DLQI: The gold standard for assessing the impact of skin disease on quality of life.
Symptoms & Feelings
Over the last week, how itchy, sore, painful or stinging has your skin been?
Symptoms & Feelings
Over the last week, how embarrassed or self conscious have you been because of your skin?
Daily Activities
Over the last week, how much has your skin interfered with you going shopping or looking after your home or garden?
Daily Activities
Over the last week, how much has your skin influenced the clothes you wear?
Leisure
Over the last week, how much has your skin affected any social or leisure activities?
Leisure
Over the last week, how much has your skin made it difficult for you to do any sport?
Work & School
Over the last week, has your skin prevented you from working or studying?
Relationships
Over the last week, how much has your skin been a problem with your partner or any of your close friends or relatives?
Relationships
Over the last week, how much has your skin caused any sexual difficulties?
Treatment
Over the last week, how much of a problem has the treatment for your skin been, for example by making your home messy, or by taking up time?
Complete Questionnaire
Answer all 10 questions to see how your skin condition is impacting your daily life, work, and relationships.
Verified
Last Review: 2026-07-17
When to Use
When to Use
Clinical Objective
Primary Clinical Uses
When NOT to Use
How it Works
Scoring Framework
| Items | 10 questions covering 6 domains |
| Domains | Symptoms/Feelings (Q1-2), Daily Activities (Q3-4), Leisure (Q5-6), Work/School (Q7), Personal Relationships (Q8-9), Treatment (Q10) |
| Recall Period | Last 7 days |
| Scale per Item | Very much = 3, A lot = 2, A little = 1, Not at all = 0, Not relevant = 0 |
| Total Range | 0 to 30 (higher = worse QoL) |
| Completion Time | ~2 minutes; typically no assistance required |
Sub-scale Structure
| Symptoms and Feelings | Questions 1-2, max 6 |
| Daily Activities | Questions 3-4, max 6 |
| Leisure | Questions 5-6, max 6 |
| Work and School | Question 7, max 3 |
| Personal Relationships | Questions 8-9, max 6 |
| Treatment | Question 10, max 3 |
Score Interpretation Bands
| 0-1 | No effect at all on patient's life |
| 2-5 | Small effect |
| 6-10 | Moderate effect |
| 11-20 | Very large effect |
| 21-30 | Extremely large effect |
The "Not Relevant" and Missing Data Rules
Psychometric Performance
| Internal Consistency | Cronbach alpha = 0.89 (original, 1994); 0.87-0.93 across multiple validations (urticaria, psoriasis, atopic dermatitis) |
| Test-Retest Reliability | Gamma s = 0.99 (original, 1-week interval, n = 53). High reliability confirmed across 43 studies in the 2024 systematic review. |
| Construct Validity | 42 studies tested known-groups validity across parameters including disease severity, anxiety, depression, stigma, scarring, sexual function, disease location, and duration (Vyas et al., 2024). |
| Convergent Validity | DLQI correlated with 119 different PROMs and QoL measures across 207 validation studies (Vyas et al., 2024). |
| Correlation with Depression | DLQI correlates strongly with the HADS depression domain (r = 0.715) per systematic review of 7 RCTs (Ali et al., 2018, Clin Dermatol). |
| Minimal Clinically Important Difference | 4 points for general inflammatory skin conditions (Basra et al., 2015, Dermatology). A change of less than 4 points may not represent meaningful improvement for the individual patient. |
| Responsiveness | 12 studies using anchor-based methods confirmed the DLQI responds appropriately to change, with effect sizes ranging from small to large (Vyas et al., 2024). |
| Unidimensionality | The original validation and several subsequent studies support a unidimensional structure. However, the comprehensive Basra 2008 review flagged ongoing debate about whether the DLQI truly measures a single construct, particularly given the "Not relevant" response option that may create floor effects in certain domains. Factor analyses have yielded mixed results across populations. |
Clinical Pearls
The "Rule of Tens" in Psoriasis
Hidden Burden: The DLQI Reveals What the Eye Misses
The "Not Relevant" Bias and Its Consequences
DLQI and Psychiatric Comorbidity
DLQI Modifications in Practice and Research
Available in 140+ Languages
Next Steps
Using the Score in Clinical Decision-Making
Beyond the Total Score: Domain Analysis
DLQI Utility Mapping and Health Economic Data
Choosing an Alternative Measure
Related Tools
The Evidence
Original Development
Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use.
Finlay AY et al. • Clin Exp Dermatol. 1994;19(3):210-216. First publication describing the creation, initial validation, and scoring of the 10-item DLQI. The questionnaire items were generated from interviews with 120 patients across a wide range of skin diseases. The measure was then tested on 200 consecutive new dermatology outpatients and 100 healthy controls. Demonstrated test-retest reliability gamma s = 0.99 (n = 53, 1-week interval). Found that atopic eczema, psoriasis, and generalized pruritus had greater QoL impact than acne, basal cell carcinomas, and viral warts.
View SourceTranslating the science of quality of life into practice: what do Dermatology Life Quality Index scores mean?
Hongbo Y et al. • J Invest Dermatol. 2005;125(4):659-664. Established the DLQI score banding system (0-1, 2-5, 6-10, 11-20, 21-30) that is now the standard interpretation framework.
View SourceComprehensive Reviews
The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results.
Basra MKA et al. • Br J Dermatol. 2008;159(5):997-1035. Comprehensive review of 272 full articles covering the DLQI in its first 14 years of use. The review documented use across 33 skin conditions, 32 countries, and 55 languages; 115 studies specifically examined psychometric aspects. A total of 33 studies assessed the effectiveness of 14 therapeutic interventions, 37 studies evaluated 9 types of clinical practice research, 60 studies involved 18 systemic drugs in clinical trials, 22 studies involved 14 topical drug trials, and 27 were multinational studies. The review also flagged unresolved issues including concerns about unidimensionality (whether the DLQI measures a single construct), differential item functioning across subgroups, and the need for further MCID research.
