Dear Sir,
The World Health Organization (WHO) defines adolescence as a period ranging between 10 and 19 years of age. It is a critical phase of transition in the body and is affected by various dermatological diseases. Teenage self-esteem is readily affected when a highly evident skin disorder draws the unwanted attention of their peers. Patients with skin disorders have been found to have higher rates of anxiety and depression with severe lifetime cumulative effects.[1] There are very few studies in the literature on the psychological impact of skin conditions on adolescents[2] provoking feelings of embarrassment and concerns about body image, thus having a negative impact on self-esteem and social engagement. A pilot study was undertaken with the objective of studying the impact of various dermatoses on quality of life (QOL) in adolescents.
This was an observational study conducted in the Department of Dermatology for 16 months after approval from the institutional ethics committee. All patients falling in the age group (10–19 years) were recruited after taking written consent in their vernacular language. Patients/Guardians were given a proforma Dermatology Life Quality Index (DLQI)/Child Dermatology Life Quality Index (CDLQI) to fill, which assesses impairment in QOL. Statistical analysis was done using STATA 14. An independent sample t-test was used to compare dermatology life quality index across genders.
The study included a total of 312 patients falling in age group of 10–19 years. Male: female ratio was found to be 1.05:1 (160:152). A maximum of 121 (38.7%) patients were found to be in the late adolescence phase followed by 105 (33.6%) patients in the mid-adolescent phase and 86 (27.5%) patients in the early adolescent phase. CDLQI was calculated in patients of early and mid-adolescence age group (10–16 years), while DLQI was calculated in patients of late adolescence age (17–19 years).
In the present study, out of a total of 312 patients, a majority had no effect 134 (42.9%) on QOL by their skin diseases. Out of (178, 57.1%) patients who had QOL affected by their dermatoses, a majority (127, 71.3%) had a small effect and (5,2.8%) had an extremely large effect [Figure 1].
Figure 1.
Impact on quality of life
On comparison of CDLQI scores in 191 patients across genders, the majority 92 (48.1%) had no effect on their QOL, while 72 (37.6%) patients had a small effect and 19 (9.9%) had a moderate effect on QOL. The QOL compared among genders showed no significant difference (P value = 0.588) [Figure 2a].
Figure 2.
(a) Comparison of CDLQI across gender. (b) Comparison of DLQI across gender
Out of 121 patients in whom DLQI was calculated, a majority had a small effect (55, 45.4%), followed by no effect (42, 34.7%), moderate effect (16, 13.2%) and very large effect (8, 6.6%). There was no significant difference found among QOL compared between genders (P value = 0.379) [Figure 2b].
The mean CDLQI score was found maximum in arthropod-borne infections (5.42) followed by fungal infections (4.42) and papulosquamous disorders (4.42). The mean DLQI score was maximum in fungal infection (5.45) followed by disorders of appendages (4.10). In our study, the majority of patients with fungal infections had a small effect in 29 (55.7%) and 2 (3.8%) patients had an extremely large effect on QOL [Table 1].
Table 1.
Mean CDLQI and DLQI of different groups of dermatoses
| Category | No. Of patients | CDLQI (<=16 years) [mean (SD)] | No. Of patients | DLQI (>16 years) [Mean (SD)] |
|---|---|---|---|---|
| Arthropod-borne infection | 21 | 5.42 (4.90) | 8 | 3.37 (2.38) |
| Fungal infection | 28 | 4.42 (5.45) | 24 | 5.45 (4.67) |
| Papulosquamous disorders | 14 | 4.42 (6.19) | 7 | 0.85 (1.21) |
| Viral infection | 12 | 3.75 (6.59) | 8 | 1.87 (1.12) |
| Pigmentary disorders | 12 | 3.5 (3.94) | 8 | 3.62 (3.73) |
| Dermatitis | 39 | 2 (1.87) | 24 | 3 (3.09) |
| Bacterial infection | 7 | 1.28 (0.95) | 6 | 2.83 (2.14) |
| Disorders of appendages | 43 | 1.27 (1.59) | 29 | 4.10 (4.59) |
| Drug reactions | 6 | 6.5 (7.47) | 3 | 2 (2) |
| Disorder of keratinization | 0 | - | 1 | 6 |
| Genodermatoses and nevi | 2 | 3.5 (0.70) | 1 | 3 |
| Miscellaneous | 7 | 4.28 (3.40) | 2 | 6 (7.07) |
| Total | 191 | 121 |
Adolescents stand at the crossroads between childhood and the adult in the world today. There are 253 million adolescents in the age group of 10–19 years in India according to the National Health Mission. There are changes in body composition, sexual development and growth spurt, which make them prone to developing various dermatoses. Teenager’s attention to their appearance in modern life has a significant impact on their self-esteem and behaviour, therefore, dermatoses like acne, alopecia, fungal infections, dermatitis, etc., can remarkably affect their mental and physical health and can have a major effect on QOL.
Adolescence is divided into three classes: early (10–13 years), mid (14–16 years) and late (17–19 years). In the present study, the maximum number of patients were in late adolescence (38.7%), similar to studies by Hmar et al.[3] (36.64%), Satish et al.[4] (50.33%) and Baskar et al.[5] (56.4%). Children with advancing age tend to become more conscious about physical appearance and gain maturity to express their issues with peers and parents.
In our study, 57.1% of patients had QOL affected by their dermatoses, of which the majority had a small effect (71.3%), similar to Baskar et al.,[5] where QOL was affected in 84.6% with the majority having a small effect (37.4%).
CDLQI scores compared between male and female adolescents in the early and mid-adolescent age groups indicated no statistically significant difference (P value = 0.588) in our study. Analysis of specific dermatoses revealed that patients with arthropod-borne infections had the highest mean CDLQI scores (5.42 ± 4.90), followed by those with fungal infections (4.42 ± 5.45) and papulosquamous disorders (4.42 ± 6.19), suggesting that these conditions have a greater impact on the QOL. In one such similar study by Goyal et al.,[6] Median CDLQI scores were higher in children affected by infestation (24.0), vesiculobullous disorders (23.0), and dermatitis (21.0). The mean (SD) CDLQI score in atopic eczema was 8.5 in children in a study by Waters et al.[7]
When comparing DLQI scores in late adolescents, our study found no significant difference between males and females (P value = 0.379), similar to the findings of Baskar et al.[5] (P value = 0.262). In our study, fungal infections had the highest mean DLQI scores (5.45 ± 4.67) in the late adolescent group, followed by disorders of appendages (4.10 ± 4.59). The QOL impairment due to fungal infections was significantly greater than that caused by dermatitis (P value = 0.037). Baskar et al.[5] also identified hyperhidrosis (10.6) and dermatophytosis (10.5 ± 4.6) as conditions with high DLQI scores, indicating their considerable impact on adolescent QOL.
These findings highlight the need for targeted interventions to manage and mitigate the impact of these skin conditions on adolescents.
Conflicts of interest
There are no conflicts of interest.
Funding Statement
Nil.
References
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