Impact of xerosis cutis, with or without skin disease, on health‐related quality of life: A prospective study

The prevalence of dry skin varies among countries.1-4 Moreover, self-reported prevalence might be higher than that of physician-confirmed prevalence. A European study in 6 regions demonstrated a self-reported prevalence as high as 51.7%. A German study showed a self-reported prevalence of nearly 30%, while a French prevalence study suggested that 23.83% of French individuals >15 years old have dry skin (20.01% without any associated dermatosis and 32.48% with a concomitant skin disease such as atopic dermatitis and psoriasis).1 However, minimal attention has been given to explore the burden of dry skin from a patients' perspective. The primary objective of our study (‘Registry of Dry Skin’) was to estimate the impact of dry skin on sleep and Quality of Life (QoL) in patients with skin dryness associated or not with one of the following chronic inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis. This French prospective, observational study was conducted from January 2017 to January 2018. It included patients from 126 dermatologists in private practice centres. Patients had a diagnosis of skin dryness made by a dermatologist associated or not with a chronic inflammatory skin disease. To avoid any centre effect, each dermatologist could not include more than five patients. The Short-Form SF-12v2 Health Survey (SF12) and the Dermatology Life Quality Index (DLQI) were completed during outpatient dermatology consultations. Sleep quality was assessed with a specific question. The SF-12 is a short version of the SF-36, a generic self-questionnaire that assesses health status in the general population. Responses to questions are dichotomous (yes/no), ordinal (excellent to poor) or expressed as a frequency (always to never). Two scores can be calculated from these 12 questions: a Physical Component Summary (PCS-12) and a Mental Component Summary (MCS-12). A higher score corresponds to a better quality of life. Five hundred forty-five patients were included. 64% were women, with a mean age that differed according to the chronic skin disorder. 96% of patients were aware of their dry skin condition. Overall, 67% of patients reported a sleep disorder, and 41% stated that it was related to their dry skin. Patients with senile xerosis reported the highest complaints about sleep disorders (83%), followed by those with psoriasis (78%), xerosis with no skin disease (73%) and atopic dermatitis (65%). The average DLQI score was 5.3 and the PCS-12 and the MCS-12 were 52.2 and 44.7, respectively. Our study showed a major impact of dry skin on sleep. However, the DLQI showed some limitations in detecting this impact, as it only showed small or moderate effect on QoL. On the contrary, the SF12, especially the mental dimension seemed more relevant. Dry skin is highly associated with old age, with a prevalence reaching 55.6%.5 Among patients who had xerosis with no skin disease, elderly were more impacted than younger patients based on SF12. They also complained more about sleep disorders. Patients with xerosis and AD had a higher burden than patients with xerosis without AD (based on MCS-12 and DLQI), which is consistent with another smaller German study.6 This was also true in the case of psoriasis where patients with disease and xerosis had a higher impact on their QoL. Special needs for elderly must be addressed by making appropriate changes in national health policies. It is imperative to include skin health as a component to assess the overall well-being of geriatrics.7 Although the impact of xerosis on patients' QoL is high, it remains difficult to assess. Therefore, it is of utmost importance to assess sleep disorder and QOL in any subject with skin xerosis associated or not with a chronic inflammatory skin disease and recommend its management (Table 1). This study was granted by La Roche Posay France. AL Demessant-Flavigny, C Le Floc'h, Sophie Seite, are employed by the La Roche Posay. Jean David Bouaziz, Charbel Skayem, Charles Taieb and Julien Seneschal have no conflict of interest in this study. The data that support the findings of this work are available from the corresponding author upon reasonable request.