South Carolina: Impact of DSAP on Quality of Life

Physical and psychological burdens of disseminated superficial actinic porokeratosis (DSAP) can be reduced by treatment with topical lovastatin as the condition significantly impacts QoL, a recent study has found. Further, the researchers suggest that clinicians should be aware of the impact of DSAP on patients' quality of life. The study was published in the Journal of the American Academy of Dermatology on February 22, 2022.

Background

Disseminated superficial actinic porokeratosis (DSAP) is typically progressive and lifelong. Not much data is available regarding the impact of DSAP on QoL. Gabriella Santa Lucia, Medical University of South Carolina, Charleston, South Carolina, and colleagues sought to identify the overall impairment of QoL in DSAP patients, measure the impact of treatment on QoL, and assess correlations in QoL impairment.

Study Methodology

For this purpose, the researchers prospectively evaluated QoL measures in adult patients with DSAP in a randomized controlled trial comparing topical 2% lovastatin and 2% lovastatin/2% cholesterol from August 2020 to April 2021. They conducted a cross-sectional analysis of sociodemographic data and averaged self-reported DSAP-related impact on QoL (scale 1-10) at baseline. The RAND36 and Dermatology Life Quality Index (DLQI) were distributed and averaged at weeks 0, 4, 8, and 12. A repeated-measures analysis of variance and Pearson correlation coefficient were the statistical measures used in the analysis.

Participants

26 (84%) of the 31 subjects were women and 5 (16%) were men, with a mean age of 57 years.

Findings

• The patients had failed a mean of 2.5 treatments before enrolling in the trial. The mean DSAP QoL score was 6.0 ± 2.3.
• The average baseline DLQI score before treatment was 6.2 ± 3.5. After 3 months of treatment, QoL increased, with DLQI scores decreasing to 2.6 ± 2.8 for both treatment groups. No significant differences in DLQI scores were observed between treatment groups, and no significant difference in RAND36 scores was found at any time point.
• The self-reported DSAP-related impact on QoL was positively correlated with the DLQI score (r = 0.584) and negatively correlated with the disease duration (r = −0.455). Age, sex, disease duration, delay of diagnosis, and the number of physicians visited were not statistically correlated with DLQI scores.
• Qualitative interviewing revealed that 29 (94%) subjects experienced negative psychosocial stigmata associated with DSAP lesions, including public commenting or ridicule, low self-esteem, intimacy issues, social withdrawal, as well as lifestyle changes in the choice of clothing and geographic residence, vacation preference, or time spent outdoors.

"The findings of this study suggest a QoL impact of DSAP similar to that of vitiligo or alopecia areata," wrote the authors. 94% of participants reported that DSAP influenced their QoL.

"After treatment, however, 77% experienced an improvement in DLQI scores from baseline, with a collectively significant reduction in the mean scores from week 0 to week 12." The greatest decrease in DLQI scores was within the first month of treatment. This underscores the need to consider early and more holistic treatment, they note.

Conclusion

To conclude, the clinician should be aware that DSAP impacts QoL and that treatment can reduce the physical and psychosocial burdens of the disease.

Reference

The study titled, "Disseminated superficial porokeratosis: Impact on quality of life," was published in the Journal of the American Academy of Dermatology.

DOI: https://doi.org/10.1016/j.jaad.2022.02.032

Keywords

Journal of the American Academy of Dermatology, disseminated superficial actinic porokeratosis, quality of life, skin condition, treatment, Gabriella Santa Lucia, disease burden, topical lovastatin, DSAP, porokeratosis, QoL