Search Results (541)

Background/Objectives: The itch–scratch cycle is a key driver of exacerbation in atopic dermatitis (AD) and requires objective monitoring, yet patient-reported itch scores are often unreliable in children. This study aimed to evaluate smartwatch-derived nocturnal scratching metrics as digital biomarkers of disease activity and treatment response in pediatric AD. Methods: In this prospective observational study, 50 children (median age 9 years) with physician-diagnosed AD wore an Apple Watch with the Itch Tracker application for 5–14 nights during initiation of topical therapy. Three scratch metrics—scratch count rate (SCR), scratch duration ratio (SDR), and scratch burden index (SBI, duration × intensity)—were analyzed. Associations with clinical outcomes [Eczema Area and Severity Index (EASI), Patient-Oriented Eczema Measure (POEM)], serum thymus and activation-regulated chemokine (TARC), and itch numerical rating scale (NRS) were examined. Logistic regression models were evaluated to examine whether these metrics could identify children who achieved clinically meaningful improvement, defined as EASI-50 plus ≥ 4-point POEM reduction. Results: All scratch metrics correlated with baseline EASI (r = 0.60–0.64, p < 0.001) and serum TARC (r = 0.58–0.60, p < 0.001). Reductions in scratching paralleled clinical improvement (r = 0.67–0.71, p < 0.0001). Among models, the SBI-based logistic regression demonstrated the best discriminative performance (AUC = 0.78, 95% CI: 0.64–0.92). Conclusions: Wearable-derived nocturnal scratching metrics showed moderate but consistent associations with disease severity and short-term improvement. Although predictive capability remains to be established, these metrics may serve as treatment-responsive digital measures. Given the cross-sectional nature of biomarker analyses and other study limitations, further prospective validation is required before clinical application in real-world pediatric AD monitoring. Full article

Helichrysum odoratissimum (L.) Less. is used as a traditional medicine in South Africa to treat tuberculosis, abdominal pains, heartburn, coughs, colds, female sterility, eczema and wounds. In Uganda, the leaves are used to treat dental/oral diseases. This review aims to provide detailed information on the traditional uses, essential oils, phytochemistry, in silico studies, and pharmacological studies and propose possible future research directions on this widely investigated species. The data was gathered from various online electronic databases such as Science Direct, Scopus, Google Scholar, Web of Science, SciFinder, Wiley Online, SpringerLink, and PubMed. Reports on the essential oil composition of H. odoratissimum showed the dominance of monoterpenoids and sesquiterpenoid compounds. Several studies also reported the isolation of the non-volatile compounds, which were mainly flavonoids and terpenes. The species has been reported to have pharmacological activities such as antimicrobial, antimycobacterial, antioxidant activity, antidiabetic, antiproliferative, anti-inflammatory activity and antityrosinase activity. The most important study on H. odoratissimum was a clinical trial in human participants in South Africa addressing its in vivo irritancy potential. However, further research on the clinical and scientific aspects is needed to justify some of its other medicinal uses. Full article

Background: Prenatal vitamin D exposure has been proposed as a potential determinant of immune development and subsequent allergic disease risk in offspring; however, long-term cohort data remain inconsistent. Methods: We analyzed data from the KLOTHO birth cohort, including 98 adolescents with available allergic outcome assessment. A maternal–neonatal sub-cohort of mother–child pairs with available maternal and neonatal serum total 25-hydroxyvitamin D₃ [25(OH)D] measurements at delivery was used for vitamin D analyses. Allergic outcomes included asthma, allergic rhinitis, and eczema in offspring. Associations were evaluated using descriptive statistics, Spearman correlation analyses, and logistic regression models. Results: Maternal 25(OH)D concentrations were not significantly associated with asthma (ρ = 0.075, p = 0.652), allergic rhinitis (ρ = 0.100, p = 0.556), or eczema (ρ = 0.131, p = 0.426). In crude logistic regression models, vitamin D concentrations were not associated with asthma (odds ratio (OR) per 10 nmol/L: 1.07, 95% confidence interval (CI): 0.78–1.48, p = 0.67), allergic rhinitis (OR: 1.05, 95% CI: 0.76–1.45, p = 0.77), or eczema (OR: 1.17, 95% CI: 0.86–1.60, p = 0.31). Adjusted models including maternal age, pre-pregnancy body mass index (BMI), season of delivery, and ultraviolet exposure yielded similar non-significant findings, although analyses were limited by a reduced complete-case sample size. Conclusions: In this prospective cohort with follow-up into early adolescence, vitamin D status at delivery was not associated with asthma, allergic rhinitis, or eczema in offspring. These findings support a lack of statistically significant association; however, potential non-linear relationships should be interpreted cautiously, given the modest sample size. Full article

