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Cross-cultural adaptation and validation of the Melasma Quality of Life scale in French language
P3203
P3205
Evaluation of the Melasma Quality of Life score of a population of French women Laurent Misery, MD, PhD, Hopital Morvan, Brest, IDF, France; Anne Marie Schmitt, MD, Centre Hospitalier sur la Peau, Toulouse, Midi Pyre´ne´es, France; Charles Taieb, MD, Public Health and Quality of Life, PFSA, Boulogne Billancourt, IDF, France; Emmanuel Questel, PhD, Centre Hospitalier sur la Peau, Toulouse, Midi Pyre´ne´es, France; Sami Boussetta, PhD, Public Health and Quality of Life, PFSA, Boulogne Billancourt, IDF, France Background: Melasma is a form of generally symmetrical hyperpigmentation that develops on areas of the face exposed to the sun (forehead, cheeks, and temples) and sometimes the neck. Women are most affected by the condition, particularly during periods of estrogen impregnation (pregnancy and contraception). As a result of its disfiguring nature, melasma has been shown to have a significant emotional and psychological impact on those affected. However, we lack data about this impact because there was no measure instrument. Objectives: Establish the appropriate Melasma Quality of Life (MELASQOL) score levels of the French population in general, and to route subjects according to how they feel about their melasma.
Association between interleukin-1 gene polymorphism and susceptibility to vitiligo Ki-Heon Jeong, MD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea; Chun-Pill Choi, MD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea; Joo-Ho Chung, MD, Department of Pharmacology, College of Medicine, Kyung Hee University, Seoul, South Korea; Min-Kyung Shin, MD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea; Mu-Hyoung Lee, MD, PhD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
Methods: The MELASQOL questionnaire and three additional approved questionnaires—the Dermatology Life Quality Index (DLQI), the Short Form-12 Health Survey (SF-12), and the Prevention Cardiovasculaire en Me´decine du Travail (PCVMETRA)—were distributed to a sample of French women suffering from melasma. The MELASQOL questionnaire is rated from seven to 70. A maximum score of 70 means that the quality of life of the sufferer is greatly affected. A descriptive analysis of the score was performed according to sociodemographic data (age, body mass index [BMI], and socioeconomic group) and the length of time of the patient had suffered from the pathology. Results: Women were 44.4 years of age (95% confidence interval [CI], 41.3-47.4), and 60.7% of women were under 45. More than three quarters had a normal BMI (17.9% were overweight). They were mostly married (60.7%) and gainfully employed (88.5%). Almost half had suffered from melasma for \5 years, and 29.6% for [10 years. Only 21.7% of patients suffered from an associated condition, and 18.5% were receiving treatment for melasma. It appeared that most women receiving treatment for melasma had suffered from the condition for a longer period of time (60% of women receiving treatment had suffered from melasma for [10 yrs). The MELASQOL score was 20.9 (95% CI, 15.9-25.9). Patients over 50 years of age had a higher MELASQOL score (24.6 vs 18.5), as did those who had suffered from melasma for a longer period of time (14.8 of women suffering from melasma for \5 yrs, 28.7 between 6 and 10 yrs, and 23.6 for [10 yrs). Treatment for melasma was generally administered to women with a much higher MELASQOL score (32.8 vs 17.7). Whether women were gainfully employed or not also seemed to have an impact on this score, as it was higher for wage earners (21.8 vs 13.7). The BMI or the presence of an associated condition did not have an impact on the MELASQOL score. Women whose physical health or mental health was affected (SF-12: physical dimension or mental dimension \50) had a higher MELASQOL score than those whose physical health or mental health was not affected (24.0 vs 20.4, respectively, for physical health, and 23.0 vs 14.7 for mental health). Conclusions: As a result of this study, information was obtained concerning the quality of life of patients suffering from melasma. Future studies can now be conducted in order to refine these results further by exploring other aspects, for example in relation to socioeconomic factors. Commercial support: 15% sponsored by Eau Thermale Avene, 15% sponsored by Laboratoires Dermatologiques Ducray.
