Dermatology Life Quality Index
The Dermatology Life Quality Index (DLQI) is a simple, self-administered and user-friendly validated questionnaire.
The DLQI is designed to measure the health-related quality of life of adult patients suffering from a skin disease.
About the questionnaire
The DLQI is the most frequently used patient-reported outcome measure in dermatology. It was the first dermatology-specific quality of life questionnaire, published in 1994. It has 10 questions about the impact of skin disease on quality of life over the last week. The DLQI has validated score meaning bands, responsiveness and defined Minimal Important Change. It is mapped to EQ-5D to calculate utility values.
Used for over 60 skin conditions in more than 80 countries, the DLQI is available in over 140 languages. Its use is described in more than 6,000 publications, including many multinational studies, and is embedded in national guidelines and registries in more than 45 countries. It has been used in over 450 randomised controlled trials (RCTs) in dermatology, in some as a primary outcome measure. It has been a benchmark in the validation of more than 100 other quality-of-life instruments. A systematic review has identified 207 articles describing aspects of DLQI validation.
Who can use it
The DLQI can be used for routine clinical purposes by patients and clinicians to assist the consultation, evaluation and decision-making process.
It can also be used in a range of settings by pharmaceutical companies, with-profit organisations, students or researchers.
Depending on who you are and what you're using the questionnaire for, you may need to apply for a licence and pay a fee.
Learn more about who can use this questionnaire and how to administer it.
Age range
The DLQI is designed for use in adults, i.e. patients aged 16 years and over.
Time for completion
The average completion time of the DLQI is two minutes. Usually no assistance is required.
Recall period
The questions are designed to be completed with a one week recall period (i.e. last seven days). The DLQI is self-explanatory and can be simply handed to the patient who is asked to fill it in. There is no need for detailed explanation.
Frequency of use
As the time frame of the DLQI questions is over the last week, there should be at least seven days between each use. Very frequent use is not recommended, because you or the patient may remember and be influenced by previous answers or become less careful answering.
Download the questionnaire
The DLQI is available in Word and PDF formats.
The zip files contain several different versions of the language (depending on what country), along with the translation certificates.
Dermatology Life Quality Index (DLQI) - original UK English version
The original version of the questionnaire, which is designed to measure the health-related quality of life of adult patients suffering from a skin disease.
Dermatology Quality of Life Index (DLQI) - USA English and other English versions
This questionnaire is available in several other English versions.
Different language versions
There are more than 140 translations available. Find out more about our translation and linguistic validation process, and what to do if you'd like to create a new translation.
DLQI App
The DLQI has been electronically validated. Cardiff University has developed an official e-version of the DLQI, available for free on both Android and Apple stores, named ‘DLQI: The Official App’.
View privacy policy for the App.
Scoring, validation and utility values
Scoring
Each question is scored on a four-point Likert scale:
- Very much = 3
- A lot = 2
- A little = 1
- Not at all = 0
- Not relevant = 0
- Question unanswered = 0
The DLQI is calculated by adding the score of each question, resulting in a maximum of 30 and a minimum of 0. The higher the score, the more quality of life is impaired. A score higher than 10 indicates that the patient's life is being severely affected by their skin disease.
The score can be expressed as a percentage of the maximum possible score of 30, but we don't recommend this, because the original score is much easier to understand.
The scores associated with the different answers should not be printed on the DLQI itself, as this might cause bias.
Scoring question 7
The first part of question 7 asks: 'Over the last week, has your skin prevented you from working or studying?'
If working or studying are not relevant to the subject, the response is 'Not relevant' (scored 0).
If the skin disease has prevented the subject from working or studying, the answer is 'Yes'. As 'prevention' is the biggest possible impact it is scored the maximum, 3.
If the skin disease has not prevented the subject from working or studying, the answer is 'No'. It is therefore assumed that as the skin disease has not prevented the subject from working or studying, the subject is able to continue to work or study, but that the skin disease may be a problem while doing so.
The subject is therefore asked the following question about the magnitude of the impact thus: 'If "No" (in other words 'If the skin disease has not prevented you from working or studying”), over the last week how much has your skin been a problem at work or studying?'
There are three possible responses to the question 'How much has your skin been a problem at work or studying': 'A lot' (scored 2), 'A little' (scored 1) or 'Not at all' (scored 0).
Meaning of scores
- 0-1 = no effect at all on patient’s life
- 2-5 = small effect on patient’s life
- 6-10 = moderate effect on patient’s life
- 11-20 = very large effect on patient’s life
- 21-30 = extremely large effect on patient’s life
Minimal clinically important difference (MCID)
For general inflammatory skin conditions, a change in DLQI score of at least four points is considered clinically important.
