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QUALITY OF LIFE ASSESSMENT IN SKIN TAG PATIENTS

— Background: Patients with skin disease may experience clinical symptoms, such as itching, pain, and discomfort, that can have a negative impact on quality of life (QOL).Skin tag is a common benign tumor of the skin with small, soft pedunculated protrusion, it commonly occur in axilla, neck and major flexura area, despitethe lesion usually asimptomatic, sometimes patients complainabout cosmetics appereance, itching or discomfort experienced. Objective : The aim of our study was to assess the impact of skin tag lesion on quality of life of patients. Material and Method: This is a descriptive study with a cross sectional design, involving 50 patients with skin tag lesion who visited the Dermatology outpatient clinic Adam Malik General Hospital, Medan from September 2016 to October 2016. The patients were filled Indonesian version of skindex-29 questionnaire to measures the effects of skin disorders on their QOL. Results: In this study QOL in skin tag patient was fairly good, 38(76%) subjects had a skindex-29 category score<5, and 12(24%) subjects had a skindex-29 score 6-17. We didn’t findimpaired QOL in all skin tag patients. Conclusion : In this study we concludedskin tag does not affect the quality of life of the patients.


I. INTRODUCTION
Skin tag is a common benign skin lesion composed of loose fibrous tissue and occurring mainly on the neck and major flexures as a small, soft, pedunculated protrusion. 1,2 The incidence of skin tag in general population is may vary from 20-25%, usually affect middle aged individualy and the elderly. 3 There is no difference in incidence of skin tag between male and female. 3,4 The cause of skin tag is still unclear, although friction, obesity, pregnancy, aging, diabetes mellitus, hyperinsulinemia, and family history have been proposed as potential aetiological or associated factors. Skin tag usually asimptomatic, but sometimes lesions can become irritated or subject frequent complaints in dermatology clinics for esthetic reasons or due to traumatism resulting from contact with clothing or jewelery does can affect the quality of life in skin tag patients. 5,6 Skin disorders are generally considered trivial and the patient distress and impact on quality of life is largely ignored. The effect of dermatological disease can vary from minor to severe handicap. The skin disorder may cause disturbances in occupation, recreation, selfimage, discrimination, embarrassment, and depression. 7 The measurement of health-related quality of life (HRQOL) is increasingly important in patients withskin diseases. 8 Health-related quality of life (HRQL) reflects patients' evaluation of the impact of disease and treatment on their physical, psychological, and social functioning and wellbeing. The Skindex is a health-related quality of life (HRQOL) instrument designed to measure the effects of skin disease on patients lives. This dermatology-specific questionnaire has been extensively studied and refined in different population samples, furthermore skindex has been used to study the effects of a wide variety of skin conditions on patients lives. 9,14 The Skindex is an instrument that measures the effects of a skin disease on a patient's QoL, and has been refined and studied extensively.17 It is a self-administered questionnaire that was originally created in English. It initially included 61 questions but was then modified to 29 questions, 11 in this study we aimed to assess quality of life in skin tag patient using skindex-29.

II. METHODOLOGY
This study is an observational study with cross sectional design conducted at Department Dermatology and Venereology Adam Malik General Hospital, Medan from September 2016 until October 2016. All skin tag patients underwent a anamnesis, physical and dermatological examination. The clinical diagnosis of skin tag based on researchers and advisor, the type of lesion (sessile, sessile and mixed type (combination pedunculated and non-pedunculated), the number of lesions (single or multiple) and the location (flexure and non-flexure area) of skin tag was recorded.
All subjects in this study were signing the informed consent voluntarily, furthermore subject do questionnaires assisted by researcher to assess the quality of life by using Skindex-29.the questionnairesconsisting of 29 questions, divided into three main criteria: symptoms, functioning and emotions. The collected then processed and presented descriptively.

