research has been conducted to understand the level of impact it has on the functioning of the patient. More recently, health psychology as a field has emerged quite significantly in terms of research and applied therapy as well, understanding the impacts of different diseases on the patient\u0026rsquo;s functioning and vice-versa. The biopsychosocial model of illness has made understanding the evolution and progression of various diseases easier and comprehensive. Hence, health psychology plays a pivotal role in understanding how chronic conditions like dermatological diseases affect a patient\u0026rsquo;s mental health and Quality of Life.\u003c/p\u003e \u003cp\u003eQuality of life (QoL) is a person\u0026rsquo;s standing in their life in terms of their aims, beliefs and values. There are different factors that affect this quality of life. These factors generally include happiness, security and safety, work satisfaction, financial stability etc.\u003c/p\u003e \u003cp\u003eA few commonly found dermatological diseases in the Indian population include:\u003c/p\u003e \u003cp\u003eEczema- It is a condition that is characterized by the skin becoming red, itchy, bumpy and dry. Dryness may also cause flaking of the skin. Most commonly, eczema results into swelling of the skin. It is seen to effect areas which involve folding of the skin such as the neck, elbows, back of the knees etc. Severe itch may also lead to lesions that may even bleed.\u003c/p\u003e \u003cp\u003eAcne Vulgaris- The disease characterized by pimples, spots, whiteheads and blackheads. It\u0026rsquo;s first eruptions are usually seen on the face but may also extend to other parts of the body like arms, neck etc. Eruptions occur when the hair follicles in the skin are blocked and the overproduction of the normal skin oil called sebum. In most cases it is seen that after the acne has been treated, the skin still produces some acne scars which are not painful.\u003c/p\u003e \u003cp\u003eVitiligo- The condition in which the skin becomes patchy due to loss of skin\u0026rsquo;s pigment cells. White patches tend to develop on the skin because of the lack of pigment cells of melanin, which give the color to the skin. Like eczema, vitiligo also starts developing in the regions which have creases, like the mouth, neck, arms, face etc.\u003c/p\u003e \u003cp\u003ePsoriasis- Psoriasis develops when the skin becomes bumpy, scaly and itchy due to a systemic inflammation of the skin. First seen on the knees, elbows and scalp of the individual, psoriasis not only targets the skin but also makes the joints weak. The skin color turns redish purple because of the inflammation.\u003c/p\u003e \u003cp\u003eNot only physical effects like inflammation, rashes and lesions, these diseases tend to also have a social impact on the individuals. Social impacts include changing major life decisions because of their condition. These decisions may include- job, career, married life etc [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The conditions not only affect those who experience it, but it also impacts the caregivers like parents, spouse, children etc. A study was conducted to understand the effect of Psoriasis on the family functioning, where the findings reported a positive association was found in the patient\u0026rsquo;s disease severity and family members\u0026rsquo; dermatology life quality index which indicated that higher the severity, more impaired is the quality of life [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost of the research performed by the researches in the field of psychodermatology has been conducted in the West. There are very limited researches conducted in India. Considering the weather and seasonal conditions in India, there should be more studies carried out to understand the effect of dermatological auto immune diseases that can be exacerbated by the seasonal changes and hence, have a detrimental effect on the social, occupational, academic functioning of a person. Most of the researches show how such auto-immune have hampered the quality of life but there is not much study on the therapy formulated especially for psychodermatological patients.\u003c/p\u003e \u003cp\u003eThe purpose of this study is to understand the prevalence of dermatological diseases in Indian population, the factors associated with the diseases and the affect they have on the quality of life of the patient. Physical as well as psychological interventions shall be employed to provide relief in the experience of the skin disease. Psychoeducation of the patients is necessary to control major flare ups by explaining them how their body actually functions and what triggers do they have.\u003c/p\u003e"},{"header":"Methodology","content":"\u003cp\u003e\u003cem\u003eAim\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo quantify the differential burden of common chronic dermatological diseases on dermatological quality of life, estimating the odds of increased impairment severity across diagnoses Eczema, Psoriasis, Acne Vulgaris.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eObjective\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe main objectives of the current study were to:\u003c/p\u003e\n\u003cp\u003ea.\u0026nbsp;\u0026nbsp;To establish the prevalence and distribution of the dermatological diagnoses in the study cohort.\u003c/p\u003e\n\u003cp\u003eb.\u0026nbsp;\u0026nbsp;To investigate the epidemiological disparities by assessing the association between diagnosis and patient gender.\u003c/p\u003e\n\u003cp\u003ec.\u0026nbsp;\u0026nbsp;To assess the association between diagnosis and occupational environment within the cohort.\u003c/p\u003e\n\u003cp\u003ed.\u0026nbsp;\u0026nbsp;To assess the association between diagnosis and socioeconomic status within the cohort.\u003c/p\u003e\n\u003cp\u003ee.\u0026nbsp;\u0026nbsp;To assess the association between diagnosis and age\u0026nbsp;within the cohort.\u003c/p\u003e\n\u003cp\u003ef.\u0026nbsp; \u0026nbsp;To assess if there is a significant difference in the quality of life burden across the diagnostic groups.\u003c/p\u003e\n\u003cp\u003eg.\u0026nbsp;\u0026nbsp;To investigate the role of gender on the perceived quality of life burden between men and women.\u003c/p\u003e\n\u003cp\u003eh.\u0026nbsp;\u0026nbsp;To determine if having a family history of a dermatological disease is associated with a significant difference in the dermatological quality of life scores.\u003c/p\u003e\n\u003cp\u003ei.\u0026nbsp; \u0026nbsp;To assess if the type of treatment a patient receives is associated with a difference in the dermatological quality of life scores.