This study explores Serbia’s rich ethnopharmacological heritage by systematically documenting the traditional use of medicinal plants for treating skin diseases during the 19th and 20th centuries. Drawing on key ethnographic sources—including monographs, scholarly articles, and field reports—the review analyzes historical records of folk medicine practices and their cultural contexts. A total of 164 plant species from 63 botanical families, as well as one mushroom species, were identified as being used in the treatment of skin-related conditions classified according to the International Classification of Primary Care. Reported ailments were grouped into three main categories: hair and scalp disorders, bites, and various inflammatory skin conditions such as eczema and psoriasis. Remedies for wound healing were the most frequently documented, both in terms of application and diversity of plant species employed. By preserving and systematizing this historical knowledge, the study provides a valuable foundation for future pharmacological and dermatological research, highlighting the continued relevance of traditional remedies in modern clinical practice. Full article

Phellodendri amurensis Cortex is the dried bark of the cork tree (Phellodendron amurense Rupr.) from the Rutaceae family, and possesses traditional efficacy in clearing heat, drying dampness, purging fire, relieving steaming sensations, detoxifying, and healing sores. Clinically, it is commonly used for treating symptoms such as damp-heat diarrhea and dysentery, jaundice with reddish urine, leukorrhea with vaginal itching, painful and difficult urination due to heat strangury, flaccidity and weakness of the lower limbs, bone-steaming and consumptive fever, night sweats and seminal emission, sores, ulcers, swellings, and toxins, eczema, damp sores, and urinary tract infections. Modern pharmacological studies have further revealed its diverse bioactivities, including antioxidant, antibacterial, anti-inflammatory, immunosuppressive, and anticancer effects. To provide an updated and comprehensive review of the research into Phellodendri amurensis Cortex, this study conducted a thorough literature search and analysis based on databases such as SciFinder, Web of Science, and China National Knowledge Infrastructure. The review integrates information on the plant’s botanical characteristics, geographical distribution, traditional applications, chemical components, quality control methods, and pharmacological effects to present a current and holistic overview of its research status. To date, approximately 170 compounds have been isolated and identified from Phellodendri amurensis Cortex, primarily including alkaloids, phenolics, terpenoids, sterols, lignans, flavonoids, and others. Among these, alkaloids exhibit significant antioxidant and anti-inflammatory activities and demonstrate potential pharmacological value in antibacterial, anticancer, hypoglycemic, and multi-organ protective effects. Although substantial foundational research exists, the mechanisms of action and quality control of Phellodendri amurensis Cortex require further in-depth exploration. Future efforts should focus on clarifying its pharmacodynamic material basis, uncovering new targets and pathways, and improving analytical methods for component analysis and quality control to advance the scientific development and rational utilization of this medicinal material. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with cutaneous pain. The objective of this study was to evaluate the impact of cutaneous pain on the prevalence of anxiety, depression, quality of life (QoL) and stigmatization in patients with AD. Methods: A cross-sectional study was conducted on a group of 113 adults with AD (61% females; mean age 34.48 ± 13.20 years). The severity of AD was evaluated using the Eczema Area and Severity Index (EASI). The intensity of cutaneous pain in the past week was measured using a Numerical Rating Scale (NRS), a Short Form McGill Pain Questionnaire (SF-MPQ) and a Visual Analogue Scale (VAS). Psychosocial burden was evaluated using the Hospital Anxiety and Depression Scale (HADS), the Anxiety Generalized Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Dermatology Life Quality Index (DLQI) and the 6-Item Stigmatization Scale (6-ISS). Results: Individuals with AD who reported cutaneous pain in the past week scored significantly higher in HADS (p < 0.001), HADS-A (p < 0.001), HADS-D (p = 0.002), GAD-7 (p < 0.001), PHQ-9 (p < 0.001), DLQI (p < 0.001) and 6-ISS (p < 0.001) than the rest of the cohort. More individuals with cutaneous pain had anxiety (36 (48.0%) vs. 7 (18.4%), p = 0.002), depression (21 (28.0%) vs. 2 (5.3%), p = 0.006) and abnormal HADS scores (46 (61.3%) vs. 9 (23.7%), p < 0.001) compared to the rest of participants. Significant correlations were observed between all studied pain assessment tools and all studied psychometric assessments. Conclusions: The prevalence and severity of anxiety, depression, stigmatization, and impaired QoL are higher in adults with AD suffering from cutaneous pain compared to those without pain. This symptom is significantly associated with disease burden. Full article

