Disease Burden Measurement Tool Performance Depends on Eczematous Disease Area

The Pictorial Representation of Illness and Self-Measure (PRISM) instrument was more accurate at detecting eczematous disease burden of the face whereas the Dermatology Life Quality Index (DLQI) instrument was more useful among patients with affected hands. These are according to study findings published in Dermatology.

Researchers recruited patients (N=143; mean age, 44.8 [SD, 18.1] years; 34.3% men) referred for a patch test with eczema or other inflammatory skin diseases affecting the face or hands. All patients underwent both PRISM and DLQI evaluations prior to patch test.

Among the participants, 28.0% had irritant contact dermatitis and 14.0% had atopic dermatitis. They had a median disease duration of 12 (IQR, 6-27) months, and 43.4% had a positive patch test.

Overall, 81 patients had affected hands and 62 had an affected face. The patients with symptoms on the hands were more likely to be male (P <.001) and fewer tested positive for the patch test (P =.02) compared with patients who had symptoms on the face.

The median PRISM score was 95 (IQR, 52-150) and the median DLQI score was 5.0 (IQR, 2.0-9.0). Stratified by symptoms, the groups had similar PRISMS scores (median, 95 vs 95; P =.9), whereas the patients with symptoms on the hands had higher DLQI scores compared with those with symptoms on the face (median, 6.0 vs 3.5; P =.004), respectively.

Overall, the PRISM and DLQI scores had a Spearman correlation of -0.50 and were more highly correlated among patients with hands symptoms (r, -0.61) vs face symptoms (r, -0.36).

In the linear regression analyses, PRISM scores were associated with age (adjusted coefficient, -17.1 per 10-year increase; 95% CI, -35.3 to -1.79; P =.03), high school (adjusted coefficient, -63.2; 95% CI, -113 to -13.3; P =.014) or university (adjusted coefficient, -70.0; 95% CI, -135 to -5.26; P =.04) education compared with primary or secondary education, and itch severity scores (adjusted coefficient, -7.25 per 1-point increase; P =.014) among patients with face symptoms. For patients with hand symptoms, PRISM scores associated with itch severity scores (adjusted coefficient, -8.00 per 1-point increase; 95% CI, -13.3 to -2.74; P =.003).

Among the hand symptom group, the DLQI scores associated with no features among the patients with face symptoms and with age (adjusted coefficient, 1.13 per 10-year increase; 95% CI, 0.29-1.98; P =.009), single or widowed status compared with married (adjusted coefficient, 2.61; 95% CI, 0.29-4.94; P =.03), currently employed (adjusted coefficient, 3.49; 95% CI, 1.25-5.74; P =.003), and itch severity scores (adjusted coefficient, 95% CI, 0.44-1.11; 0.78 per 1-point increase; P <.001).

The major limitation of the study is the small sample size.

Researchers conclude, “[T]he results of the present study showed a moderate to strong correlation between PRISM and DLQI in measuring impact on [QOL] in patients affected by itching eczematous diseases. When compared with DLQI, PRISM seemed to be more accurate in detecting the abstract, individual suffering focusing largely on the emotional aspects of disease.”