\u003c/p\u003e\n\u003cp\u003ej.\u0026nbsp; \u0026nbsp;To assess if there is a significant difference in the quality of life burden across the illness duration groups.\u003c/p\u003e\n\u003cp\u003ek.\u0026nbsp;\u0026nbsp;To identify the predictors of dermatological quality of life by modeling the odds of increased quality-of-life impairment across diagnoses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eHypotheses\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003ea.\u0026nbsp;\u0026nbsp;There will be no statistically significant\u0026nbsp;association between diagnosis and patient gender.\u003c/p\u003e\n\u003cp\u003eb.\u0026nbsp;\u0026nbsp;There will be no statistically significant\u0026nbsp;association between diagnosis and occupational Environment within the cohort.\u003c/p\u003e\n\u003cp\u003ec.\u0026nbsp;\u0026nbsp;There will be no statistically significant\u0026nbsp;association between diagnosis and socioeconomic Status within the cohort.\u003c/p\u003e\n\u003cp\u003ed.\u0026nbsp;\u0026nbsp;There will be no statistically significant\u0026nbsp;association between diagnosis and age groups.\u003c/p\u003e\n\u003cp\u003ee.\u0026nbsp;\u0026nbsp;There will be no statistically significant difference in the quality of life burden across the diagnostic groups.\u003c/p\u003e\n\u003cp\u003ef.\u0026nbsp; \u0026nbsp;There will be no statistically significant role of gender on the perceived quality of life burden between men and women.\u003c/p\u003e\n\u003cp\u003eg.\u0026nbsp;\u0026nbsp;There will be no statistically significant difference\u0026nbsp;in the dermatological quality of life scores among those who with and without a family history of dermatological disease.\u003c/p\u003e\n\u003cp\u003eh.\u0026nbsp;\u0026nbsp;There will be no statistically significant difference\u0026nbsp;in the dermatological quality of life scores with different types of treatment a patient receives.\u003c/p\u003e\n\u003cp\u003ei.\u0026nbsp; \u0026nbsp;There will be no statistically significant difference in the quality of life burden across the illness duration groups.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ej.\u0026nbsp; \u0026nbsp;\u003c/em\u003eThere will be no statistically significant predictors of dermatological quality of life by modeling the odds of increased quality-of-life impairment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDesign\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe study is based on a correlational research design. The impact of the dermatological disease on the Quality of life was analyzed through the sociodemographic variables that are:\u003c/p\u003e\n\u003cp\u003eGender\u003c/p\u003e\n\u003cp\u003eAge\u003c/p\u003e\n\u003cp\u003eDuration of disease\u003c/p\u003e\n\u003cp\u003eOccupational Environment\u003c/p\u003e\n\u003cp\u003eFamily history\u003c/p\u003e\n\u003cp\u003eTreatment type\u003c/p\u003e\n\u003cp\u003eSocioeconomic Status\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eParticipants and sampling\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eEligibility criteria included patients above 18 years old who had the ability to understand and communicate in English language. These participants were technically sound which made it possible for them to fill the questionnaires online. \u0026nbsp;They were recruited through the use of social media. The sampling method used was purposive sampling. All subjects were fully informed and gave their informed consent before participating in the study. 110 participants filled the questionnaires of which 103 met the inclusion criteria.\u003c/p\u003e\n\u003cp\u003eInclusion criteria:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ea.\u0026nbsp;\u0026nbsp;Participant must be 18 years or older.\u003c/p\u003e\n\u003cp\u003eb.\u0026nbsp;\u0026nbsp;Participant must have a diagnosed skin condition.\u003c/p\u003e\n\u003cp\u003ec.\u0026nbsp;\u0026nbsp;Participant must have had experienced symptoms for at least a week.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eTools\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe complete google form included a purpose designed datasheet form as well as the DLQI items. The google form assessed (a) socio-demographic characteristics (age, gender, occupational environment, duration of disease, family history of skin conditions, current treatment, diagnosis and education and occupation of the head of the family and total family income, and (b) data regarding skin conditions (diagnosis, DLQI), which was duly filled by the patients.\u003c/p\u003e\n\u003cp\u003eKuppuswamy’s Socioeconomic status scale 2022: This version of Kuppuswamy’s Socioeconomic status scale is widely used in Indian urban settings to categorize the socioeconomic status of an individual based on their education and occupation of the head of the family and the total family income. The total score ranges from 0 to 29. The lowest to highest socioeconomic status are Lower, Upper lower, Lower Middle, Upper Middle and Upper class respectively [3].\u003c/p\u003e\n\u003cp\u003eDermatological Quality of Life Index (DLQI):\u0026nbsp;It is the first dermatology-specific Quality of Life tool and is given by AY Finlay and GK Khan, in April 1992. \u0026nbsp;It is a simple 10-item validated questionnaire that has been translated in over 90 languages and used in over 40 different skin conditions in over 80 countries. The tool is divided into six domains that are: symptoms and feelings, daily activities, leisure, working and schooling, personal relationships, and treatment. The total score ranges from 0 to 30 with the interpretation being that higher the score, the more Quality of Life of the patient is impaired [4]. For employing DLQI in this study, a prior written permission to avail the English version was obtained from the DLQI corresponding licensor through email.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eProcedure\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFirstly, an extensive research was conducted to select the most appropriate tool for assessing the Quality of Life in patients with dermatological concerns. Next, its permission was taken from the authors through the mail. After the permission to use the tool in an online form was granted, the next step was to add the necessary socio demographic characteristics within the tool selected (DLQI).