Bakker, M. (Myrna) (2015) De Invloed van Ashy Dermatose / Lichen Planus Pigmentosus op de Gezondheidsgerelateerde Kwaliteit van Leven. thesis, Medicine.
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Abstract
Background and objectives: Ashy dermatosis (AD) is an uncommon skin pigmentary disorder characterized by ashy-gray macular discoloration of the skin. Some authors categorize AD as a pigmentary macular variant of lichen planus (lichen planus pigmentosus, LPP). However, the etiology is unknown and effective treatment options are not available. The impact of the skin lesions on (health related) quality of life (HRQoL) is unknown. The objective of this study is to assess the HRQoL of patients with AD/LPP. Secondary objective was to, retrospectively, identify a possible subgroup of patients who share a common clinical presentation, response to therapy and/or course of the disease. The identification of such a subgroup of patients could possibly support an improvement in the HRQoL. Materials and methods: 32 patients diagnosed with AD/LPP filled out a validated questionnaire about quality of life (skindex-29) as well as questions about the course of their skin disorder and their response to therapy. An assessment of the clinical presentation was performed by an independent dermatologist who determined the morphology of the skin disorder based on photos made during the first consultation. The course of the skin disorder was investigated by comparing color, size, severity and difference in number of lesions based on the aforementioned photos and photos made during a single consultation for the purpose of this study. The results of this comparison are based on expert opinion (physician global assessment, PhGA). Patients also gave their opinion about the course of their disorder (patient global assessment, PtGA). Results: The mean scores (range: 0 – 100) of the different domains of HRQoL (‘scale scores’) were 26.0 (symptoms), 43.6 (emotions) and 22.7 (functioning). The mean total score was 30.7. The scale score for ‘emotions’ was significantly higher compared to the other domains (p<0.01). HRQoL was significantly more impaired for the emotional domain in patients who have had treatment in the past and in patients having hyperpigmentations located on the (ventral) chest (p<0.05). Clinical presentation of the patients showed a high degree of variation. Most of the patients had undergone treatment in the past. The duration between the consultations ranged from 1 to 16 years. For most patients it was observed that the colour of the hyperpigmentations had become lighter (53.8%) or remained the same (30.8%). The size of the individual lesions remained the same (41.0%) or became smaller (41.0%). For 46.2% of the patients an increase in the number of lesions was observed. At clinical presentation, a moderate severity of the skin disorder was observed for most patients. For 47.7% of the patients the severity remained stable, for 38.5% an improvement was observed. Conclusion: AD/LPP has an adverse impact on HRQoL. Scores indicated that emotions were severely influenced and functioning was influenced mildly. Patients who had undergone treatment in the past and patients having hyperpigmented lesions on the ventral chest showed a higher impact on the emotional domain of HRQoL. AD/LPP seems to be a dynamic disorder with a high degree of variation in clinical presentation. In many patients a change in colour, size or number of lesions was observed, however in the majority of the patients the severity of the skin disorder remained stable. No association between colour, size, severity or number of lesions and the duration of the skin disorder was found. No specific subgroup of patients who share a common clinical presentation, results to therapy and/or course of the disorder could be identified.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Vodegel, R.M. |
| Supervisor name: | Bekkenk, M.W. and Academisch Medisch Centrum Amsterdam |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:55 |
| Last Modified: | 25 Jun 2020 10:55 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1585 |
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