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 Table of Contents  
Year : 2016  |  Volume : 36  |  Issue : 1  |  Page : 1-3

Quality-of-life assessment in pemphigus vulgaris in Upper Egypt using the Dermatology Life Quality Index and SF-36 questionnaires

1 Department of Dermatology, Venereology and Andrology, Assiut University, Assiut, Egypt
2 Department of Public Health & Community Medicine, Assiut University, Assiut, Egypt

Date of Submission04-Sep-2015
Date of Acceptance28-Apr-2016
Date of Web Publication22-Nov-2016

Correspondence Address:
Hanan Morsya
Department of Dermatology, Venereology and Andrology, Assiut University, Assiut
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-6530.194152

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Background Autoimmune bullous dermatoses are characterized by recurrent painful erosions in the mucus membranes and blisters all over the body. The objective of this study was to evaluate quality-of-life and mental health status in patients diagnosed as having pemphigus.
Patients and methods A total of 40 patients with pemphigus were recruited from the Dermatology Clinic, Assiut University Hospitals, Egypt. They were assessed clinically, and then the Dermatology Life Quality Index (DLQI) was determined and SF-36 questionnaires were administered to patients.
Results Of the 40 patients, there were 14 male and 26 female patients. Range of the DLQI for male patients was 8.0–22.0 and that for female patients was 3.0–27.0. The DLQI showed a significant correlation with surface area measured (P=0.048).
Conclusion These results suggest that the DLQI and SF-36 can be very useful tools in assessing the outcome criteria for clinical studies of patients with pemphigus. Patient’s quality-of-life is much impaired with this type of disorders.

How to cite this article:
Morsya H, Abdel-Motaleba AA, Solimanb AM. Quality-of-life assessment in pemphigus vulgaris in Upper Egypt using the Dermatology Life Quality Index and SF-36 questionnaires. Egypt J Dermatol Venerol 2016;36:1-3

How to cite this URL:
Morsya H, Abdel-Motaleba AA, Solimanb AM. Quality-of-life assessment in pemphigus vulgaris in Upper Egypt using the Dermatology Life Quality Index and SF-36 questionnaires. Egypt J Dermatol Venerol [serial online] 2016 [cited 2022 Dec 10];36:1-3. Available from: http://www.ejdv.eg.net/text.asp?2016/36/1/1/194152

  Introduction Top

Autoimmune bullous dermatoses are one of the most serious problems in dermatology, as the lesions are recurrent and stressing for both the patient and the physician [1]. Pemphigus vulgaris usually affects a large surface area of the body, together with mucous membrane lesions; this has a negative impact in attitude in patient’s life.

Pemphigus are a group of diseases due to autoantibodies that attack desmosomes, dedicated to epidermal cell adhesion or because of genetically determined dysfunction of these cellular components [2]. Autoimmune blistering diseases cause impaired adhesion of the epidermis to the basement membrane or impaired adhesion among epidermal cell [3].

Clinical evaluation of disease severity is neccessary together with other tools, which may help in follow-up and management. We have viewed bulla with OCT, which is one of the new imaging techniques used to view the blisters, as dark, rounded, and well-demarcated areas according to blistering level [4]. Quality-of-life (QoL) assessment tools are essential also for the dermatologist to measure the disease impact on patient’s life and for evaluating the efficacy of treatment [5].

Bullous dermatosis were proved in many studies to have negative impact on patients life in western countries [6], but no studies have been conducted among Arabs, especially Egyptians, who have distinctive social and cultural traditions.

The aim of this study was to assess the QoL in pemphigus patients using the Arabic version of the Dermatology Life Quality Index (DLQI) and SF-36 questionnaires. Patients attending the Dermatology Clinic, Assiut University Hospitals, which serves patients who come from southern regions in Upper Egypt, were included in this study.

  Patients and methods Top

This study was conducted on 40 patients with pemphigus (34 with pemphigus vulgaris, five with pemphigus foliaceus, and one with pemphigus herpetiformis) attending the Dermatology Department, Assiut University Hospitals, from January 2014 until October 2014 based on clinical and/or histopathological diagnosis. Approval from local Ethics Committee was ensured. Demographical and clinical data were investigated for bullous patients who were treated as outpatients and the admitted patients, and they were asked to answer the questions mentioned in the Arabic version of DLQI and SF-36 questionnaires, after explaining the purpose of research (the nurse helped the patients who could not complete or read the questions in a nondirective manner).

The DLQI is a 10-item questionnaire and has responses ranging from very much, a lot, a little, to not at all [7]. Short form (SF-36) health survey is a 36-item questionnaire to evaluate patients’ well-being (physical and mental health) from patients’ point of view [8].

  Results Top

The present study included 40 patients with pemphigus disease. There were 14 male and 26 female patients. The mean age for the studied group was 43.38±7.45 years.

The age of patients did not show any statistically significant correlation with DLQI questionnaire (P=0.471).

Besides, no statistically significant correlation was found between sex of patients and DLQI questionnaire (P=0.638). The mean values for DLQI are shown in [Table 1].
Table 1: Mean values for Dermatology Life Quality Index questionnaire for both male and female patients

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There was a statistically significant difference between single and married patients as regards DLQI questionnaire (P=0.014) [Table 2].
Table 2: Mean values for Dermatology Life Quality Index questionnaire for single and married patients

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The analysis of variance test showed a statistically significant correlation (P<0.048) between surface area of bullous lesions and DLQI questionnaire [Figure 1].
Figure 1: Correlation between surface area and Dermatology Life Quality Index (DLQI) score.