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThen, various dermatological support groups and organizations were approached through the social media. Purposive sampling was carried out and 200 dermatological patients were approached using support groups and NGOs. Out of the total, 110 patients filled the survey form. After the inclusion criteria were met by 103 participants, 91 of them had primary dermatological condition suggesting that statistical analysis was carried out on 91 of them and thereof the results were communicated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eStatistical Analysis\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eClinical and Sociodemographic characteristics of patients and their QOL scores were explained using Descriptive statistics. Percentages and frequencies were used for the categorical variables, whereas means and standard deviations were calculated for the continuous variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFollowing the descriptive analysis, the four most prevalent and clinically relevant diagnoses of: Vitiligo, Eczema, Psoriasis, and Acne Vulgaris were retained for all comparisons and modeling (Objectives b–k). This decision was made as \u0026nbsp;these four conditions account for 88.35% of the total sample, and retaining the highly heterogeneous 'Other Diagnoses' group would introduce unacceptable heterogeneity and clinical non-specificity into the comparative statistical analyses. Hence, final analysis was conducted on 91 patients.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAs the data was not normally distributed, the association between sociodemographic variables and diagnoses was assessed using chi square test. The differences between patients’ sociodemographic characteristics and their QOL were then explained using MannWhitney and Kruskal–Wallis test. The standard Maximum Likelihood Estimation (MLE) for the final multivariate logistic regression model produced unstable estimates due to an occurrence of quasi-complete separation in the data. This issue was specifically seen with the “Topical steroids” variable. To address the data sparsity problem, the final model was executed using Firth's Bias-Reduced Penalized Likelihood Estimation. The effect size was explained using the categorization proposed by [5]. \u0026nbsp;All analyses were performed using SPSS statistical software version 25. The significance level was set at p value\u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cem\u003eDisease Prevalence\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA total of 103 patients with mean age of 27.70 years (\u0026plusmn;10.35 years) were enrolled in this study. Most of the patients included in our study were women (63%). Majority of the patients were working in a combined form of outdoor and indoor environment (51.5%) and 48.54% patients belonged to the age group of 18-25.\u003c/p\u003e\n\u003cp\u003eAbout 69.9% of the patients had their disease for more than 10 years. Most of patients (68.9%) did not have any family history of skin disease. Among total respondents, 38.8% were currently not on medication and were only applying creams.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong all the skin diseases included in this study, the highest prevalence was for vitiligo (40.78%) followed by Acne Vulgaris (18.45%), Psoriasis (16.5%), Eczema (12.62%) and others (11.65%) including urticaria, hyperpigmentation etc. Table 1 summarizes the patient and diagnostic characteristics of the current cohort.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eEpidemiological disparities\u003c/em\u003e\u003cem\u003e\u0026nbsp;in disease prevalence with respect to gender\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTo investigate epidemiological disparities in disease prevalence with respect to gender, a Chi-Square test of independence was performed comparing the frequencies of the primary dermatological diagnoses that are Acne Vulgaris, Eczema, Psoriasis, and Vitiligo across patient gender. The analysis revealed a highly statistically significant association between the diagnosis and gender and a significant medium effect size as showed by Cramer\u0026rsquo;s V. This result also confirms that the distribution of these major skin conditions is not independent of gender in the cohort.\u003c/p\u003e\n\u003cp\u003eThe prevalence of Acne Vulgaris was disproportionately higher in women (30.9%) as compared to men (5.6%). \u0026nbsp;While, Eczema also showed higher prevalence in women (18.2%), Psoriasis and Vitiligo were found to be more prevalent among men (27.8% and 58.3% respectively) as compared to women counterparts. This suggests that gender is a critical demographic factor influencing which dermatological conditions affect patients in this population. Table 2 explains the specific nature of this disparity.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisease prevalence across Occupational Environment\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe overall model of association between the dermatological diagnoses and the patient\u0026apos;s Occupational Environment was not statistically significant, and the\u003cstrong\u003e\u0026nbsp;observed association was weak, as indicated by Cramer\u0026apos;s\u0026nbsp;\u003c/strong\u003eV = 0.15. \u0026nbsp; This explains that the \u003cstrong\u003edistribution of the diagnoses does not depend on the patient\u0026apos;s occupational environment or setting such as\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eIndoor, Outdoor, Both, or Not Working, suggesting that the prevalence of these diseases could possibly be driven more by factors such as genetic predisposition or non-occupational lifestyle factors, rather than environmental exposure to the skin. Table 3 explains the association between diagnosis and occupation environment.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisease prevalence across Socioeconomic Status\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe model revealed \u003cstrong\u003eno statistically significant association\u003c/strong\u003e between the patient\u0026rsquo;s primary diagnosis and their socioeconomic status as p\u0026gt;0.05. The strength of the association was calculated to be small-to-moderate, as indicated by Cramer\u0026apos;s V = 0.29. This non-significant finding suggests that the distribution of these four specific dermatological conditions is independent of the broad Socioeconomic categorization utilized in this sample. Table 4 shows disease prevalence as per socioeconomic status.