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Our Dermatol Online 2014; 5(2): 124 
Date of submission:  03.04.2014 / acceptance: 07.04.2014
Conflicts of interest: None

Vasanthada Deepthi, PM Vasanth Kumar, Pasagadagula Krishna Rao, Tatapudi Ramesh, Malothu Ramesh


Ass. Prof. Antonio Chuh MD FRCP FRCPCH1, Prof. Vijay Zawar MD DNB DV&D FAAD2

1School of Public Health, The Chinese University of Hong Kong and Prince of Wales Hospital, Shatin, Hong Kong
2Department of Dermatology, Godavari Foundation Medical College and Research Center, DUPMCJ, India
How to cite an article: Chuh A, Zawar V. comment: Evaluation of therapeutic response of methotrexate and calcipotriol combination compared with methotrexate alone in plaque psoriasis. Our Dermatol Online. 2014; 5(2): 124.

We write to express our concerns on the adoption of only physician-rated outcome measurement, namely the Psoriasis Area and Severity Index, in this otherwise exceptionally well conducted randomised controlled trial, without the adoption of any patient-rated outcome variable, such as quality of life (QOL) indexes. Skin diseases might cast very significant impacts on the quality of life of patients. However, symptoms and impacts on the QOL are known to be not necessarily correlate directly with disease severity as rated by physicians for skin diseases [1, 2], including psoriasis vulgaris [3]. QOL indexes, such as the Dermatology Life Quality Index [4] and the Children Dermatology Life Quality Index [5], have been constructed, validated, and validly translated into a large number of languages [1, 6, 7]. A vast range of skin disease-specific instruments from acne vulgaris [8] to autoimmnune bullous diseases [9] is also available. Treatment options would be tailored-made for individual patients based on such evaluations. For psoriasis specifically, it has been recommended that Psoriasis Area and Severity index and Dermatology Life Quality Index should be measured at the same frequency in daily clinical practice [10]. As for clinical trials, it has been found that the high-quality Cochrane systematic reviews in skin diseases included significantly more QOL as outcome measures than non-Cochrane non-Cochrane systematic reviews [11]. Moreover, Cochrane skin reviews usually adopt QOL indexes as primary outcome measures in randomised controlled studies. We therefore cast hopes that future clinical trials on psoriasis and other skin diseases would incorporate QOL measurements as outcome measures, so that the symptoms, the impacts on daily activities and self image, and the negative impacts exerted by treatments could be validly and reliably compared for different therapeutic approaches. Lastly, we congratulate the success of Vasanthada D et al again in reporting this study which will affect treatment decisions for patients with psoriasis vulgaris necessitating systemic immunosuppressive therapies.
1. Chuh AAT, Chan HHL. The effect on quality of life in patients with pityriasis rosea – is it associated with rash severity? Int J Dermatol. 2005;44:372-7.
2. Mulder MM, Sigurdsson V, van Zuuren EJ, Klaassen EJ, Faber JA, de Wit JB. Psychosocial impact of acne vulgaris – evaluation of the relation between a change in clinical acne severity and psychosocial state. Dermatology. 2001;203:124-30.
3. Roblin D, Wickramasinghe R, Yosipovitch G. Pruritus severity in patients with psoriasis is not correlated with psoriasis disease severity. J Am Acad Dermatol. 2014;70:390-1.
4. Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clin Exp Dermatol. 1994;19:210-6.
5. Lewis-Jones MS, Finlay AY. The Children’s Dermatology Life Quality Index (CDLQI): initial validation and practical use. Br J Dermatol. 1995;132:942-9.
6. Chuh AAT. Validation of a Cantonese version of the Children Dermatology Life Quality Index. Pediatr Dermatol. 2003;20:479-81.
7. Jankovic S, Vukicevic J, Djordjevic S, Jankovic J, Marinkovic J, Eric M. The Children’s Dermatology Life Quality Index (CDLQI): linguistic and cultural validation in Serbia. J Cutan Med Surg. 2013:17:316-20.
8. Motley RJ, Finlay AY. Practical use of a disability index in the routine management of acne. Clin Exp Dermatol. 1992;17:1-3.
9. Sebaratnam DF, Hanna AM, Chee SN, Frew JW, Venugopal SS, Daniel BS et al. Development of a quality-of-life instrument for autoimmune bullous diseases: the Autoimmune Bullous Disease Quality of Life questionnaire. JAMA Dermatol. 2013;149:1186-91.
10. Kragballe K, Gniadecki R, Mork NJ, Rantanen T, Stahle M. Implementing best practice in psoriasis: A Nordic Expert Group Consensus. Acta Derm Venereol. 2014; 10.2340/00015555-1809 (Epub ahead of print).
11. Collier A, Heilig L, Schilling L, Williams H, Dellavalle RP. Cochrane Skin Group systematic reviews are more methodologically rigorous than other systematic reviews in dermatology. Br J Dermatol 2006;155:1230-5.

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