The Children's Dermatology Life Quality Index (CDLQI): initial validation and practical use

Lewis‐Jones, M.S.; Finlay, Andrew Y.

doi:10.1111/j.1365-2133.1995.tb16953.x

Cited by 835 publications

(475 citation statements)

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“…Dermatology-specific quality of life was assessed using the IDQoL 41 (for children aged 3 months to < 4 years) and the CDLQI 42 (for children aged 4 years to < 8 years). These instruments have both been validated and are used extensively in dermatology research.…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

Francis

Ridd

Thomas-Jones

et al. 2016

Health Technol Assess

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BackgroundSecondary skin infection is common during eczema exacerbations and many children are treated with antibiotics when this is suspected, although there is little high-quality evidence to justify this practice.ObjectiveTo determine the clinical effectiveness of oral and topical antibiotics, in addition to standard treatment with emollients and topical corticosteroids, in children with clinically infected eczema.DesignMulticentre randomised, double-blind, placebo-controlled trial.SettingGeneral practices and dermatology clinics in England, Wales and Scotland.ParticipantsChildren (aged 3 months to < 8 years) with a diagnosis of eczema (according to U.K. Working Party definition) and clinical suspicion of infection.Interventions(1) Oral flucloxacillin and topical placebo; (2) topical fusidic acid (Fucidin®, Leo Laboratories Limited) and oral placebo; and (3) oral and topical placebos, all for 1 week.Main outcome measuresPatient-Orientated Eczema Measure (POEM) at 2 weeks (assessing subjective severity in the week following treatment).ResultsWe randomised 113 children (36 to oral antibiotic, 37 to topical antibiotic and 40 to placebo), which was fewer than our revised target sample size of 282. A total of 103 (92.0%) children had one or more clinical features suggestive of infection and 78 (69.6%) children hadStaphylococcus aureuscultured from a skin swab. Oral and topical antibiotics resulted in a 1.52 [95% confidence interval (CI) –1.35 to 4.40] and 1.49 (95% CI –1.55 to 4.53) increase (worse subjective severity) in POEM score at 2 weeks, relative to placebo and controlling for baseline POEM score. Eczema Area and Severity Index (objective severity) scores were also higher (worse) in the intervention groups, at 0.20 (95% CI –0.12 to 0.52) and 0.42 (95% CI 0.09 to 0.75) for oral and topical antibiotics, respectively, at 2 weeks. Analyses of impact on the family, quality of life, daily symptom scores, and longer-term outcomes were all consistent with the finding of no or limited difference and a trend towards worse outcomes in the intervention groups. Sensitivity analyses, including adjusting for compliance and imputation for missing data, were consistent with the main findings.ConclusionsOur data suggest that oral and topical antibiotics have no effect, or a harmful effect, on subjective eczema severity in children with clinically infected eczema in the community. The CIs around our estimates exclude a meaningful beneficial effect (published minimal clinically important difference for POEM is 3.4). Although most patients in this trial had features suggestive of infection andS. aureuson their skin, participants primarily had mild–moderate eczema and those with signs of more severe infection were often excluded. Clinicians should consider avoiding oral and topical antibiotic use in children with suspected infected eczema in the community who do not have signs of ‘severe infection’. Further research should seek to understand how best to encourage the use of topical steroids and limit use of antibiotics in those with eczema flares without signs of severe infection, as well as developing tools to better phenotype eczema flares, in order to better define a population that may benefit from antibiotic treatment.Trial registrationEuropean Union Drug Regulating Authorities Clinical Trials (EudraCT) number 2011-003591-37 and Current Controlled Trials ISRCTN96705420.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Section: Secondary Outcome Measuresmentioning

confidence: 99%

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

Francis

Ridd

Thomas-Jones

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

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“…Patients self-assessed their quality of life using a validated scale specific of their age: the Infant's Dermatitis Quality of Life Index for subjects under 5 years [21], Children's Dermatology Life Quality Index ‘cartoon' for children aged 5-10 [22], the Children's Dermatology Life Quality Index for subjects aged 11-16 [23] and the DLQI for subjects above the age of 16 [11]. …”

Section: Methodsmentioning

confidence: 99%

Analysis of Correlations between Patient-Oriented SCORAD (PO-SCORAD) and Other Assessment Scores of Atopic Dermatitis Severity and Quality of Life

Coutanceau

Stalder²

2014

Dermatology

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Objective: Self-assessment scores such as the Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD) index being recommended by public health authorities for chronic disease management, we aimed at analysing correlations between PO-SCORAD and physician and patient assessment scores of atopic dermatitis (AD) severity and quality of life. Methods: We perfomed an observational study conducted in 12 European countries in 4,222 atopic patients aged ≥1 month and prescribed Exomega® emollient cream. AD severity was measured by the SCORAD index, PO-SCORAD, Patient-Oriented Eczema Measure (POEM) and Self-Administered Eczema Area and Severity Index (SA-EASI) scales, and patient and family quality of life by the Dermatology Life Quality Index (DLQI) and Dermatitis Family Questionnaire Impact (DFQI) scales, respectively. Their correlations were analysed. Results: PO-SCORAD was the only self-assessment score to be highly correlated with the SCORAD index and POEM (r ≥ 0.70). It was also the best correlated with the DLQI (r = 0.67) and DFQI (r = 0.56). After a 5-week treatment, SCORAD index and PO-SCORAD severity scores had decreased significantly by 60 and 56% (p < 0.0001), and quality of life had improved. Conclusion: PO-SCORAD is better correlated with quality of life scales than other self-assessment scores.

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“…A systematic review of named outcome measure scales for atopic eczema 45 found that, of the 20 named scales in current use, only three have been validated adequately enough to be recommended for use in clinical trials: Severity Scoring of Atopic Dermatitis (SCORAD), 47 Eczema Area and Severity Index (EASI) 48 and the Patient-Oriented Eczema Measure (POEM). 49 Quality-of-life measures specific to dermatology include the Dermatology Quality of Life Index [50][51][52] and Skindex 53,54 Why is a scoping systematic review still needed?…”

Section: Other Recommendations Includedmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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The Children's Dermatology Life Quality Index (CDLQI): initial validation and practical use

Cited by 835 publications

References 10 publications

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

A randomised placebo-controlled trial of oral and topical antibiotics for children with clinically infected eczema in the community: the ChildRen with Eczema, Antibiotic Management (CREAM) study

Analysis of Correlations between Patient-Oriented SCORAD (PO-SCORAD) and Other Assessment Scores of Atopic Dermatitis Severity and Quality of Life

Scoping systematic review of treatments for eczema

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