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDisease prevalence across Age groups\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis showed a highly statistically significant association between primary diagnosis and age groups, p \u0026lt; 0.001. The strength of this relationship was large, as indicated by Cramer\u0026apos;s V = 0.56, confirming that the prevalence of specific dermatological condition differs across the patient lifespan in this cohort. Table 5 shows disease association with age groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eQuality of life burden\u003c/em\u003e\u003cem\u003e\u0026nbsp;across the diagnostic groups\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eKruskal Wallis H test was conducted to test for dermatological life quality differences across diagnostic groups. \u0026nbsp;The results indicated a \u003cstrong\u003ehighly significant difference\u003c/strong\u003e in Dermatological Life Quality Index scores across the diagnostic categories, \u003cem\u003eH\u0026nbsp;\u003c/em\u003e(3, \u003cem\u003eN\u003c/em\u003e = 91) = 16.01, \u003cem\u003ep\u003c/em\u003e = 0.001. This outcome confirms that quality of life impairment is significantly heterogeneous across the four skin diseases. The large gap in mean ranks between Eczema and the other groups suggests that \u003cstrong\u003eEczema patients experience the most severe impairment in quality of life\u003c/strong\u003e compared to the rest of the cohort.\u003c/p\u003e\n\u003cp\u003eThe post hoc Dunn\u0026apos;s test was conducted for pairwise comparisons. The findings indicate that the Eczema group reported significantly worse DLQI scores than the Vitiligo group (\u003cem\u003ep\u003c/em\u003e= 0.001) and the Acne Vulgaris group (\u003cem\u003ep\u003c/em\u003e = 0.018). \u0026nbsp;The results between Psoriasis and all other groups were not statistically significant suggesting that its quality of life impairment is statistically similar to that of Eczema and the lower-ranked conditions. Table 6 shows difference in Dermatological life Quality as per diagnoses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRole of Gender on the perceived Quality of Life burden\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMann Whitney U test was conducted to understand if there is a significant gender difference across dermatological life quality index scores across the Men and Women. It was found that men had a Mean Rank of 45.49 while women had a Mean Rank of 46.34. Hence, there was no significant difference in the scores, thereby suggesting that the functional impairment is equal across the genders and no one gender is more vulnerable to functional disability as compared to the other.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eRole of Family history on the perceived Quality of Life burden\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eMann Whitney U test was conducted to test for differences in DLQI scores in those who reported a family history of a dermatological disorder and those who did not report a prior family history of a dermatological disease.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhile the difference was not statistically significant, patients who reported a family history (\u0026quot;Yes\u0026quot;) had a slightly higher mean rank (50.12) and patients who reported no family history (\u0026quot;No\u0026quot;) had a slightly lower mean rank (43.98). Since a higher mean rank indicates greater quality-of-life impairment, this descriptive pattern suggests that patients with a family history of the condition tend to report a slightly higher, but not statistically verifiable, psychosocial burden.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDifferences in Dermatological Life Quality Index Scores among\u003c/em\u003e \u003cem\u003edifferent treatment types\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eFor the analysis of this, the treatments were divided into 4 categories being: \u0026nbsp;Only creams, Topical Steroids, Systemics and Alternatives. Kruskal Wallis was performed and results indicated a statistically significant difference in DLQI scores across the four treatment categories, \u003cem\u003eH\u003c/em\u003e(3, \u003cem\u003eN\u003c/em\u003e = 91) = 11.01, \u003cem\u003ep\u003c/em\u003e = .012. The mean ranks indicated that the \u003cstrong\u003eTopical steroids\u003c/strong\u003e group reported the greatest psychosocial burden (Mean Rank = 76.75), significantly higher than the \u003cstrong\u003eOnly creams\u003c/strong\u003e group (Mean Rank = 40.51). Dunn\u0026rsquo;s post-hoc test, with a Bonferroni correction, confirmed that the only statistically significant pairwise difference was found between the \u003cstrong\u003eTopic steroids\u003c/strong\u003e group and the \u003cstrong\u003eOnly creams\u003c/strong\u003e group. This finding suggests that patients who only require minimal treatment report the lowest burden, while those engaged in topical regimens experience a significantly elevated DLQI impairment.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eDifferences in Dermatological Life Quality Index Scores among\u003c/em\u003e \u003cem\u003edifferent illness duration groups\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA Kruskal-Wallis H test was conducted to determine if Dermatological Quality of Life Index (DLQI) scores differed significantly across the five categories of illness duration. The overall model was \u003cstrong\u003enot statistically significant\u003c/strong\u003e, \u003cem\u003eH\u003c/em\u003e(4, \u003cem\u003eN\u003c/em\u003e = 91) = 2.76, \u003cem\u003ep\u0026nbsp;\u003c/em\u003e= .599. This indicates that the duration of the dermatological condition, as defined in categories (0\u0026ndash;2 years, 2\u0026ndash;5 years, 5\u0026ndash;7 years, 7\u0026ndash;10 years, and 10+ years), does not have a measurable impact on the patients\u0026apos; psychosocial and functional burden. However, the shortest duration group (5\u0026ndash;7 years) showed the lowest descriptive mean rank (35.30), the lack of statistical significance suggests that these variations in quality of life are not large enough to be considered a true difference based on how long a patient has lived with the condition.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003ePredictors of dermatological quality of life\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eA Firth Logistic Regression was conducted to identify predictors of elevated dermatological quality of life (DLQI) impairment which was defined as a binary outcome based on the DLQI score (cutoff was a score of 6 and above for DLQI impairment). This method was necessary due to an occurrence of quasi-complete separation observed with the Topical Steroids variable. The final model included gender, occupational environment, socioeconomic status, and treatment type as predictors.