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DLQI

DLQI: The gold standard for assessing the impact of skin disease on quality of life.

1

Symptoms & Feelings

Over the last week, how itchy, sore, painful or stinging has your skin been?

2

Symptoms & Feelings

Over the last week, how embarrassed or self conscious have you been because of your skin?

3

Daily Activities

Over the last week, how much has your skin interfered with you going shopping or looking after your home or garden?

4

Daily Activities

Over the last week, how much has your skin influenced the clothes you wear?

5

Leisure

Over the last week, how much has your skin affected any social or leisure activities?

6

Leisure

Over the last week, how much has your skin made it difficult for you to do any sport?

7

Work & School

Over the last week, has your skin prevented you from working or studying?

8

Relationships

Over the last week, how much has your skin been a problem with your partner or any of your close friends or relatives?

9

Relationships

Over the last week, how much has your skin caused any sexual difficulties?

10

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.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

When to Use

When to Use

Quantifying the impact of any skin condition on a patient's quality of life over the previous 7 days. The DLQI is the most frequently used patient-reported outcome measure (PROM) in dermatology worldwide, with use described in more than 6,000 publications across over 60 skin conditions and 80 countries (Cardiff University DLQI Resource).
Documenting the need for systemic or biologic therapy. In psoriasis, a DLQI > 10 combined with PASI > 10 or BSA > 10% is the standard "Rule of Tens" threshold for severe disease, embedded in national guidelines and reimbursement criteria in more than 45 countries.
Monitoring treatment response over time in routine care. A systematic review of 207 validation studies confirmed the DLQI responds appropriately to clinical change, with effect sizes ranging from small to large (Vyas et al., 2024, n = 58,828 across 49+ countries).
Clinical trials and outcomes research. The DLQI has been used as an outcome measure in over 450 randomised controlled trials across 69 diseases and 43 countries (Vyas et al., 2024, Br J Dermatol). It has been used as a primary outcome measure and is embedded in core outcome sets for atopic dermatitis (HOME VII consensus).
Benchmarking new quality-of-life instruments. The DLQI has served as the validation benchmark for more than 100 other patient-reported outcome measures (Johns et al., 2025, JEADV).

Clinical Objective

The DLQI is a 10-item, self-administered questionnaire designed to measure health-related quality of life in adult patients (age 16+) with skin disease. It was developed in 1994 by Professor Andrew Y. Finlay and Dr. G.K. Khan at Cardiff University, Wales. It was the first dermatology-specific quality-of-life questionnaire and remains the most widely used. The recall period is the previous 7 days, and average completion time is approximately 2 minutes.

Primary Clinical Uses

Evaluating subjective disease burden in chronic conditions including psoriasis, atopic dermatitis, chronic urticaria, acne, hidradenitis suppurativa, hyperhidrosis, and vitiligo
Documenting medical necessity for advanced systemic or biologic therapies per national guideline thresholds (DLQI > 10 in the UK, many EU countries, and increasingly elsewhere)
Monitoring patient-reported treatment efficacy over time, with the MCID of 4 points as the benchmark for meaningful improvement
Identifying patients whose psychological or functional impairment is disproportionate to objective clinical severity (e.g., a patient with limited BSA but high DLQI due to visible or intimate-site disease)

When NOT to Use

Pediatric patients under 16 years old. Use the Children's DLQI (CDLQI) instead, which has different wording and validated age-appropriate norms.
As a substitute for objective clinical severity assessment. Always pair DLQI with objective measures such as PASI, EASI, BSA, or IGA. The DLQI captures the patient perspective; objective scores capture disease activity. Both are needed.
Acute, life-threatening skin conditions requiring emergency intervention, such as Stevens-Johnson syndrome or toxic epidermal necrolysis.
Situations where the patient cannot reliably self-report due to cognitive impairment, language barrier without a validated translation, or severe psychiatric comorbidity.

