Quality of life and psychological impact in the photodermatoses: a systematic review

Background The photodermatoses affect large proportions of the population but their impact on quality of life (QoL) and psychological health has not been reviewed. Several tools are available to evaluate QoL and psychological impacts. Objective To systematically review current literature to identify tools used to assess QoL and psychological impacts in patients with photodermatoses, and to summarise reported findings. Methods A systematic search of Pubmed, OVID Medline, PsycInfo and CINAHL was performed for articles investigating QoL and/or psychological impact in patients with photodermatoses, published between 1960‐September 2018. Results 20 studies were included; 19 incorporated QoL assessment while 3 evaluated psychological morbidity. Six QoL tools were found to be used: Dermatology Life Quality Index (DLQI), Children's DLQI, Family DLQI, Skindex (versions 16, 29), Erythropoietic Protoporphyria Quality‐of‐Life (EPP‐QOL) and EuroQoL. Between 31‐39% of photosensitive patients reported very large impact on QoL (DLQI>10). Employment/education, social/leisure activities and clothing choices were particularly affected. Only one tool was specifically designed for a photodermatosis (EPP‐QOL). Four tools were used to evaluate psychological impact: the Hospital Anxiety and Depression Scale, Fear of Negative Evaluation, brief COPE and Illness Perception Questionnaire‐Revised. Levels of anxiety and depression were approximately double British population data. Patients with facial involvement, female gender and younger age at onset showed more psychological morbidity. Conclusions Several tools have been used to assess QoL in the photodermatoses, and confirm substantial impact on QoL. Development of specific, validated QoL measures would address their unique impacts. Research delineating their psychological comorbidity is sparse and requires further exploration.