\u003c/p\u003e\n\u003cp\u003eThe analysis indicated that most sociodemographic factors were not significant predictors of DLQI impact:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGender (Reference Group: Men):\u003c/strong\u003e In our cohort, women did not show a statistically significant difference in the odds of experiencing DLQI impairment (\u003cem\u003ep\u003c/em\u003e = 0.50).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOccupational Environment (Reference Group: Not working):\u003c/strong\u003e The environment in which a patient worked was not a significant predictor of DLQI impairment. None of the environments Indoor only (OR = 0.84, \u003cem\u003ep\u003c/em\u003e = 0.81), Outdoor only (OR = 1.82, \u003cem\u003ep\u003c/em\u003e = 0.52), nor Indoor and outdoor both (OR = 0.61, \u003cem\u003ep\u003c/em\u003e = 0.47) demonstrated significantly different odds of high DLQI burden compared to patients who were not working.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSocioeconomic Status (Reference Group: Lower):\u003c/strong\u003e The socioeconomic status of a patient was not a significant predictor of DLQI impairment. None of the groups Upper Lower (OR = 0.87, \u003cem\u003ep\u003c/em\u003e = 0.89), Lower Middle (OR = 0.70, \u003cem\u003ep\u003c/em\u003e = 0.71), and Upper Middle (OR = 1.06, \u003cem\u003ep\u003c/em\u003e = 0.94) demonstrated significantly different odds of high DLQI burden as compared to those in the Lower SES group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTreatment Type\u003c/strong\u003e demonstrated a significant association with the odds of DLQI impairment (Reference Group: \u003cstrong\u003eOnly Creams\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e Two categories were found to be statistically significant:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTopical Steroids:\u003c/strong\u003e Patients currently using topical steroids showed significantly higher odds of experiencing DLQI impairment compared to the group using only non-steroid creams (B = 2.54, Wald Z = 1.72, \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;= 0.03\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e The estimated odds ratio was substantial, suggesting that these patients are \u003cstrong\u003e12.68 times\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003emore likely to report a high DLQI burden (95% CI: 1.22\u0026ndash;1722.36).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAlternatives:\u003c/strong\u003e Patients using alternative treatments also indicated significantly higher odds of DLQI impairment compared to the only creams group (B = 1.24, Wald Z = 1.89, \u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;= 0.03\u003c/strong\u003e). These patients had \u003cstrong\u003e3.48 times\u003c/strong\u003e the odds of high DLQI burden (95% CI: 1.11\u0026ndash;12.71).\u003c/p\u003e\n\u003cp\u003eHowever, patients currently on systemic treatments did not show a statistically significant difference in DLQI impairment compared to the \u0026quot;Only Creams\u0026quot; reference group (OR = 1.78, \u003cem\u003ep\u003c/em\u003e = 0.38). Table 11 shows the predictors of DLQI impairment\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDermatological conditions have seen to significantly impair the functioning of patients as the conditions exert debilitating effects on the emotional, occupational and social functioning of the patients. Several studies are being conducted across the globe to find preventive and intervention factors that can ease the experience of a skin condition, particularly in those countries where weather conditions are extreme throughout the year. India has a seasonal pattern of longer summers and shorter winters with majority of the states experiencing very harsh summers where the temperature goes above 52 degrees Celsius or 125 Fahrenheit. Therefore it is important to study the cultural and physical impact of these diseases.\u003c/p\u003e \u003cp\u003eAn important aspect was that even though skin diseases do not contribute significantly to the years of life lost and disability-adjusted life years due to skin diseases are less, their impact on disability or years lived with disability is more significant [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe central objective of the current study was to assess current epidemiological trends and the factors contributing to the patients\u0026rsquo; burden of chronic dermatological diseases, a critical area within public health. The findings challenge several notions about health disparities, instead highlighting the often underestimated role of treatment modality in Quality of life burden.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eEpidemiological Trends and Diagnostic Disparities\u003c/h2\u003e \u003cp\u003eThe initial phase of the study provided a demographic view of the cohort, showing the high prevalence of Vitiligo (40.78%), Acne Vulgaris (18.45%), Psoriasis (16.5%), and Eczema (12.62%). This distribution itself is a critical epidemiological finding, suggesting that conditions with high psycho-social impact such as Vitiligo and Acne Vulgaris dominate, beside chronic inflammatory conditions such as Psoriasis and Eczema.\u003c/p\u003e \u003cdiv id=\"Sec24\" class=\"Section3\"\u003e \u003ch2\u003eDiagnostic Vulnerability and Health Disparities\u003c/h2\u003e \u003cp\u003eThe investigation into sociodemographic associations revealed specific vulnerabilities within the patient population:\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGender and Diagnosis\u003c/strong\u003e \u003cp\u003eWe rejected the null hypothesis that there is no association between gender and diagnosis. The results indicate a meaningful relationship, likely reflecting the higher prevalence of certain conditions in female patients within this cohort. This finding underscores the need for gender-specific epidemiological modeling and clinical resource allocation, particularly in young adult populations where women have a significant majority, as seen in the descriptive results (60.44% female). This result is supported by a study conducted that showed 2.5 times higher prevalence of acne vulgaris in adult women as compared to men [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eOccupation environment and Diagnosis\u003c/b\u003e: There was no significant association between diagnosis and occupational environment within the cohort, hence the null hypothesis was accepted. Thus, dermatological diseases are independent of the patient\u0026rsquo;s occupational environment. This suggests that the distribution of these diseases is not being significantly skewed by exposure factors related to the workplace among the patients. However, occupational dermatoses are an important part of dermatology but these certainly include contact dermatitis and certain bacterial and viral infections [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Thus, presenting provide contradictory evidence to our finding.