Skindex-16 shows bullous disease flares impair patient quality of life

Key takeaways:

• Patients with disease flares experience poorer quality of life outcomes emotionally, symptomatically and functionally.
• During the nonflare state, patients with pemphigus were the least impacted by their disease.

The Skindex-16, a clinical tool for measuring the skin-related quality of life of patients, showed that patients with autoimmune bullous diseases are greatly impacted by disease flares, according to a study.

“Autoimmune bullous disease (AIBD) constitutes multiple chronic relapsing-remitting diseases, often leading to significant morbidity,” Zachary H. Hopkins, MD, of the autoimmune dermatology clinic at University of Utah Health and department of dermatology at University of Utah, and colleagues wrote.

To evaluate the impact AIBD flares have on patients, Hopkins and colleagues used the Skindex-16 to measure the skin-related quality of life impact on patients’ emotions, symptoms and functionality. The scores range from 0 to 100, with 0 signifying no effect on quality of life and 100 signifying maximum effect.

The study included 192 patients (median age, 68 years; 58% women). At the time of testing, 64 of the patients were in a flare state and 148 were in a nonflare state.

Skindex-16 results showed that patients in flare state vs. nonflare state reported consistently higher scores in all disease categories.

For those with pemphigoid, patients with flares vs. no flares reported greater disease impact on their emotional state (52.4 vs. 7), symptoms (37.5 vs. 13) and daily functioning (26.7 vs. 0).

This was also true among those with pemphigus, with patients with vs. without flares reporting higher scores in emotional impact (54.8 vs. 0), symptom impact (58.3 vs. 4) and functioning impact (26.7 vs. 0).

Patients with dermatitis herpetiformis flares also experienced greater disease impact on their emotions (72.6 vs. 14.3), symptoms (69 vs. 12.5) and functioning (38.3 vs. 0) compared with those that did not experience flares.

Overall, skin-related quality of life was highly correlated with flares of AIBDs, according to the study. However, the authors noted that patients without flares that had pemphigoid and dermatitis ranked their quality of life as worse than patients without flares that had pemphigus.

“During the nonflare state, pemphigus had the lowest association with [skin-related quality of life] perhaps owing to the effectiveness of rituximab in significantly improving disease despite high severity during patient-perceived flares,” the authors stated. “It may also signal an SRQL effect in some diseases that extends beyond physical symptoms, such as comorbidities associated with perception of SRQL.”

Additionally, the Skindex-16 model proved to be a helpful clinical measurement of quality of life in patients with AIBDs and may be added to practitioners’ armamentarium to increase disease management, according to the study.