View SourceA systematic review of 207 studies describing validation aspects of the Dermatology Life Quality Index.
Vyas J et al. • Acta Derm Venereol. 2024;104:adv41120. Most comprehensive validation review to date: 207 articles, 58,828 patients, 49+ countries, 41 diseases. Confirmed strong test-retest reliability, good internal consistency (43 studies), responsiveness (12 studies), and known-groups validity (42 studies). Also identified that only 15% of studies explicitly recruited minority ethnic participants.
View SourceA systematic review of 454 randomised controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries.
Vyas J et al. • Br J Dermatol. 2024;190:315-339. Documented DLQI use across 454 RCTs, 69 diseases, and 43 countries. The DLQI was used as a primary outcome in a subset of these trials.
View SourceKey Validation and Application Studies
Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data.
Basra MKA et al. • Dermatology. 2015;230(1):27-33. Established the MCID of 4 points for inflammatory skin conditions, which remains the accepted threshold.
View SourceMapping of the DLQI scores to EQ-5D utility values using ordinal logistic regression.
Ali FM et al. • Qual Life Res. 2017;26:3025-3034. Developed the mapping algorithm that allows QALY calculation from DLQI data for health economic analyses.
View SourceCorrelating the Dermatology Life Quality Index with psychiatric measures: A systematic review.
Ali FM et al. • Clin Dermatol. 2018;36(6):691-697. Systematic review of 7 RCTs. Found strong correlation between DLQI and HADS depression domain (r = 0.715). HADS was the most commonly used psychiatric measure in dermatology trials.
View SourceThe Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality of life instruments: A systematic review.
Johns JR et al. • J Eur Acad Dermatol Venereol. 2025;39:631-679. Systematic review of 122 articles (30,727 patients, 34 countries, 41 diseases) confirming the DLQI as the most frequently used benchmark instrument for validating new QoL measures in dermatology. The DLQI was used to validate 101 measures (80 dermatology-specific, 21 generic) and supported 47 cross-cultural adaptations. Study designs included 116 single-arm, 100 cross-sectional, 18 longitudinal, and 6 RCTs. The DLQI was used in 14 known-groups, 10 construct, 101 convergent, 10 concurrent, 10 divergent or discriminant, and 3 criterion validity tests, plus 13 responsiveness analyses. Only 13.9% of studies explicitly recruited minority ethnic participants; 76% of included publications appeared in the last 10 years.
Validation of the Dermatology Life Quality Index as an outcome measure for urticaria-related quality of life.
Lennox RD et al. • Ann Allergy Asthma Immunol. 2004;93(2):142-146. Validation in chronic idiopathic urticaria (n = 418 and n = 439). Cronbach alpha = 0.89 and 0.87. Confirmed unidimensional factor structure and responsiveness.
View SourceValidation and application of the Dermatology Life Quality Index score, a modification of the DLQI score, in psoriasis patients.
Zou Q et al. • J Health Popul Nutr. 2024;43:92. Proposed and validated the DLQI-NS (DLQI new scoring), which adds a "moderate" option between "a little" and "a lot" creating a 5-point scale per item (0-4, total 0-40). In 425 psoriasis patients, 14.4-32.5% chose the moderate option across items, and 17 patients (4.0%) were reclassified as severe under guideline criteria. DLQI-NS showed Cronbach alpha 0.90 vs 0.89, KMO 0.927 vs 0.916, one-factor explaining 53.36% vs 49.85% variance, and stronger Skindex-16 correlation (0.89 vs 0.84). No ceiling effects were found for either questionnaire; however, 8 of 10 items showed high floor effects on both, suggesting items may not capture mild HRQoL problems well.
View SourceQuestionnaire modifications and alternative scoring methods of the Dermatology Life Quality Index: A systematic review.
Rencz F et al. • Value Health. 2021;24(8):1158-1171. Systematic review of 81 articles describing 59 distinct DLQI modifications encompassing 25,509 patients, 47 diagnoses, and 28 countries. Modification types included bolt-ons and bolt-offs (48%), disease or symptom specifications (42%), changes in existing items (34%), scoring modifications (27%), and recall period changes (19%). The most frequently studied conditions were psoriasis, hirsutism, acne, alopecia, and bromhidrosis. The DLQI-R (revised scoring) showed the strongest psychometric evidence among alternative approaches; the LY-DLQI (last year recall) also showed promise. Most modifications had incomplete psychometric validation, only 14.5% explicitly stated permission from copyright holders, and 78% did not declare whether permission was obtained.
View SourceCross-Cultural Validations
Cross validation of the Turkish version of dermatology life quality index.
Ozturkcan S et al. • Int J Dermatol. 2006;45:1300-1307. Turkish validation confirming psychometric equivalence.
Japanese version of the Dermatology Life Quality Index: validity and reliability in patients with acne.
Takahashi N et al. • Health Qual Life Outcomes. 2006;4:46. Japanese adaptation and validation.
View SourceThe impact of lupus erythematosus cutaneous on the quality of life: the Brazilian-Portuguese version of DLQI.
Ferraz LB et al. • Qual Life Res. 2006;15:565-570. Brazilian-Portuguese adaptation in cutaneous lupus patients.
Sensitivity of the Dermatology Life Quality Index to clinical change in patients with psoriasis.
Mazzotti E et al. • Br J Dermatol. 2003;149:318-322. Italian validation in 900 psoriasis patients.
Official Resources and Further Reading
Last Comprehensive Review: 2026-07-17