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAge and Diagnosis\u003c/strong\u003e \u003cp\u003eWe rejected the null hypothesis as a significant association was found between age group and diagnosis. The association between dermatological diagnoses and age groups was highly significant reflecting an established important epidemiological trend, where diagnoses like Acne Vulgaris cluster in younger age groups (18\u0026ndash;25 years, representing 48.54% of the cohort), while other conditions may become more prevalent in older cohorts. This outcome shows the urgent need of public health strategies that are specifically for the early detection and prevention efforts to specific age-diagnostic profiles. Another study explained that as individuals reach puberty, their chances of being diagnosed with atopic dermatitis which is a form of eczema, increases significantly [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, in the later years, atopic dermatitis seems to be less prevalent. One important study shows the average age of vitiligo patients being between 40\u0026ndash;50 years [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSocioeconomic Status and Diagnosis\u003c/strong\u003e \u003cp\u003eWe failed to reject the null hypothesis for the association between diagnosis and Occupational Environment and Socioeconomic Status. This finding suggests that the distribution of these four dermatological diagnoses is largely independent of socioeconomic class the patient belongs to. This is an important finding for health equity as it emphasizes that patients across different SES levels are equally vulnerable to developing these chronic skin conditions and that no particular strata of patients is at a higher risk of developing them. An epidemiological study on skin disorders was performed and it was found that most of the conditions were prevalent across lower and middle class groups; however the study did not test for significant differences in this case [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDLQI across Diagnoses\u003c/strong\u003e \u003cp\u003eWe rejected the null hypothesis of no difference in DLQI scores across the four diagnostic groups. This states that the average QOL burden is not uniform and that specific diagnoses inherently have a greater impairment than others. This finding is essential in prioritizing and allocating resources in healthcare systems, signaling that clinical pathways must move beyond simple diagnostic codes to incorporate patient-reported burden. Among all the diseases, eczema was found to deteriorate the life quality the most. A researchstudy on dermatological severity was conducted on Saudi Arabic dermatological patients. Results reported that the effect of atopic dermatitis(eczema) was the most severe on quality of life in the group[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Moreover, A colombian study reported that patients with psoriasis, urticaria, atopic dermatitis had the worst quality of life and daily functioning as compared to other skin diseases [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. An Indian study assessed quality of life of patients having a diagnosis of vitiligo. They found that 44% of the patients had mild effect on their quality of life and 46% patients had a moderate effect. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eGender and DLQI\u003c/strong\u003e \u003cp\u003eWe failed to reject the null hypothesis of no difference in DLQI scores between genders. Despite the significant gender disparity in diagnostic prevalence as we quoted, the severity of the impact on DLQI, appears to be equalized between men and women after the diagnosis of the patient is established. This challenges traditional findings about women reporting higher psychological distress, indicating that the clinical visibility and severity of skin disease generate a high burden irrespective the gender. Along the same findings, a study assessed sex differences in dermatological quality of life of psoriasis patients and found that on the baseline visit, men and women had no significant differences in their total DLQI indicating equal burden of psoriasis on overall functioning across the genders [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. An Indian study on Acne vulgaris patients also showed no significant differences in the quality of life scores of men and women samples [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFamily History and DLQI\u003c/strong\u003e \u003cp\u003eWe failed to reject the null hypothesis in DLQI scores of those who had and those who did not have a family history of a dermatological disorder. This shows that functional impairment of a patient with dermatological disorder is equal across patients that report a prior family history of a skin condition and patients who report not having a family history of the same. On the contrary, a study assessed the family dermatological quality of life index of vitiligo patients in India and reported that 13% of the participants reported a positive family history of vitiligo and they had a slightly more impaired quality of life as compared to those who did not report a family history [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIllness Duration and DLQI\u003c/strong\u003e \u003cp\u003eThe failure to reject the null hypothesis for and illness duration is significant. This implies that the duration of adapting the disease mitigates the daily QOL impact. The burden remains constant regardless of the patient\u0026rsquo;s long term or short term experience with the condition. A study was conducted on 551 Psoriasis patients and to assess their DLQI. It was found that patients with illness duration of more than 10 years showed a higher DLQI score as compared to lesser durations [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTreatment Modality and DLQI\u003c/strong\u003e \u003cp\u003eThe most clinically and public health-relevant findings emerged from the analysis of treatment type, which resulted in the rejection of the null hypothesis for both models.