P3204 Idiopathic eruptive macular pigmentation: Unusual case presentation Khalid Alhawsawi, MBBS, King Abdul Aziz Hospital, Makkah, Saudi Arabia; Khalid Alaboad, MD, King Faisal Hospital, Makkah, Saudi Arabia Idiopathic eruptive macular pigmentation (IEMP) is an extremely rare distinct clinicopathologic entity characterized by asymptomatic pigmented macules involving neck, trunk, and proximal parts of extremities. Herein we present an 8-year-old male presenting with widespread asymptomatic progressive pigmented lesions since 1 year of age. No history of preceding eruptions was noted. Medical history was unremarkable; there was no drug history. His parents are not consanguineous and there was no similar case in the family. The physical examination showed widespread, nonscaly, ill-defined brownish macules ranging in sizes from 5 to 15 mm on the trunk and proximal part of extremities. Hair, nails, teeth, and mucous membrane examinations were normal. The differential diagnosis includes IEMP, ashy dermatosis, drug reaction, and mastocytosis. The early onset of cutaneous eruptions in our case necessitates the exclusion of hereditary and congenital pigmentary disorders like cafe´-au-lait spots (as a variant of neurofibromatosis), dyschromatosis universalis hereditaria, familial progressive hyperpigmentation, pigmentary mosaicism, chimerism, or other pigmentary disorders that appear in a reticular pattern, like dermatopathia pigmentosa reticularis and Naegeli-Franceschetti-Jadassohn syndrome. Skin biopsy showed basal layer pigmentation and pigment incontinence in the reticular dermis. After 2 years of follow-up, all skin lesions had healed, leaving postinflammatory hypopigmentation. The morphology, distribution, and histopathology of the skin lesions in our case were typical for IEMP, whereas the early onset presentation and duration of the illness were unusual. Commercial support: None identified.
AB158
J AM ACAD DERMATOL
Background: Vitiligo is a multifactorial disorder related to genetic, environmental, local, and immunologic factors; however, the exact pathogenesis is not yet known. Interleukin-1 (IL-1) plays a role in the pathogenesis of autoimmune diseases, including Hashimoto thyroiditis and insulin-dependent diabetes mellitus. In addition, IL-1a is a potent inhibitor of melanocyte proliferation. Objective: To investigate the significance of IL-1 gene polymorphisms in the susceptibility to vitiligo and understand the pathogenesis of vitiligo. Methods: We conducted a case control association study of vitiligo patients and matched healthy controls. We genotyped 8 single nucleotide polymorphims (SNPs) in the IL-1a gene and 8 SNPs in the IL-1b gene, respectively. The statistical analyses were performed according to onset age, the presence of autoimmune diseases and family history, and distribution. Results: Two SNPs (rs3783546 and rs1609682) of the IL-1a gene showed significant difference between vitiligo patients and controls. Three SNPs (rs1071676, rs1143637, and rs1143634) of IL-1b gene showed significant difference between presence and absence of family history in vitiligo patients. In addition, two SNPs (rs1143630 and rs3917356) of IL-1b gene showed significant difference between segmental and nonsegmental distribution of lesion in vitiligo patients. The two SNPs (rs1143630 and rs3917356) that showed association with distribution of lesion in vitiligo patients were within a block of strong LD. Conclusion: These results suggest that IL-1 genes polymorphisms have an association with the development of vitiligo in Korean population. Commercial support: None identified.