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As regards SF-36 questionnaire, evaluation of its different parameters did not reveal any statistically significant difference between male and female patients, except in pain (P=0.044) [Table 3].
Table 3: Comparison between male and female patients as regards the SF-36 questionnaire

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No statistically significant correlation was found between surface area affected and SF-36 parameters.

  Discussion Top

Routine clinical assessment of any dermatological disorder is neccessary for clinicians to evaluate disease and its progress. However, in the last 20 years, an important assessment tool has been developed, in dermatology the QoL assessment tools. A meaningful clinical response experienced by patient was not an issue before. This development is obliviously to the better, as the patients can express problems with disease socially physically and evaluate therapy as well. [5].

Incidence of pemphigus vulgaris is increasing among Egyptians; a new study has proved the presence of anti-Dsg3 antibodies in 40 normal population sera out of 200 people [9]; this explains why much attention should be given to bullous disorders. To our knowledge, this study is one of newest studies in our region that is considering this aspect in dermatology. Many studies were conducted in western countries. However, as Arabs have a specific lifestyle and social beliefs, better understanding of patient needs and improving the QoL will lead to better management of the disease.

A similar study that investigated the psychological status for patients with pemphigus using the DLQI showed that more than 77% of patients expressed anxiety and depression with impaired QoL [10].

Similar results were obtained in epidermolysis bullosa, as QoL was impaired with increased severity and surface area involved [11].

Single patients were more prone to be affected compared with married people (significant increase in their DLQI scores). This may be attributed to greater fragility and fear of failure in the future.

In the present study, patients who suffered from lesions with larger surface area showed higher DLQI scores. The mean DLQI values revealed marked impairment in daily activities and social life of patients; this emphasizes that efforts towards management should consider the extent of lesions. This is in accordance with the findings of another study, which proved that mucosal erosions and blisters affect psychological condition negatively. The mean DLQI score was 10.9±6.9, as the high probability of anxiety and depression in these patients will negatively affect their QoL [10].

Patient satisfaction is the main aim to achieve proper management. Usually, clinicians depend on clinical scores, but patients evaluate their own disease in different manner. Self-image and patient satisfaction is a crucial step in management. The autoimmune bullous skin disorder intensity score [12] and the pemphigus disease area index [13] are the more recently developed clinical scores, which are most recent development clinical scores specialized for bullous disorders.

Absence of significant correlation between surface area and SF-36 questionnaire may be due to small sample of patients, and the nature of Arab patients living in countryside denying the complications of the disease.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Paradisi A, Sampogna F, Di Pietro C, Cianchini G, Didona B, Ferri R et al. Quality-of-life assessment in patients with pemphigus using a minimum set of evaluation tools. J Am Acad Dermatol 2009; 60(2):261–269.  Back to cited text no. 1
Damoiseaux J. Bullous skin diseases: classical types of autoimmune diseases. Scientifica (Cairo) 2013; 2013:457982.  Back to cited text no. 2
Spindler V, Waschke J. Desmosomal cadherins and signaling: lessons from autoimmune disease. Cell Commun Adhes 2014; 21(1):77–84.  Back to cited text no. 3
Mogensen M, Morsy HA, Nurnberg BM, Jemec GB. Optical coherence tomography imaging of bullous diseases. J Eur Acad Dermatol Venereol 2008; 22(12):1458–1464.  Back to cited text no. 4
Morsy H, Kamp S, Jemec GB. Outcomes in randomized controlled trials in psoriasis: what has changed over the last 20 years? J Dermatolog Treat 2007; 18(5):261–267.  Back to cited text no. 5
Sebaratnam DF, Frew JW, Davatchi F, Murrell DF. Quality-of-life measurement in blistering diseases. Dermatol Clin 2012; 30(2):301–307.  Back to cited text no. 6
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) − a simple practical measure for routine clinical use. Clin Exp Dermatol 1994; 19(3):210–216.  Back to cited text no. 7
Brazier JE, Harper R, Jones NM, O’Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305(6846):160–164.  Back to cited text no. 8
Saleh MA, El-Bahy MM. Do normal Egyptians possess anti-desmoglein 3 antibodies? Int J Dermatol 2015; 54(10):1145–1149.  Back to cited text no. 9
Ghodsi SZ, Chams-Davatchi C, Daneshpazhooh M, Valikhani M, Esmaili N. Quality of life and psychological status of patients with pemphigus vulgaris using Dermatology Life Quality Index and General Health Questionnaires. J Dermatol 2012; 39(2):141–144.  Back to cited text no. 10
Tabolli S, Sampogna F, Di PC, Paradisi A, Uras C, Zotti P et al. Quality of life in patients with epidermolysis bullosa. Br J Dermatol 2009; 161:869–877.  Back to cited text no. 11
Rahbar Z, Daneshpazhooh M, Mirshams-Shahshahani M, Esmaili N, Heidari K, Aghazadeh N et al. Pemphigus disease activity measurements: pemphigus disease area index, autoimmune bullous skin disorder intensity score, and pemphigus vulgaris activity score. JAMA Dermatol 2014; 150(3):266–272.  Back to cited text no. 12
Shimizu T, Takebayashi T, Sato Y, Niizeki H, Aoyama Y, Kitajima Y et al. Grading criteria for disease severity by pemphigus disease area index. J Dermatol 2014; 41(11):969–973.  Back to cited text no. 13


  [Figure 1]

  [Table 1], [Table 2], [Table 3]

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