Background: Mechanistic evidence increasingly implicates fructose exposures as contributors to the development and exacerbation of asthma and other atopic diseases. Proposed mechanisms include gut dysbiosis, impaired epithelial barrier integrity in the gut and airways, metabolic endotoxemia, and amplification of type 2 immune responses. However, epidemiologic findings linking fructose intake with asthma and atopic disorders remain heterogeneous. Objective: To conduct a review of epidemiologic studies evaluating associations between dietary fructose-containing exposures and atopic outcomes in pediatric populations. Methods: A systematic search of PubMed and Embase identified cohort, case-control, cross-sectional, and randomized feeding studies assessing fructose exposure in relation to asthma and atopic outcomes in pediatric populations. Eligibility screening, data extraction, and risk-of-bias assessment were conducted by one reviewer and confirmed by the other. Results: Seventeen epidemiologic studies met criteria. Multiple cohorts (e.g., BRISA, PIAMA) reported modest to moderate associations between higher sugar-sweetened beverage (SSB) intake and pediatric asthma or “asthma traits.” Cross-sectional analyses from NHANES and the National Children’s Study showed stronger associations, with greater fructose exposures linked to two- to five-fold higher odds of asthma. High fructose beverage consumption demonstrated the most consistent positive associations. Large ISAAC-based studies reported largely null findings, reflecting broad dietary exposure categories and limited specificity for fructose-rich beverages. Evidence for rhinitis, eczema, and sensitization was directionally consistent. Conclusions: Despite heterogeneity, the convergence of mechanistic plausibility with epidemiologic signals supports a potential contributory role of high fructose exposure in pediatric atopic disease. More rigorous longitudinal studies with biomarker-based exposure assessment are needed to refine causal inference. Full article

Background: Food allergy (FA) is an increasing public health concern with significant implications for child health and quality of life. Early introduction of allergenic foods has been shown to reduce the risk of food allergy development; however, maternal awareness and adherence to these recommendations remain inconsistent. This study aimed to assess maternal awareness and practices regarding the timing of allergenic food introduction among mothers residing in Makkah, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted between November 2023 and March 2024 involving parents of children aged younger than 48 monthsin the Makkah region. Data were collected via a self-administered electronic questionnaire distributed through social media platforms. Results: A total of 391 parents participated. Parent-reported food allergy was identified in 11.3% of children, while 14.6% had eczema. Early introduction (<12 months) was more common for egg (43.3%) and wheat (71.1%) compared to peanut (28.9%), tree nuts (30.9%), sesame (30.9%), and seafood (28.9%). A considerable proportion of children had not been introduced to key allergenic foods even after 36 months, particularly peanuts (45.3%) and sesame (42.2%). Children with eczema were significantly more likely to have early introduction of egg (p = 0.035), tree nuts (p = 0.046), and seafood (p = 0.031). Similarly, children with a family history of food allergy had higher early introduction rates of tree nuts (55.3% vs. 44.0%, p = 0.043) and seafood (62.3% vs. 49.1%, p = 0.019). Only 25.8% of mothers were aware that early introduction might prevent food allergies, and just 22% reported receiving professional advice to introduce allergenic foods early. Conclusions: Maternal awareness regarding the timely introduction of allergenic foods in Makkah remains limited, with delayed introduction persisting beyond 36 months for several high-risk allergens. These findings underscore the need for targeted educational interventions and improved counseling by healthcare providers. Full article