How it Works

Scoring Framework

Items10 questions covering 6 domains
DomainsSymptoms/Feelings (Q1-2), Daily Activities (Q3-4), Leisure (Q5-6), Work/School (Q7), Personal Relationships (Q8-9), Treatment (Q10)
Recall PeriodLast 7 days
Scale per ItemVery much = 3, A lot = 2, A little = 1, Not at all = 0, Not relevant = 0
Total Range0 to 30 (higher = worse QoL)
Completion Time~2 minutes; typically no assistance required

Sub-scale Structure

Symptoms and FeelingsQuestions 1-2, max 6
Daily ActivitiesQuestions 3-4, max 6
LeisureQuestions 5-6, max 6
Work and SchoolQuestion 7, max 3
Personal RelationshipsQuestions 8-9, max 6
TreatmentQuestion 10, max 3

Score Interpretation Bands

0-1No effect at all on patient's life
2-5Small effect
6-10Moderate effect
11-20Very large effect
21-30Extremely large effect

The "Not Relevant" and Missing Data Rules

If a question is answered "Not relevant" or is left unanswered, it is scored as 0. If one question is left unanswered, the total is summed out of 30 (the missing item is scored 0). If two or more questions are unanswered, the questionnaire is considered invalid and should not be scored. Sub-scales with any missing item should not be interpreted. Question 7 (work/study) has a two-part structure: if the patient is prevented from working/studying, the score is 3. If not prevented, the patient rates how much the skin was a problem at work/study: "A lot" = 2, "A little" = 1, "Not at all" = 0.

Psychometric Performance

Internal ConsistencyCronbach alpha = 0.89 (original, 1994); 0.87-0.93 across multiple validations (urticaria, psoriasis, atopic dermatitis)
Test-Retest ReliabilityGamma s = 0.99 (original, 1-week interval, n = 53). High reliability confirmed across 43 studies in the 2024 systematic review.
Construct Validity42 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 ValidityDLQI correlated with 119 different PROMs and QoL measures across 207 validation studies (Vyas et al., 2024).
Correlation with DepressionDLQI 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 Difference4 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.
Responsiveness12 studies using anchor-based methods confirmed the DLQI responds appropriately to change, with effect sizes ranging from small to large (Vyas et al., 2024).
UnidimensionalityThe 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

The "Rule of Tens" (Finlay, 2005, Br J Dermatol) classifies psoriasis as severe when DLQI > 10, PASI > 10, and BSA > 10%. This framework is embedded in NICE, EuroGuiDerm, and many national guidelines for biologic therapy eligibility. However, a patient with low BSA but high DLQI (e.g., genital or palmoplantar psoriasis with DLQI > 15 but BSA < 5%) may still qualify for systemic therapy based on DLQI alone in some guidelines.

Hidden Burden: The DLQI Reveals What the Eye Misses

Objective severity scores like PASI or EASI capture disease extent and activity but miss the patient's lived experience. A patient with 2% BSA psoriasis confined to the genitals, scalp, or hands may have a DLQI above 15 due to psychosexual impairment, visible stigma, or functional limitation. Locally adapted versions of the DLQI have identified similar patterns across cultures, including the Italian validation in 900 psoriasis patients (Mazzotti et al., 2005) and the Brazilian-Portuguese adaptation in cutaneous lupus (Ferraz et al., 2006). Always assess the DLQI domain scores individually, not just the total.

The "Not Relevant" Bias and Its Consequences

The DLQI contains a known structural limitation. Questions about work/study (Q7), sports/leisure (Q6), and sexual relationships (Q9) may be marked "Not relevant" by elderly, retired, or inactive patients. Because "Not relevant" scores as 0, this artificially lowers the total DLQI. An older patient with significant psoriasis may score below the DLQI > 10 biologic threshold simply because multiple items do not apply to their lifestyle. Some guidelines permit DLQI score adjustment or clinician override in this scenario. A systematic review of questionnaire modifications (Rencz et al., 2021, Value Health) identified this as a key area for alternative scoring methods.

DLQI and Psychiatric Comorbidity

Depression and anxiety are highly prevalent in dermatology patients, often exceeding rates in the general population by 2- to 3-fold. A systematic review of 7 RCTs (Ali et al., 2018) found that the DLQI correlates strongly with the HADS depression domain (r = 0.715), suggesting the DLQI may partially capture psychological burden. However, the DLQI is not a diagnostic instrument for depression or anxiety. Patients with high DLQI scores, particularly driven by Q1 (pain/soreness) and Q2 (embarrassment/self-consciousness), should be screened separately for psychiatric comorbidity.

DLQI Modifications in Practice and Research

A systematic review identified 59 distinct modifications to the DLQI across 81 articles, with DLQI-R (revised scoring) having the strongest psychometric evidence among alternative approaches. The LY-DLQI (last year recall) also shows promise for capturing chronic burden. A newer approach, the DLQI-NS (2024), adds a "moderate" option between "a little" and "a lot" on all 10 items, creating a 5-point scale (0-4 per item, total 0-40). In a study of 425 psoriasis patients, 14.4-32.5% chose the moderate option, and 4% of patients were reclassified as severe who would have been moderate under the original scoring. The DLQI-NS also showed improved construct validity over the original DLQI. Most modifications have incomplete psychometric validation. Only 14.5% of modifications explicitly stated permission from copyright holders; 78% did not declare whether permission was obtained. Clinicians encountering modified DLQI versions should verify whether the modification has been properly validated and whether permission from Cardiff University (the copyright holder) was obtained.