Sub-scales
The Dermatology Life Quality Index can be analysed under six sub-scales:
| Section | Questions | Score |
|---|---|---|
| Symptoms and feelings | Questions 1 and 2 | Maximum 6 |
| Daily activities | Questions 3 and 4 | Maximum 6 |
| Leisure | Questions 5 and 6 | Maximum 6 |
| Work and school | Question 7 | Maximum 3 |
| Personal relationships | Questions 8 and 9 | Maximum 6 |
| Treatment | Question 10 | Maximum 3 |
The scores for each of these sections can also be expressed as a percentage of either 6 or 3.
Missing data
If one question is unanswered, this is allocated a score of 0 and the DLQI score summed in the usual way, out of 30. If two or more questions are unanswered, the questionnaire is not scored.
It has been suggested that if there are one or more questions unanswered, an adjusted score should be calculated based on the percentage of the maximum score possible. We don't recommend this, and our reasons are given in the publication:
Finlay AY, Sampogna F. What do scores mean? Informed interpretation and clinical judgement are needed .Br J Dermatol 2018; 179: 1021-1022.
Scoring of DLQI sub-scales: If one question is left unanswered, the corresponding sub-scale should not be scored. It would not be appropriate to draw any conclusions from a subscale unless the subscale were fully answered.
Validation
The DLQI and the translations are extensively validated.
The original publication covers the initial validation process:
Finlay AY, Khan GK. Dermatology Life Quality Index (DLQI): A simple practical measure for routine clinical use. Clinical and Experimental Dermatology 1994; 19: 210-216.
This review article covers multiple aspects of validation data up to 2008:
Basra MKA, Fenech R, Gatt RM, Salek MS, Finlay AY. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. Br J Dermatol. 2008; 159:997-1035.
Since 2008, there have been many publications which address various aspects of validation of the DLQI, best accessed by searching PubMed or Google Scholar using the search term 'DLQI'.
To find dermatology publications about quality of life from Cardiff University, you can search ORCA, the University's digital repository of its research outputs, or search PubMed, by using the author search term ‘Finlay AY'.
Deriving utility values, EQ-5D
Although the DLQI is a dermatology-specific measure, it is possible using a mapping technique and ordinal logistic regression to generate quality adjusted life years (QALYs) from DLQI data.
For more information, please see:
An Excel spreadsheet is freely available for researchers who may be interested in generating utility values from DLQI data. Please email Dr Faraz Ali for a copy of this spreadsheet at alifm@cardiff.ac.uk.
In this study, the predicted utilities were not assigned by using cut-offs. We calculated probabilities based on the fitted ordinal logistic models for each EQ-5D domain and each outcome within that domain. Using Monte-Carlo simulation, we then obtained outcomes for each subject on each domain and predicted utilities for each subject based on these outcomes.
The mapping algorithm was tested on a European dataset and not specifically on a UK population. Though there may be cultural variation influencing health-related quality of life (HRQoL) and utility responses, we have not tested this specific question in detail.
However, when our model was created using only Italian patients and tested on a Norway population, it performed almost as well as the model derived from the complete dataset.
Our experience suggests that within the European context there is some uniformity of attitudes, cultural norms and responses, as the DLQI has undergone over one hundred validated translations, with many in continental European countries.
As no official European Time Trade-Off (TTO) values exist for EQ-5D health states, we applied the UK TTO values throughout the validation process.
We are not aware of any similar exercise being carried out for any of the other University dermatology quality of life questionnaires.
Use of the DLQI for validation of new measures
The DLQI has been used in the validation of >100 other disease measures.
View the publication: Johns JR, Vyas J, Ali FM, Ingram JR, Salek S,, Finlay AY. The Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality of life instruments: A systematic review. J Eur Acad Dermatol Venereol 2024 Sep 13. doi: 10.1111/jdv.20321 .
Copyright
The DLQI is protected under copyright, so you must not change the format, wording or design of the questionnaire.
The copyright statement must always be reprinted at the end of every copy of the questionnaire in whatever language. On electronic formats the copyright statement must be clearly visible to users:
© Dermatology Life Quality Index. A Y Finlay, G K Khan, April 1992
The authors of the DLQI were Professor A Y Finlay and Dr G K Khan. By agreement, Cardiff University now owns and administers all copyright matters relating to the DLQI.
The USA Library of Congress Registration
Number: TXU 608406
Registration date: 6 December 1993
Authors: Professor A Y Finlay and Dr G K Khan
The USA has reciprocal copyright agreements with most countries in the world, thereby establishing worldwide copyright of the DLQI.