P3206 Cross-cultural adaptation and validation of the Melasma Quality of Life scale in French language Laurent Misery, PharmD, Hopital Morvan, Brest, Nord, France; Charles Taieb, MD, Pierre Fabre, Public Health, Boulogne Billancourt, IDF, France; Sami Boussetta, PhD, Pierre Fabre, Public Health, Boulogne Billancourt, IDF, France Background: An instrument designed to assess the quality of life of patients suffering from melasma was developed and approved in 2003: the Melasma Quality of Life (MELASQOL). However, this questionnaire (Q) does not exist in French. Objectives: Proceed with the linguistic and cultural validation of the MELASQOL Q in French based on current recommendations. Methods: There are five stages in a linguistic and cultural validation exercise. The ‘‘forward’’ translation, consisting of translating the Q from its original language into the desired language. This stage is carried out by two different translators who are mother tongue speakers of the target language. Then the review of these two translations by a panel of experts who merge them, amending certain items if need be in order to produce the most relevant and useable single translated version. The next stage is the ‘‘back’’ translation, consisting of translating the translation back into the original language in order to check that any amendments made have not radically altered the original Q. Once the final translated version is obtained, the ‘‘test/retest’’ stage begins in order to check the reproducibility of the Q. This stage consists of giving the Q to a minimum of 30 patients on two different occasions at 10-day intervals (7-15 days). It is recommended to submit to patients at one and the same time a Q specific to the field covered by the Q to be validated (Dermatology Life Quality Index [DLQI]) and a more generic Q (Short Form-12 Health Survey [SF-12]), which is used to verify the convergence of results. Once all these stages are completed, a psychometric validation report is drawn up, summarizing the results of each stage. Results: The ‘‘forward’’ translation stage was successfully completed. Several amendments were made during the meeting with the panel of experts. It was decided that it was preferable to ask patients ‘‘what they felt’’ rather than requesting their ‘‘impression’’ or their ‘‘opinion.’’ Furthermore, the translation of some words has been further refined (‘‘discoloration’’ translated as ‘‘hyperpigmentation’’ rather than ‘‘de´coloration’’). Psychometric validation resulted in excellent internal consistency (Cronbach a ¼ 0.95) and very good reproducibility (ICC ¼ 0.88) with a MELASQoL score upon inclusion of 19.8 (95% confidence interval [CI], 14.5-25.0) and 18.6 (95% CI, 12.8-24.4). In terms of clinical validity, the MELASQoL score significantly correlated with the global DLQI score (Spearman P ¼ 0.62 upon inclusion and 0.85 at follow-up; P \ .001). There was no significant correlation between the physical component of the SF-12 and the MELASQoL, but there was a moderate correlation with the mental component at follow-up (Spearman P ¼ 0.52; P ¼.016). Conclusions: The linguistic and cultural validation of the MELASQoL in French means we will have access to a pertinent tool for assessing the quality of life of patients suffering from melasma. This tool will therefore facilitate the conducting of melasma research in France, thereby allowing progress to be made in this field. Commercial support: 20% sponsored by Labaratoires Dermatologiques Ducray, 20% sponsored by Eau Thermale Avene.
MARCH 2009
P3205
Evaluation of the Melasma Quality of Life score of a population of French women Laurent Misery, MD, PhD, Hopital Morvan, Brest, IDF, France; Anne Marie Schmitt, MD, Centre Hospitalier sur la Peau, Toulouse, Midi Pyre´ne´es, France; Charles Taieb, MD, Public Health and Quality of Life, PFSA, Boulogne Billancourt, IDF, France; Emmanuel Questel, PhD, Centre Hospitalier sur la Peau, Toulouse, Midi Pyre´ne´es, France; Sami Boussetta, PhD, Public Health and Quality of Life, PFSA, Boulogne Billancourt, IDF, France Background: Melasma is a form of generally symmetrical hyperpigmentation that develops on areas of the face exposed to the sun (forehead, cheeks, and temples) and sometimes the neck. Women are most affected by the condition, particularly during periods of estrogen impregnation (pregnancy and contraception). As a result of its disfiguring nature, melasma has been shown to have a significant emotional and psychological impact on those affected. However, we lack data about this impact because there was no measure instrument. Objectives: Establish the appropriate Melasma Quality of Life (MELASQOL) score levels of the French population in general, and to route subjects according to how they feel about their melasma.