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex and highly polygenic genetic architecture, in which immune-mediated mechanisms play a central role. Here, we integrated single-cell cis-expression quantitative trait loci from 14 immune cell types with AD GWAS summary statistics using a two-sample Mendelian Randomization (MR) framework to resolve cell-specific genetically mediated transcriptional effects. We identified 303 significant cell-specific gene–trait associations with limited overlaps across cell types. A multi-step prioritization strategy refined these findings to 35 genes across all 14 cell types. A comparison with whole blood cis-eQTLs revealed a limited concordance, suggesting an attenuation of cell-specific regulatory effects in bulk transcriptomic approaches. Intersecting single-cell and bulk evidence identified 22 high-confidence genes with a relatively independent mechanism of action. Integrative annotation implicated several immune-relevant and druggable genes, including IL2RA, with distinct cell-specific effects. Our findings demonstrate diverse mechanisms of risk genes for AD at the single-cell level that act across immune cell states and pathways, with implications for therapeutic interventions. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with substantial symptom burden and impaired quality of life. Lebrikizumab, a monoclonal antibody targeting interleukin-13, has emerged as a therapeutic option for patients with moderate-to-severe AD; however, a comprehensive synthesis of its efficacy and safety is required. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials comparing lebrikizumab with placebo in patients with moderate-to-severe AD. Searches were performed across major databases and trial registries. The primary outcome was achievement of a 50% improvement in the Eczema Area and Severity Index (EASI-50). Secondary efficacy outcomes included EASI-75, EASI-90, and improvement in pruritus measured by the Numeric Rating Scale (NRS). Safety was assessed through a quantitative meta-analysis of treatment-emergent adverse events (TEAEs) when extractable arm-level data were available. Random-effects models were applied, and certainty of evidence was evaluated using the GRADE framework. Results: Twelve randomized controlled trials were included. Lebrikizumab significantly increased the likelihood of achieving EASI-50 (RR 1.51, 95% CI 1.20–1.89), EASI-75 (RR 1.78, 95% CI 1.43–2.22), and EASI-90 (RR 2.26, 95% CI 1.67–3.06) compared with placebo, and was associated with clinically meaningful improvement in pruritus (RR 1.73, 95% CI 1.38–2.17). Substantial heterogeneity was observed for EASI-75 (I² = 77.5%); predefined subgroup analyses based on dosing regimen and dosing frequency partially explored this variability, but residual heterogeneity persisted, leading to downgrading of the certainty of evidence for EASI-75 to low. The certainty of evidence was moderate for EASI-50 and low for EASI-90 and pruritus improvement. Six trials contributed to the quantitative safety analysis. The pooled meta-analysis showed no significant difference in the risk of treatment-emergent adverse events between lebrikizumab and placebo (RR 1.03, 95% CI 0.82–1.28), with moderate heterogeneity (I² = 60.5%). Serious adverse events and treatment discontinuations were infrequently reported and could not be pooled quantitatively due to inconsistent reporting. Conclusions: Lebrikizumab demonstrates clinically meaningful efficacy and a favorable safety profile in patients with moderate-to-severe atopic dermatitis. However, as the available randomized evidence is predominantly derived from adult populations, the applicability of these findings to adolescents remains limited and warrants confirmation in adequately powered, adolescent-focused studies. Full article