DLQI worldwide guidelines and registries
DLQI worldwide guidelines and registries
Details of national and international guidelines, registries and reimbursement guidelines.
If this document cannot be read by your assistive software, you can request an accessible version by emailing web@cardiff.ac.uk. Please include the assistive tools you use and the format you require.
Publications
Original key publications
- Finlay, A. Y. and Khan, G. K. 1994. Dermatology Life Quality Index (DLQI)--a simple practical measure for routine clinical use. Clinical and Experimental Dermatology 19 (3), pp.210-216. (10.1111/j.1365-2230.1994.tb01167.x )
- Hongbo, Y. et al., 2005. Translating the science of quality of life into practice: what do Dermatology Life Quality Index scores mean?. Journal of Investigative Dermatology 125 (4), pp.659-664. (10.1111/j.0022-202X.2005.23621.x)
- Basra, M. et al., 2015. Determining the minimal clinically important difference and responsiveness of the Dermatology Life Quality Index (DLQI): further data. Dermatology 230 (1), pp.27-33. (10.1159/000365390)
- Ali, F. M. et al., 2017. Mapping of the DLQI scores to EQ-5D utility values using ordinal logistic regression. Quality of Life Research 26 , pp.3025-3034. (10.1007/s11136-017-1607-4)
- Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 454 randomised controlled trials using the Dermatology Life Quality Index: experience in 69 diseases and 43 countries. Br J Dermatol 2024; 190: 315-339
- Johns JR, Vyas J, Ali FM, Ingram JR, Salek S,, Finlay AY. The Dermatology Life Quality Index (DLQI) as Primary Outcome in Randomised Clinical Trials: A paradigm shift. Br J Dermatol 2024; 191: 497-507.
- Johns JR, Vyas J, Ali FM, Ingram JR, Salek S,, Finlay AY. The Dermatology Life Quality Index (DLQI) used as the benchmark in validation of 101 quality of life instruments: A systematic review. J Eur Acad Dermatol Venereol 2024 Sep 13. doi: 10.1111/jdv.20321.
- Vyas J, Johns JR, Ali FM, Singh RK, Ingram JR, Salek S, Finlay AY. A systematic review of 207 studies describing validation aspects of the Dermatology Life Quality Index (DLQI). Acta Derm Venereol. 2024 Nov 7;104:adv41120. doi: 10.2340/actadv.v104.41120.
Other key publications
- Lewis V J, Finlay A Y. Ten years experience of the Dermatology Life Quality Index (DLQI) J Investig Dermatol Symp Proc, 2004; 9(2):169-180.
- Finlay, A. Y. 2005. Current severe psoriasis and the Rule of Tens. British Journal of Dermatology 152 (5), pp.861-867. (10.1111/j.1365-2133.2005.06502.x)
- Basra, M. K. A. et al., 2008. The Dermatology Life Quality Index 1994-2007: a comprehensive review of validation data and clinical results. British Journal of Dermatology 159 (5), pp.997-1035. (10.1111/j.1365-2133.2008.08832.x)
- Finlay, A. 2017. Broader concepts of quality of life measurement, encompassing validation. Journal of the European Academy of Dermatology and Venereology 31 (8), pp.1254-1259. (10.1111/jdv.14254)
- Finlay, A. 2017. Quimp: A word meaning "quality of life impairment". Acta Derm Venereol 97 (4), pp.546-547. (10.2340/00015555-2650)
- Ali FM, Johns N, Finlay AY, Salek MS, Piguet V. Comparison of the paper-based and electronic versions of the Dermatology Life Quality Index: evidence of equivalence. Br J Dermatol 2017; 117: 1306-15.
- Thomas KS, Apfelbacher CA, Chalmers JR et al. Recommended core outcome instruments for health‐related quality of life, long‐term control and itch intensity in atopic eczema trials: results of the HOME VII consensus meeting. Br J Dermatol 2021.
- Fekete L, Iantovics LB, Fekete GL. Validation of the DLQI questionnaire in assessing the disease burden and principal aspects related to life quality of vitiligo patients. Frontiers in Psychology. 2024 May 30;15:1333723.
Contact us
If you have any questions, or you have feedback on our web pages, please get in touch.
General queries
Dr. Faraz Ali
Dermatology Quality of Life Administrator
Joy Hayes
Licencing, financial and contractual enquiries
Technology Transfer office
We have an official free app for the Dermatology Life Quality Index (DLQI) available in a range of languages