Association between interleukin-1 gene polymorphism and susceptibility to vitiligo Ki-Heon Jeong, MD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea; Chun-Pill Choi, MD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea; Joo-Ho Chung, MD, Department of Pharmacology, College of Medicine, Kyung Hee University, Seoul, South Korea; Min-Kyung Shin, MD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea; Mu-Hyoung Lee, MD, PhD, Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, South Korea
Methods: The MELASQOL questionnaire and three additional approved questionnaires—the Dermatology Life Quality Index (DLQI), the Short Form-12 Health Survey (SF-12), and the Prevention Cardiovasculaire en Me´decine du Travail (PCVMETRA)—were distributed to a sample of French women suffering from melasma. The MELASQOL questionnaire is rated from seven to 70. A maximum score of 70 means that the quality of life of the sufferer is greatly affected. A descriptive analysis of the score was performed according to sociodemographic data (age, body mass index [BMI], and socioeconomic group) and the length of time of the patient had suffered from the pathology. Results: Women were 44.4 years of age (95% confidence interval [CI], 41.3-47.4), and 60.7% of women were under 45. More than three quarters had a normal BMI (17.9% were overweight). They were mostly married (60.7%) and gainfully employed (88.5%). Almost half had suffered from melasma for \5 years, and 29.6% for [10 years. Only 21.7% of patients suffered from an associated condition, and 18.5% were receiving treatment for melasma. It appeared that most women receiving treatment for melasma had suffered from the condition for a longer period of time (60% of women receiving treatment had suffered from melasma for [10 yrs). The MELASQOL score was 20.9 (95% CI, 15.9-25.9). Patients over 50 years of age had a higher MELASQOL score (24.6 vs 18.5), as did those who had suffered from melasma for a longer period of time (14.8 of women suffering from melasma for \5 yrs, 28.7 between 6 and 10 yrs, and 23.6 for [10 yrs). Treatment for melasma was generally administered to women with a much higher MELASQOL score (32.8 vs 17.7). Whether women were gainfully employed or not also seemed to have an impact on this score, as it was higher for wage earners (21.8 vs 13.7). The BMI or the presence of an associated condition did not have an impact on the MELASQOL score. Women whose physical health or mental health was affected (SF-12: physical dimension or mental dimension \50) had a higher MELASQOL score than those whose physical health or mental health was not affected (24.0 vs 20.4, respectively, for physical health, and 23.0 vs 14.7 for mental health). Conclusions: As a result of this study, information was obtained concerning the quality of life of patients suffering from melasma. Future studies can now be conducted in order to refine these results further by exploring other aspects, for example in relation to socioeconomic factors. Commercial support: 15% sponsored by Eau Thermale Avene, 15% sponsored by Laboratoires Dermatologiques Ducray.
P3204 Idiopathic eruptive macular pigmentation: Unusual case presentation Khalid Alhawsawi, MBBS, King Abdul Aziz Hospital, Makkah, Saudi Arabia; Khalid Alaboad, MD, King Faisal Hospital, Makkah, Saudi Arabia Idiopathic eruptive macular pigmentation (IEMP) is an extremely rare distinct clinicopathologic entity characterized by asymptomatic pigmented macules involving neck, trunk, and proximal parts of extremities. Herein we present an 8-year-old male presenting with widespread asymptomatic progressive pigmented lesions since 1 year of age. No history of preceding eruptions was noted. Medical history was unremarkable; there was no drug history. His parents are not consanguineous and there was no similar case in the family. The physical examination showed widespread, nonscaly, ill-defined brownish macules ranging in sizes from 5 to 15 mm on the trunk and proximal part of extremities. Hair, nails, teeth, and mucous membrane examinations were normal. The differential diagnosis includes IEMP, ashy dermatosis, drug reaction, and mastocytosis. The early onset of cutaneous eruptions in our case necessitates the exclusion of hereditary and congenital pigmentary disorders like cafe´-au-lait spots (as a variant of neurofibromatosis), dyschromatosis universalis hereditaria, familial progressive hyperpigmentation, pigmentary mosaicism, chimerism, or other pigmentary disorders that appear in a reticular pattern, like dermatopathia pigmentosa reticularis and Naegeli-Franceschetti-Jadassohn syndrome. Skin biopsy showed basal layer pigmentation and pigment incontinence in the reticular dermis. After 2 years of follow-up, all skin lesions had healed, leaving postinflammatory hypopigmentation. The morphology, distribution, and histopathology of the skin lesions in our case were typical for IEMP, whereas the early onset presentation and duration of the illness were unusual. Commercial support: None identified.