III. RESULTS
Fifty subjects with skin tags were offered and assessed to fill the skindex 29 questionnaire. Characteristics of the subjects in this study are shown based on patient sociodemographic and characteristics of skin tags lesion include gender, age, education level, occupation, family history, duration of skin tag, and clinical picture of skin tag lesion (table. 1). Total from 50 subjects enrolled in this study, 33 (66%) subjects were female and 17 (34%) subjects were male, 46 (92%) subjects were married. The age distribution of subjects in this study majority in the age group 40-49 years (36%). Duration of skin tag varied from 1 years to 15 years, whereasmajority in the group 1-5 years (58%). Distribution quality of life scores in this study showed 38 (76%) subjects had a very high quality of life and 12 (24%) subjects had a high quality of life and we didn't find a moderate or low quality of life score in all subjects (Table. 2), furthermore based on the characteristics of the skin tag lesions we also didn't find a significant difference in the quality of life score from all subject (table 4). It has now been determined that quality of life impact of certain skin disorders can be at a magnitude of several systemic disorders like diabetes mellitus and chronic renal disease 7 The measurement of health-related quality of life (HRQOL) is increasingly important in patients with skin diseases. Despite the availability of a variety of instruments and new psychometric techniques, there is no consensus as to which HRQOL instruments are to be preferred in dermatology 8 HRQOL reflects patients' evaluation of the impact of disease and treatment on their physical, psychological, and social functioning and wellbeing 12 The concept of QOL was developed from an array of information about physical, social and psychological well-being; it was fostered by the World Health Organization's broad view of health as not merely the absence of disease or infirmity, but the ability of a person to lead a productive and enjoyable life. Skin disease has been recognized as having a detrimental effect on the QOL of patients. This psychosocial aspect of skin disease has important implications for the optimal management of patients. 8 The Skindex-29 is among the most commonly used dermatology-specific, health-related quality of life (HRQOL) instruments. The excellent psychometric features of the Skindex-29, including factor structure, have been confirmed by multiple studies. 13 Skindex-29 is one of the HRQOL instruments that comprehensively designed to measure the effects of skin disease suffered in daily life of patient. 13,14 In Skindex-29 questionnaire consists of 29 questions combinations of clinical symptoms, emotions and functioning. 12 Skindex scores are reported as three-score scale, related to the three domains; a higher score indicate the lower level of quality of life. [15][16][17] Skin tag or acrochordons is benign skin tumours commonly found in the general population.Skin tag generally asymptomatic and does not cause pain, but it can cause a cosmetic disorders and discomfort to the patient, 5,18 until now researchers didn't find any published study that measured the quality of life score in patient with skin tag, but there are a few studies which measured the quality of life scores in patient with benign skin tumours.
In a study conducted by Chren, showedpatients with benign skin tumors have a goodquality of life when compared with patients with other dermatological symptoms like psoriasis, acne, dermatitis, and verruca, so it can be concluded that patients with benign skin tumours is not bothered with the lesion. 15 Accordance with studyconducted by Taborda et al, they also found similar results, patients with benign tumors of the skin generally have a high quality of life scores. 19 The results in this study is agreement withstudy conducted by Chren and Taborda who find the quality of life in skin tag patients is fairly good.It can be concluded the skin tag lesions does not affectthe psychological and social life of the patient.
In this study we also found that there was no significant differencesin quality of life scores based on gender and age of the subject (Table.3). In a study conducted by Tejada et al in patients with skin disorders in southern Brazil,reveal that there was no significant differences in quality of life score both in male and female patient, 20 this result contrast with the study conducted by Abolfotouh et al, they founda female patients have a lower quality of life scores compared with male patients, because women tend to care about their cosmetic appearances in a public. 21 Based on the age of patients, the results in this study also accordance with study conducted by Harlow et al and Al-Hoqail on patients with skin disease, they didn't any difference in quality of life scorebetween the younger and older patients, 22,23 Contrast with other study conducted by Tejada et al, they found the older patient had a lower impact on quality of life compared to the younger patient. In this study based on the characteristics of skin tag lesion,we also didnt find asignificant differences in the quality of life score for all subjects (Table.4).

V. CONCLUSIONS
The results of this study, showed patients with skin tag have a fairly good of quality of life, no subject has a moderate or poor quality of life. It can be concluded in this study, the skin tag lesions arising in patients does not cause impaired quality of life both psychologically and socially. ACKNOWLEDGMENT None declare.

CONFLICT OF INTEREST
The Authors declare that there is no conflict of interest. The findings in this article represent the conclusions of the authors. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.