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eTopical Steroid\u003c/strong\u003e \u003cp\u003eThe Odds Ratio of 12.68 for topical steroid use is very high. This finding explains that patients requiring topical steroids invariably have severe disease. However, the finding also addresses the burden of treatment such as the physical and psychological demands of such topical regimens. This complex regimen often involve daily application, staining, greasing of skin due to the topical and fear of side effects. All of these contribute to the medical compliance fatigue and distress inturn increasing the burden beyond the disease itself.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAlternative Treatment Seeking\u003c/strong\u003e \u003cp\u003eThe Odds Ratio of 3.48 for alternative treatment such as Homeopathy and Ayurveda suggests these patients face severe functional impairment. When a patient shifts to non-conventional treatments, it is often an indicator of treatment dissatisfaction and refractory disease indicating the patient\u0026rsquo;s last effort after exhausting all of their standard medical options. This finding signals a major rift in health system capacity to effectively manage chronic inflammatory cases for different people from different socioeconomic backgrounds.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eThe key public health implications derived from these findings include:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGiven the findings across key sociodemographics, Quality of Life screening across dermatological settings should be mandatory and universal, not restricted to perceived \"high-risk\" groups, to assess the nature of the psychosocial burden on the patient.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eHealth systems and patient care models must actively work on mitigating the burden of treatments such as topical steroids. It must be ensured that medical professionals simply the treatments and conduct psychoeducation of patients regarding their triggers and side effects, that will ultimately help them manage their condition effectively.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePatients seeking alternative treatment options represent a highly vulnerable, high-burden group. Health policies must ensure timely access to specialist care, novel treatments, and increased specialty clinics such as for Eczema and Psoriasis.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003ePublic health initiatives must recognize the burden of treatment adherence as a crucial factor.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThe study limits the generalizability of conclusions as the sample size of the study is considerably small for all four skin diseases. Future studies could employ a larger sample and explore the level of awareness patients have regarding their skin being able to develop infections and its relationship with quality of life.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study presented that dermatological diseases significantly lead to functional impairment of the affected patient. For our population, symptoms/feelings and daily activities were the most affected where individuals have difficulty performing activities of daily living and have worse feelings which may lead to additional problems like anxiety, depression etc.\u003c/p\u003e \u003cp\u003eMoreover, eczema was found to be the most significant contributor to the burden in patients\u0026rsquo; quality of life followed by psoriasis, acne vulgaris and vitiligo.\u003c/p\u003e \u003cp\u003eLastly, significant predictors of quality of life were the use of topical steroids and alternative therapies. The current study recommended that not only physical but psychological support as well, should be given to help patients improve their daily lives along with psychoeducating them regarding aggravating factors and awareness of possible skin infections.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eWe confirm that this manuscript is original, has not been published previously, and is not under consideration for publication elsewhere.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical consideration:\u0026nbsp;\u003c/strong\u003eAll necessary ethical guidelines were followed and consents were taken from the participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial:\u003c/strong\u003e Not Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest:\u003c/strong\u003e We confirm that there are no conflicts of interest related to the authorship or publication of this article.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e We received no financial support for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement:\u003c/strong\u003e The datasets generated and analyzed during the current study are not publicly available due to confidentiality and privacy issues but are available from the corresponding author Gunjan Bhutani ([email protected]) at a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Statement:\u0026nbsp;\u003c/strong\u003eThe data collection was conducted in 2022 and the protocol was reviewed and approved by the Faculty for the Master\u0026rsquo;s thesis. Formal ethical oversight was provided by the Amity Institute of Psychology and Allied Sciences (AIPS), Amity University, Noida ensuring standards of institution and Declaration of Helsinki. Informed Consent was obtained electronically from all the participants prior to data collection and the data was anonymized to maintain confidentiality.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eBhatti ZU, Salek MS, Finlay AY. Chronic diseases influence major life changing decisions: a new domain in quality of life research. \u003cem\u003eJ R Soc Med\u003c/em\u003e. 2011;\u003cem\u003e104\u003c/em\u003e:241\u0026ndash;50.\u003c/li\u003e\n \u003cli\u003eEghlileb AM, Basra MK, Finlay AY. The psoriasis family index: preliminary results of validation of a quality of life instrument for family members of patients with psoriasis. \u003cem\u003eDermatology (Basel)\u003c/em\u003e. 2009;\u003cem\u003e219\u003c/em\u003e(1):63\u0026ndash;70. doi: 10.1159/000209234.\u003c/li\u003e\n \u003cli\u003eSood P, Bindra S. Modified Kuppuswamy socioeconomic scale: 2022 update of India. \u003cem\u003eInt J Community Med Public Health\u003c/em\u003e. 2022;\u003cem\u003e9\u003c/em\u003e:3841-4.\u003c/li\u003e\n \u003cli\u003eFinlay AY, Khan GK. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. \u003cem\u003eClin Exp Dermatol\u003c/em\u003e. 1994;\u003cem\u003e19\u003c/em\u003e(3):210\u0026ndash;6. doi: 10.1111/j.1365-2230.1994.tb01167.x.\u003c/li\u003e\n \u003cli\u003eCohen J. \u003cem\u003eStatistical Power Analysis for the Behavioral Sciences\u003c/em\u003e. 2nd ed. Hillsdale, NJ: Lawrence Erlbaum Associates, Publishers; 1988.