AB158
J AM ACAD DERMATOL
Background: Vitiligo is a multifactorial disorder related to genetic, environmental, local, and immunologic factors; however, the exact pathogenesis is not yet known. Interleukin-1 (IL-1) plays a role in the pathogenesis of autoimmune diseases, including Hashimoto thyroiditis and insulin-dependent diabetes mellitus. In addition, IL-1a is a potent inhibitor of melanocyte proliferation. Objective: To investigate the significance of IL-1 gene polymorphisms in the susceptibility to vitiligo and understand the pathogenesis of vitiligo. Methods: We conducted a case control association study of vitiligo patients and matched healthy controls. We genotyped 8 single nucleotide polymorphims (SNPs) in the IL-1a gene and 8 SNPs in the IL-1b gene, respectively. The statistical analyses were performed according to onset age, the presence of autoimmune diseases and family history, and distribution. Results: Two SNPs (rs3783546 and rs1609682) of the IL-1a gene showed significant difference between vitiligo patients and controls. Three SNPs (rs1071676, rs1143637, and rs1143634) of IL-1b gene showed significant difference between presence and absence of family history in vitiligo patients. In addition, two SNPs (rs1143630 and rs3917356) of IL-1b gene showed significant difference between segmental and nonsegmental distribution of lesion in vitiligo patients. The two SNPs (rs1143630 and rs3917356) that showed association with distribution of lesion in vitiligo patients were within a block of strong LD. Conclusion: These results suggest that IL-1 genes polymorphisms have an association with the development of vitiligo in Korean population. Commercial support: None identified.
P3206 Cross-cultural adaptation and validation of the Melasma Quality of Life scale in French language Laurent Misery, PharmD, Hopital Morvan, Brest, Nord, France; Charles Taieb, MD, Pierre Fabre, Public Health, Boulogne Billancourt, IDF, France; Sami Boussetta, PhD, Pierre Fabre, Public Health, Boulogne Billancourt, IDF, France Background: An instrument designed to assess the quality of life of patients suffering from melasma was developed and approved in 2003: the Melasma Quality of Life (MELASQOL). However, this questionnaire (Q) does not exist in French. Objectives: Proceed with the linguistic and cultural validation of the MELASQOL Q in French based on current recommendations. Methods: There are five stages in a linguistic and cultural validation exercise. The ‘‘forward’’ translation, consisting of translating the Q from its original language into the desired language. This stage is carried out by two different translators who are mother tongue speakers of the target language. Then the review of these two translations by a panel of experts who merge them, amending certain items if need be in order to produce the most relevant and useable single translated version. The next stage is the ‘‘back’’ translation, consisting of translating the translation back into the original language in order to check that any amendments made have not radically altered the original Q. Once the final translated version is obtained, the ‘‘test/retest’’ stage begins in order to check the reproducibility of the Q. This stage consists of giving the Q to a minimum of 30 patients on two different occasions at 10-day intervals (7-15 days). It is recommended to submit to patients at one and the same time a Q specific to the field covered by the Q to be validated (Dermatology Life Quality Index [DLQI]) and a more generic Q (Short Form-12 Health Survey [SF-12]), which is used to verify the convergence of results. Once all these stages are completed, a psychometric validation report is drawn up, summarizing the results of each stage. Results: The ‘‘forward’’ translation stage was successfully completed. Several amendments were made during the meeting with the panel of experts. It was decided that it was preferable to ask patients ‘‘what they felt’’ rather than requesting their ‘‘impression’’ or their ‘‘opinion.’’ Furthermore, the translation of some words has been further refined (‘‘discoloration’’ translated as ‘‘hyperpigmentation’’ rather than ‘‘de´coloration’’). Psychometric validation resulted in excellent internal consistency (Cronbach a ¼ 0.95) and very good reproducibility (ICC ¼ 0.88) with a MELASQoL score upon inclusion of 19.8 (95% confidence interval [CI], 14.5-25.0) and 18.6 (95% CI, 12.8-24.4). In terms of clinical validity, the MELASQoL score significantly correlated with the global DLQI score (Spearman P ¼ 0.62 upon inclusion and 0.85 at follow-up; P \ .001). There was no significant correlation between the physical component of the SF-12 and the MELASQoL, but there was a moderate correlation with the mental component at follow-up (Spearman P ¼ 0.52; P ¼.016). Conclusions: The linguistic and cultural validation of the MELASQoL in French means we will have access to a pertinent tool for assessing the quality of life of patients suffering from melasma. This tool will therefore facilitate the conducting of melasma research in France, thereby allowing progress to be made in this field. Commercial support: 20% sponsored by Labaratoires Dermatologiques Ducray, 20% sponsored by Eau Thermale Avene.
MARCH 2009