The Dermatology life Quality Index (DLQI) is a ten-question questionnaire used to measure the impact of skin disease on the quality of life of an affected person. It is designed for people aged 16 years and above.
History The DLQI was created by Andrew Y Finlay and Gul Karim Khan from 1990 to 1994 at the Department of Dermatology, University of Wales College of Medicine (now Cardiff University), Cardiff, UK.Finlay AY, Khan GK. "The Dermatology Life Quality Index: A simple practical measure for routine clinical use". British Association of Dermatologists Annual Meeting, Oxford, July 1993. British Journal of Dermatology, 1993; 129 (Suppl 42): 27. 120 patients with a variety of skin diseases completed a questionnaire that asked them to write down all of the ways that their skin disease affected their lives. 49 different ways were identified, and these were used as the basis of the questions of the DLQI.Finlay AY, Khan GK. "Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use". Clinical and Experimental Dermatology, 1994; 19: 210-216.
The DLQI was first presented at the British Association of Dermatologists annual meeting in July 1993Finlay AY, Khan GK. "The Dermatology Life Quality Index: A simple practical measure for routine clinical use". British Association of Dermatologists Annual Meeting, Oxford, July 1993. British Journal of Dermatology, 1993; 129 (Suppl 42): 27. and described in an article published in 1994 in Clinical and Experimental Dermatology.Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clinical and Experimental Dermatology, 1994; 19: 210-216. This article has become one of the most frequently cited articles in clinical dermatology.Anstey A, Reynolds NJ. "What does the BJD now stand for? A position statement". British Journal of Dermatology 2015; 172: 1463-1465. The DLQI is the most frequently used method for evaluating quality of life for patients with different skin conditions.World Health Organisation. Global report on psoriasis. . WHO Press, Geneva, 2016, p16.
Questionnaire description There are 10 questions, covering the following topics: symptoms, embarrassment, shopping and home care, clothes, social and leisure, sport, work or study, close relationships, sex, treatment. Each question refers to the impact of the skin disease on the patient’s life over the previous week.
Language availability
The DLQI has been translated into over 140 languages. The full translations are available at the Cardiff University Department of Dermatology website.Cardiff University Department of Dermatology website www.cardiff.ac.uk/medicine/resources/quality-of-life-questionnaires/dermatology-life-quality-index
Scoring
Each question is scored from 0 to 3, giving a possible score range from 0 (meaning no impact of skin disease on quality of life) to 30 (meaning maximum impact on quality of life).
Meaning of DLQI scores A series of validated “band descriptors” were described in 2005 to give meaning to the scores of the DLQI.Hongbo Y, Thomas CL, Harrison MA. Salek MS, Finlay AY. Translating the science of quality of life into practice: what do Dermatology Life Quality Index scores mean? Journal of Investigative Dermatology 2005; 125: 659-664.
These bands are as follows: 0-1 = No effect on patient’s life, 2-5 = Small effect, 6-10 = Moderate effect, 11-20 = Very large effect, 21-30 = Extremely large effect.
The Minimal Clinically Important Difference (MCID) is the score difference that is the minimum meaningful difference for a patient. Although previously considered to be 5,Khilji FA, Gonzalez M, Finlay AY. Clinical meaning of change in Dermatology Life Quality Index scores. British Journal of Dermatology 2002; 147 (Suppl 62): 50. the DLQI MCID for inflammatory skin diseases should be considered to be a score difference of 4.Basra MK, Salek MS, Camilleri I, Sturkey R, Finlay AY. "Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data". Dermatology 2015: 230 (1): 27-33.
Conversion to EQ-5D scores
DLQI scores can be converted to EQ-5D utility values.Ali FM, Kay R, Finlay AY, Piguet V, Kupfer J, Dalgard F, Salek MS. Mapping of the DLQI TO EQ-5D Utility Values using ordinal logistic regression. Quality of Life Research 2017 (in press)
Uses of DLQI
Clinical practice
The DLQI can provide clinicians with more accurate insight into the impairment of quality of life experienced by individual patients. This may lead to more appropriate clinical decisions.Salek S, Roberts A, Finlay AY. "The practical reality of using a patient-reported outcome measure in a routine dermatology clinic". Dermatology 2007; 215: 315-319. The DLQI can also be used when required by national guidelines, for example in the management of psoriasisSmith CH, Anstey AV, Barker JNWN, Burden AD, Chalmers RJG, Chandler DA, Finlay AY, Griffiths CEM, Jackson K, McHugh NJ, McKenna KE, Reynolds NJ, Ormerod AD. "British Association of Dermatologists’ guidelines for biologic interventions for psoriasis" 2009. British Journal of Dermatology 2009; 161: 987-1019. or hand eczema.Basra MK, Chowdhury MM, Smith EV, Freemantle N, Piguet V. "A review of the use of the dermatology life quality index as a criterion in guidelines and health technology assessments in psoriasis and hand eczema". Dermatol Clin 2012; 30: 237-44.