Available in 140+ Languages

The DLQI has been translated into more than 140 languages following a rigorous translation and linguistic validation process managed by Cardiff University. Cross-cultural validations include Turkish (Ozturkcan et al., 2006), Japanese (Takahashi et al., 2006), Brazilian-Portuguese (Ferraz et al., 2006), Italian (Mazzotti et al., 2005), and many others. An official free app (DLQI: The Official App) is available on iOS and Android.

Next Steps

Using the Score in Clinical Decision-Making

01
Score > 10: Indicates a "very large" or "extremely large" effect on QoL. In psoriasis, this is the standard threshold for initiating systemic or biologic therapy, especially when combined with PASI > 10 or BSA > 10%. Document the score precisely (e.g., "DLQI: 14/30") for prior authorization and guideline compliance.
02
Score 6-10: Moderate effect. Structured treatment optimization is warranted. If the score does not improve by at least 4 points after 3-6 months of treatment, reassess the therapeutic strategy.
03
Score 2-5: Small effect. Continue current management but remain alert for domain-specific issues. A domain analysis may reveal an area of concern that is masked by a relatively low total score.
04
Score 0-1: No or minimal effect on QoL. This is the therapeutic target. If the DLQI is 0-1 but the patient still has significant objective disease, consider whether the patient has adapted to their condition or whether the "Not relevant" bias is artificially lowering the score.
05
Target goal of therapy: DLQI 0 or 1 (complete or near-complete resolution of QoL impact). A change of 4 or more points is considered the minimal clinically important difference.

Beyond the Total Score: Domain Analysis

The DLQI can be analysed across its 6 sub-scales. If the Symptoms/Feelings domain (Q1-2) score is disproportionately high, consider the need for better symptom control or psychological support. If the Personal Relationships domain (Q8-9) is driving the total, consider the impact of intimate-site or visible disease. Domain analysis often reveals specific interventions that the total score alone would miss.

DLQI Utility Mapping and Health Economic Data

The DLQI can be mapped to EQ-5D utility values using ordinal logistic regression (Ali et al., 2017, Qual Life Res), allowing calculation of quality-adjusted life years (QALYs) from DLQI data for health economic analyses. A mapping spreadsheet is available from Cardiff University.

Choosing an Alternative Measure

For pediatric patients, use the Children's DLQI (CDLQI, age 4-16). For infant eczema, use the Infants' Dermatitis Quality of Life Index (IDQoL). For family impact, use the Family Dermatology Life Quality Index (FDLQI) or the Dermatitis Family Impact Questionnaire (DFI). For disease-specific instruments, consider the Psoriasis Disability Index (PDI) or the Cardiff Acne Disability Index (CADI).

Related Tools

PASI Score - objective measure of psoriasis severity BSA (Body Surface Area) - clinical estimate of disease extent EASI Score - objective measure of atopic dermatitis severity POEM (Patient-Oriented Eczema Measure) - patient-reported eczema control SCORAD - composite atopic dermatitis severity score IGA (Investigator Global Assessment) - physician-rated global severity

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 Source
Translating 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 Source

Comprehensive 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 Source
A 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 Source
A 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 Source

Key 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 Source
Mapping 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 Source
Correlating 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 Source
The 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 Source
Validation 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 Source
Questionnaire 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 Source

Cross-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 Source
The 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

Cardiff University DLQI Official Page - downloads, translations, licensing DLQI Original Paper (Clin Exp Dermatol 1994) - PubMed DLQI Comprehensive Review (Basra et al., 2008) - PubMed DLQI 207 Validation Studies Systematic Review (Vyas et al., 2024) - PubMed DLQI in 454 RCTs (Vyas et al., 2024) - PubMed DLQI as Benchmark for 101 QoL Instruments (Johns et al., 2025) - PubMed DLQI Modifications Systematic Review (Rencz et al., 2021) - PubMed DLQI-Psychiatric Measures Correlation (Ali et al., 2018) - PubMed DLQI Validation in Chronic Urticaria (Lennox & Leahy, 2004) - PubMed

Last Comprehensive Review: 2026-07-17

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