Aim of the study was to investigate the impact of TNF-α antagonists on 
health-related quality of life (HRQoL) in selected skin diseases, i.e. chronic 
plaque psoriasis, Behçet's disease (BD), hidradenitis suppurativa (HS) and 
pyoderma gangrenosum (PG). We have carried out a systematic literature search of 
Medline (2000 to April 2013) using the Cochrane highly sensitive and specific 
search strategy. Citations were screened for randomized, controlled trials of 
TNF-α antagonists (adalimumab, etanercept and infliximab) versus placebo in 
adults with psoriasis, BD, HS or PG. From the literature it is evident that skin 
diseases can affect physical, psychological, social and occupational aspects of 
everyday life. TNF-α antagonists induced consistent benefits across health 
outcomes in psoriasis, but only monoclonal antibodies, infliximab and adalimumab 
were effective in improving QoL in patients with BD, HS and PG. Dermatology Life 
Quality Index was the most common used tool for investigating HRQoL. For the 
majority of patients with skin diseases, the most important negative impacts on 
QoL were appearance related. Generally, the burden on QoL was correlated to the 
severity of skin disease and the improvement in QoL achieved by TNF-α blockers 
was proportional to the degree of disease remission. HRQoL issues are becoming 
even more important in evaluating medical care, including treatment of skin 
diseases. In general, achieving the highest clearing of skin disease with 
anti-TNF-α agents is required for optimal improvement in QoL.