Background/Objectives: Chronic rhinosinusitis with nasal polyps (CRSwNP) represents a common and debilitating inflammatory disorder primarily driven by type 2 immune mechanisms. Its frequent overlap with asthma, allergic rhinoconjunctivitis and atopic dermatitis highlights the need for therapeutic strategies able to address multimorbidity within the same pathogenic spectrum. The development of monoclonal antibodies targeting signaling pathways provides an effective and well-tolerated option that addresses common comorbidities. Targeting the IL-4 receptor alpha subunit, dupilumab is a completely human IgG4 monoclonal antibody that reduces type 2 inflammation in many organ systems by blocking IL-4 and IL-13 signaling. This study aimed to assess the long-term effectiveness and safety of dupilumab in a real-world cohort of patients with severe CRSwNP, stratified according to the presence of common type 2 comorbidities, over a 52-week treatment period. Methods: We conducted a prospective, multicenter, observational study across ten Italian secondary care centers for Allergy and Clinical Immunology and Otolaryngology. All participating centers were affiliated with the Italian Society of Allergy, Asthma and Clinical Immunology (SIAAIC). Enrolled adult subjects with severe CRSwNP received dupilumab treatment in the context of standard care for 52 weeks. Several efficacy parameters were used. Results: A significant improvement was detected for all the applied efficacy parameters, i.e., 22-item Sinonasal Outcome Test (SNOT-22) and bilateral endoscopic nasal polyp (NPS) scores for CRSwNP, Rhinitis Control Scoring System (RCSS) and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) scores for allergic perennial rhinitis, Forced Expiratory Volume in the first second (FEV1) and Asthma Quality of Life Questionnaire (AQLQ) scores for asthma, Eczema Area and Severity Index (EASI), Atopic Dermatitis Control Toll (ADCT) and Dermatology Life Quality Index (DLQI) scores for AD. Dupilumab was well-tolerated, with no new safety signals. Conclusions: This multicenter real-world study demonstrates that dupilumab provides sustained, clinically meaningful, and safe benefits for patients with severe CRSwNP and coexisting type 2 comorbidities, supporting its role as an integrated therapeutic option in precision management of type 2 inflammatory diseases. Full article

Background: Atopic dermatitis (AD) is a chronic, pruritic and relapsing inflammatory skin disorder affecting children’s quality of life (QoL). Despite rising global prevalence, data on its impact on QoL in low-resource settings remain limited. This study aimed to assess the impact of AD and associated factors on the QoL of children and assesses the effect of educational intervention in Ethiopia. Methods: A prospective cohort study was conducted among 461 AD children and their caregivers across four randomly selected hospitals dermatology clinics in Ethiopia from October 2022 to March 2024. Assessments included AD Severity using Scoring Atopic Dermatitis (SCORAD), Infants’ Dermatitis Quality of Life Index (IDLQI) for children aged 0–4, and Children’s Dermatology Life Quality Index (CDLQI) for children aged 5 to 16. Participants received educational guidance from trained nurses during follow-up beyond routine AD treatment. Trained personnel collected clinical and sociodemographic data. AD severity and QoL were reassessed after 6 months. Descriptive, univariate, and linear regression analyses identified factors influencing QoL, with associations reported as odds ratios (95% CI) and significance set at p < 0.05. Results: Of 461 children, 424 (92%) completed follow-up. Most were under five (67%) with a median age of 3 years; 72.2% had AD onset before age two. Most caregivers were female (68.9%). After six months, clinical signs of AD, including dryness, erythema, excoriation, and lichenification, improved notably. Mild AD increased by 33.5%, while moderate and severe cases decreased by 17.5% and 16%, respectively. QoL significantly improved across all domains (p = 0.001). Baseline disease severity (β = 0.11), change in severity (ΔSCORAD) (β = 0.043), number of dependents (β = −0.71), and age at disease onset (β = 0.005) as significant predictors of QoL. Conclusions: AD significantly impairs QoL in Ethiopian children, with greater severity causing more disruption. Routine treatments with educational interventions significantly improve disease severity and QoL. Integrated clinical and psychosocial care approaches for pediatric AD are crucial in resource-limited settings. Full article

Background/Objective: Tralokinumab, a monoclonal antibody targeting interleukin-13, is an effective treatment for atopic dermatitis (AD). However, real-world data on age-related differences in clinical responses, particularly among older patients, remain limited. We compared early improvements in pruritus and skin lesions, as well as effectiveness, safety, and treatment persistence of tralokinumab, between older patients aged ≥ 70 and <70 years in real-world clinical practice. Methods: This single-center retrospective study included 43 patients with AD who initiated tralokinumab. Patients who discontinued treatment within 3 months, lacked a 3-month evaluation, or had a baseline Eczema Area and Severity Index (EASI) score < 16 were excluded, leaving 33 patients for effectiveness analyses. Patients were stratified by age (≥70 vs. <70 years). Outcomes at 3 months included pruritus severity assessed by the Peak Pruritus Numerical Rating Scale (PP-NRS), eczema severity assessed by the EASI, and response rates (PP-NRS4 and EASI75). Adverse events and reasons for treatment discontinuation were evaluated in all patients. Results: At 3 months, both age groups showed improvement in pruritus and skin lesions. Patients aged ≥ 70 years demonstrated more pronounced early improvement, with a median PP-NRS of 1 (interquartile range, 0–3), a PP-NRS4 response rate of 89.5%, and an EASI75 response rate of 84.2%. Treatment continuation rates did not differ significantly between age groups, indicating comparable tolerability. Conclusions: Tralokinumab was effective and well tolerated in both age groups, with older patients experiencing earlier and more pronounced clinical improvement. These findings suggest that tralokinumab may be effective in elderly patients with atopic dermatitis. These results may suggest tralokinumab as an effective therapy for elderly patients with atopic dermatitis. Validation using larger prospective studies is needed. Full article