Guidelines
The DLQI is recommended for use in national treatment guidelines, and to assist management decisions,Mrowietz U, Kragballe K, Reich K et al. Definition of treatment goals for moderate to severe psoriasis: a European consensus. Arch Derm Res 2011; 303; 1-10. in many countries, including: Australia,Baker C, Mack A, Cooper A, Fischer G, Shumack S, Sidhu S, Soyer P, Wu J, Chan J, Nash P, Rawlin M, Radulski B, Foley P. Treatment goals for moderate to severe psoriasis: An Australian consensus. Australas J Dermatol. 2013; 54: 148-154. Canada,Adams SP, Albrecht L, Barankin B et al. Canadian guidelines for the management of plaque psoriasis: overview. J Cutan Med Surg 2011:15; 210-219. Bulgaria,Rencz F, Kemény L, Gajdácsi JZ, Owczarek W, Arenberger P, Tiplica GS, Stanimirović A, Niewada M, Petrova G, Marinov LT, Péntek M, Brodszky V, Gulácsi L. Use of biologics for psoriasis in Central and Eastern European countries. J Eur Acad Dermatol Venereol. 2015;29(11):2222-30. Croatia, Czech Republic, England and Wales,NICE guidelines: Psoriasis: Infliximab TA134 (2008), pages 4,6,8-13,15-16, available at http://www.nice.org.uk/nicemedia/live/11910/38954/38954.pdf . Europe,Pathirana D, Ormerod AD, Saiag P et al. European S-3 guidelines on the systemic treatment of psoriasis vulgaris. J Eur Acad Dermatol Venereol 2009; 23 (Suppl 2): 1-70. Germany,Nast A, Kopp IB, Augustin M, et al. Evidence-based (S3) guidelines for the treatment of psoriasis vulgaris. J Dtsch Dermatol Ges 2007;5 Suppl 3:1-119. Hungary, Italy,Marchesoni A, Altomare G, Matucci-Cerinic M et al. An Italian shared dermatological and rheumatological proposal for the use of biological agents in psoriatic disease. J Eur Acad Dermatol Venereol 2010; 24: 578-586. Japan,Ohtsuki M, Terui T, Ozawa A et al. Japanese guidance for use of biologics for psoriasis (the 2013 version). J Dermatol 2013; 40: 683-95. Norway,Kragballe K, Gniadecki R, Mork N-J et al. Implementing best practice in psoriasis: a Nordic expert group consensus. Acta Dermato-Venereolica 2014; 94: 547-552. Poland, Romania, Saudi Arabia,Hamadah IR, Al Raddadi AA, Bahamdan KA et al. Saudi practical guidelines on biologic treatment of psoriasis. J Dermatolog Treat 2015; 26: 223-9. Scotland,Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis and management of psoriasis and psoriatic arthritis in adults. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2010 Oct. 65 p. (SIGN publication; no. 121). Singapore,Su-Ni W, Theng C. Dermatological Society of Singapore Psoriasis Management Guidelines, 2016. South Africa,Raboobee N, Boobaker J, Jordaan HF et al. Guideline on the management of psoriasis in South Africa. South African Medical Journal 2010; 100: 259-282. Spain,L. Puig, J.M. Carrascosa, E. Daudén, J.L. Sánchez-Carazo, C. Ferrándiz, M. Sánchez-Regaña, M. García-Bustinduy, X. Bordas, J.C. Moreno, J.M. Hernanz. Spanish Evidence-Based Guidelines on the Treatment of Moderate to Severe Psoriasis with Biologic Agents. Actas Dermo-Sifiliográficas 2009; 100: 386-413. Sweden,M Schmitt-Egenolf. PsoReg – The Swedish registry for systemic psoriasis treatment. The registry’s design and objectives. Dermatology 2007; 214: 112-7. Switzerland,Kolios AGA, Yawalker N, Anliker M et al. Swiss S1 guidelines on the systemic treatment of psoriasis vulgaris. Dermatology 2016; 232: 385-406. Taiwan,Tsai TF, Lee C-H, Huang Y-H. Taiwanese dermatological consensus statement on management of psoriasis. Dermatologica Sinica 2017; 35: 66-77. TurkeyAlper S et al. Updated guidelines for the management of psoriasis with biologic agents. Turkderm 2010; 44: 105-112. and Venezuela.Otero FG, Paez E. I consenso nacional de psoriasis, 2009. Dermatol Venez 2009; 47: 37-56.
Research
The DLQI has been used as a patient reported outcome measure in many published clinical research studies.Basra MKA, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: A comprehensive review of validation data and clinical results. British Journal of Dermatology 2008; 159: 997-1035. For example, it has been used to assess novel drugs,Katugampola RP, Lewis VJ, Finlay AY. The Dermatology Life Quality Index: assessing the efficacy of biological therapies for psoriasis. British Journal of Dermatology 2007; 156: 945-950. models of clinical care, in audit of clinical services and in assessment of teledermatology. The DLQI is the most widely used quality of life outcome measure in randomised controlled trials of therapies for psoriasis.Ali FM, Cueva AC, Vyas J, Atwan AA, Salek MS, Finlay AY, Piguet V. A systematic review of the use of quality of life instruments in randomized controlled trials of psoriasis. Br J Dermatol 2017; 176(3): 577-593.
Rule of Tens
The Rule of Tens is a concept to aid clinicians in making the diagnosis of “severe psoriasis”.Finlay AY. "Current severe psoriasis and the Rule of Tens". British Journal of Dermatology 2005; 152: 861-867. It states that a patient is considered to have “severe psoriasis” if their body surface area affected is >10%, or if their Psoriasis Area and Severity Index (PASI) score is >10, or if the DLQI score is >10. The Rule of Tens has influenced national guidelines concerning the criteria to be fulfilled before starting a patient on biological therapy.
Copyright The DLQI is copyrighted but the originators allow it to be used for routine clinical purposes without seeking permission and without charge.
E-delivery The DLQI has been validated for use on tablets such as the iPad.Ali FM, Johns N, Finlay A, Salek MS, Piguet V. Comparison of the paper-based and electronic versions of the Dermatology Life Quality Index (DLQI): evidence of equivalence. Br J Dermatol. 2017 Jan 23. doi: 10.1111/bjd.15314.
Systematic reviews of DLQI usage
Several systematic reviews have been carried out documenting the use of the DLQI.