\u003c/li\u003e\n \u003cli\u003eMurray CJ. Quantifying the burden of disease: the technical basis for disability-adjusted life years. \u003cem\u003eBull World Health Organ\u003c/em\u003e. 1994;\u003cem\u003e72\u003c/em\u003e(3):429\u0026ndash;45.\u003c/li\u003e\n \u003cli\u003eChang J, Nock MR, Cohen JM, Bunick CG. Acne accounts for an almost 2.5-fold higher proportion of dermatology visits among adult females compared to adult males in the United States: A study of the national ambulatory medical care survey from 2002-2016. \u003cem\u003ePLoS One\u003c/em\u003e. 2023;\u003cem\u003e18\u003c/em\u003e(9):e0290763. doi: 10.1371/journal.pone.0290763.\u003c/li\u003e\n \u003cli\u003eSrinivas CR, Sethy M. Occupational Dermatoses. \u003cem\u003eIndian Dermatol Online J\u003c/em\u003e. 2022;\u003cem\u003e14\u003c/em\u003e(1):21\u0026ndash;31. doi: 10.4103/idoj.idoj_332_22.\u003c/li\u003e\n \u003cli\u003eKanwar AJ. Adult-onset Atopic Dermatitis. \u003cem\u003eIndian J Dermatol\u003c/em\u003e. 2016;\u003cem\u003e61\u003c/em\u003e(6):662\u0026ndash;3. doi: 10.4103/0019-5154.193679.\u003c/li\u003e\n \u003cli\u003eMohr N, Petersen J, Kirsten N, Augustin M. Epidemiology of Vitiligo - A Dual Population-Based Approach. \u003cem\u003eClin Epidemiol\u003c/em\u003e. 2021;\u003cem\u003e13\u003c/em\u003e:373\u0026ndash;82. doi: 10.2147/CLEP.S304155.\u003c/li\u003e\n \u003cli\u003eKumar TP, Shivani S. Epidemiological study of various skin diseases and prescription pattern of drugs in dermatological OPD in Khammam Region. \u003cem\u003eIndian J Pharm Pract\u003c/em\u003e. 2020;\u003cem\u003e13\u003c/em\u003e(1):42\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eAlhoqail I. Impairment of quality of life among adults with skin disease in King Fahad Medical City, Saudi Arabia. \u003cem\u003eJ Fam Community Med\u003c/em\u003e. 2009;\u003cem\u003e16\u003c/em\u003e:105-9.\u003c/li\u003e\n \u003cli\u003eSanclemente C, Burgos J, Nova F, Hern\u0026aacute;ndez C, Gonz\u0026aacute;lez MI, Reyes N, et al. The impact of skin diseases on quality of life: A multicenter study. \u003cem\u003eActas Dermosifiliogr (Engl Ed)\u003c/em\u003e. 2017;\u003cem\u003e108\u003c/em\u003e(3):244-52.\u003c/li\u003e\n \u003cli\u003eBhuptani NV, Parmar PJ, Selot NK, Patel BK. Quality of life in patients with vitiligo. \u003cem\u003eInt J Res Dermatol\u003c/em\u003e. 2020;\u003cem\u003e6\u003c/em\u003e(3):388\u0026ndash;91. doi: 10.18203/issn.2455-4529.IntJResDermatol20201586.\u003c/li\u003e\n \u003cli\u003eJensen MB, Loft N, Zacheriae C, Skov L. Sex Differences in Dermatology Life Quality Index (DLQI) among Patients with Psoriasis. \u003cem\u003eActa Derm Venereol\u003c/em\u003e. 2024;\u003cem\u003e104\u003c/em\u003e:adv42441. doi: 10.2340/actadv.v104.42441.\u003c/li\u003e\n \u003cli\u003eKanagala Chowdary N, Prabhu SS, Shenoi SD, Nayak SU. Quality of life in acne patients: A clinical and Dermatology Life Quality Index (DLQI) based cross-sectional study. \u003cem\u003eJ Pak Assoc Dermatol\u003c/em\u003e. 2018;\u003cem\u003e28\u003c/em\u003e(4):415\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eSaxena A, Dey VK, Chaudhary N, Shrivastava P, Sharma S. Impact on quality of life in family members of patients suffering from vitiligo. \u003cem\u003eIP Indian J Clin Exp Dermatol\u003c/em\u003e. 2020;\u003cem\u003e6\u003c/em\u003e(1):5-9. doi: 10.18231/j.ijced.2020.002.\u003c/li\u003e\n \u003cli\u003eMa X, Xu Q, Kuai L, Shen F, Duan Z, Gao X, et al. Beyond Skin Clearance: Personalized Strategies for DLQI Improvement in Psoriasis -Insights From a Shanghai Prospective Cohort. \u003cem\u003ePsoriasis (Auckl)\u003c/em\u003e. 2025;\u003cem\u003e15\u003c/em\u003e:373\u0026ndash;87. doi: 10.2147/PTT.S534881.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 11 are available in the supplementary files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Amity University","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Quality of Life, Skin diseases, India, Dermatology, Psychosocial support","lastPublishedDoi":"10.21203/rs.3.rs-9604902/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9604902/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSkin diseases, also known as dermatological diseases are among the most common chronic inflammatory and auto-immune diseases in the general population. Its ramifications are seen to have an impact on the individual\u0026rsquo;s occupational, financial, as well as personal life. The aim of the current study is to assess the impact of dermatological diseases on the quality of life of the patients, to identify and explore the various factors associated with it. This study includes a sample of 103 patients with Acne Vulgaris, Psoriasis, Eczema, Vitiligo, Urticaria, Rosacea and others. The final analysis was conducted on 91 patients. Participants filled the online version of the Dermatological Life Quality Index (DLQI) and Sociodemographic and medical datasheet. Descriptive as well as inferential statistics were applied to analyze the data using SPSS. Among all the skin diseases included in this study, the highest prevalence was of Vitiligo (40.78%) followed by Acne Vulgaris (18.45%), Psoriasis (16.50%), Eczema (12.62%) and others (11.65%) including Urticaria, Rosacea and others. The condition that had the most influence on patients\u0026rsquo; Quality of Life burden was Eczema. Different treatment modalities were explored as Predictors of Quality of Life Impairment in Chronic Dermatological Diseases. The present study recommends that psychophysical and social support should be provided to help patients improve their functioning of daily activities, along with psycho educating them regarding their subjective aggravating factors and possibility of inflammations.\u003c/p\u003e","manuscriptTitle":"Treatment Modality as a Key Predictor of Quality of Life Impairment in Chronic Dermatological Diseases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 08:12:32","doi":"10.21203/rs.3.rs-9604902/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1fc1dac4-3b58-47c8-8eb3-beebff15a8a6","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":67458898,"name":"Psychology"},{"id":67458899,"name":"Psychiatry"},{"id":67458900,"name":"Dermatology"}],"tags":[],"updatedAt":"2026-05-07T08:12:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 08:12:32","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9604902","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9604902","identity":"rs-9604902","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}