PD03 Psychological morbidity and health-related quality of life in a tertiary photobiology clinic: a cross-sectional study
Authors: Jason Ting, Sheila McSweeney, Kelsey Jones, Sophie Momen, Hiva Fassihi, Robert Sarkany, John Ferguson
Journal: British Journal of Dermatology (2024)

Abstract Photodermatoses comprise a heterogeneous group of disorders characterized by abnormal skin responses following physiological exposure to solar radiation. Previous investigations have established that photodermatoses are associated with significant psychological morbidity and poor health-related quality of life (HRQoL), although few studies have quantified this phenomenon in large patient cohorts. Therefore, the aim of this study was to perform a cross-sectional evaluation of patient-reported psychological morbidity and HRQoL in a large tertiary photobiology unit. Patients aged ≥ 16 years who attended outpatient appointments at a tertiary photobiology unit between October 2022 and August 2023 were issued a survey delivered directly to their smartphone using an online platform (DrDoctor). This survey used both free-text questions and established questionnaire tools to measure psychological morbidity and HRQoL. The questionnaires included General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), Brief Illness Perception Questionnaire, Patient-Reported Outcome Measurement System-Profile 57, and Dermatology Life Quality Index (DLQI). Based on screening questions that identified the patient as new or follow-up and their diagnosis (if known), a tailored selection of questionnaires was administered. Formal thematic analysis was performed on free-text answers using NVivo (QSR International, Doncaster, Australia) and WordCloud. Descriptive statistical analyses were performed using SPSS (IBM, Armonk, NY, USA). During the study period, 1538 surveys were sent to patients, including those attending for repeat follow-ups. Data from 176 new patients were analysed and, following exclusion of surveys derived from repeat attendances, data from 414 follow-up patients were analysed. Among new patients, 86.9% were aware of their skin’s sensitivity to sunlight, with 61.3% reporting symptoms year round and 27.8% in summer only. Additional perceived triggers included stress, genetics, heat and medication, while patients’ aims for their appointments were to identify the cause of their condition, their diagnosis, a potential cure, and the best treatment options. Of 414 follow-up patients, 75% reported knowing their diagnosis. These were chronic actinic dermatitis (19%), erythropoietic protoporphyria (19%), polymorphic light eruption (15%), solar urticaria (12%), photoaggravated eczema (12%), lupus or other connective tissue disorders (7%), and other diagnoses (16%). In total, 32.6% of follow-up patients had a GAD-7 score ≥ 5 (consistent with clinically relevant anxiety) and 36.7% had a PHQ-9 score ≥ 5 (consistent with clinically relevant depression). Among conditions for which DLQI was measured, the highest median DLQI over the past year was 13, reported by patients with chronic actinic dermatitis. This study highlights the significant psychological impact of photodermatoses and their detrimental effects on HRQoL, which affect patients with chronic actinic dermatitis in particular.