Background: Dermatitis affecting the earlobe is a highly frequent clinical presentation, predominantly attributed to Allergic Contact Dermatitis (ACD) caused by metallic ions like nickel from earrings. However, a significant subset of patients presents with recurrent eczematous lesions highly suggestive of ACD but with inconclusive or negative patch test results, posing a profound diagnostic and therapeutic dilemma. Objective: This comprehensive review critically evaluates the differential diagnosis of earlobe eczema in the context of negative patch tests. Drawing from a representative case of a 30-year-old female with recurrent earlobe eczema and a strong family history of psoriasis, we explore alternative non-immunological and endogenous mechanisms, specifically Irritant Contact Dermatitis (ICD) and the Koebner Phenomenon on a background of Psoriatic Diathesis. Methods: We performed an extensive review of the current literature focusing on the epidemiology and pathogenesis of metal ACD, non-allergic mechanisms of jewelry-induced dermatitis (ICD), the molecular basis of the Koebner phenomenon, and the clinical overlap between eczema and psoriasis (Eczematous Psoriasis). Results: The localized nature of the inflammation, coupled with the absence of generalized nickel sensitivity, strongly suggests that the mechanical and occlusive trauma from earrings can induce a purely irritant reaction. Crucially, the presence of a familial psoriatic diathesis supports the hypothesis that this local irritation acts as a Koebner phenomenon trigger, leading to an eczematous manifestation of an underlying psoriatic tendency. Conclusions: Not all recurrent eczematous lesions at common contact sites are caused by ACD. Clinicians must adopt an integrated diagnostic approach, factoring in personal and family history alongside patch test results, to differentiate true allergy from ICD and the Koebner phenomenon. This nuanced perspective is vital for providing appropriate counseling (strict jewelry avoidance) and targeted, often steroid-sparing, management (e.g., topical calcineurin inhibitors) for a durable therapeutic outcome. Full article

Background and Objectives: Atopic dermatitis and psoriasis are life-long inflammatory diseases affecting more than just the skin. Although their link with mental comorbidities has been established, the role of using self-assessment questionnaires is still debated. The aim of our study was to evaluate differences in the quality of life (DLQI) as well as depression (PHQ-9) and anxiety (GAD-7) questionnaire data and determine their link with individual patient and skin disease factors. Materials and Methods: Demographic, clinical and questionnaire data were collected from Riga 1st hospitals archive. For statistical evaluation, the Mann–Whitney U test and Spearman’s rank correlation coefficient were used. Results: The median DLQI for atopic dermatitis and psoriasis was 10.5 and 10, respectively. The prevalence among women with atopic dermatitis who had a PHQ-9 ≥ 10 was 42.9%, compared to 50.0% in men, and GAD-7 ≥ 10 prevalence was 14.3% and 20.0%, respectively. Psoriatic women had a PHQ-9 ≥ 10 prevalence of 25.0% compared with 28.9% in men. The prevalence of GAD-7 ≥ 10 was 20.0% in females and 15.8% in males. GAD-7 score was elevated in patients with psoriatic genital involvement. Multiple positive correlations were noted between PHQ-9, GAD-7 and DLQI scores. Conclusions: Patient quality of life and prevalence of anxiety and depression symptoms are impacted by psoriasis and atopic dermatitis, with similar patterns observed across genders and comorbidities. Genital involvement could be associated with more severe anxiety symptoms. The correlations between PHQ-9, GAD-7 and DLQI scores indicate that further evaluation might be necessary if quality of life is impaired. Full article