Low Quality of Life, High Disease Burden Seen in Atopic Dermatitis
The study findings support the heavy burden that atopic dermatitis places on patients, particularly those with moderate and severe disease. Credit:Medical Images RM / BOB TAPPER
Atopic dermatitis (AD) is associated with a lower overall health rating and life satisfaction, as well as with impaired quality of life (QoL) in terms of both physical and mental well-being, according to the results of a population-based, cross-sectional study published in the Annals of Asthma, Allergy & Immunology.
The investigators sought to elucidate the patient burden of AD in the US population. A total of 602 adults met AD criteria and were included in the final analysis. Overall, 53.6% of the participants were women; the mean patient age was 52.0±16.3 years.
The presence of AD was established using modified UK Diagnostic Criteria for AD. The severity of AD was evaluated with the use of self-reported global AD severity, Patient-Oriented Eczema Measure, Patient-Oriented Scoring AD (POSCORAD), POSCORAD-itch, and POSCORAD-sleep. QoL was assessed using the Short-Form (SF)-12 mental and physical health scores and Dermatology Life Quality Index.
A higher proportion of patients with AD vs those without the condition reported having only fair or poor overall health (25.8% vs 15.8%, respectively) and being somewhat or very dissatisfied with life (16.7% vs 11.4%, respectively). In fact, more severe AD was associated with even stronger effects on health ratings and satisfaction with life. In multivariable logistic regression models, self-reported global AD severity (adjusted odds ratio [aOR], 3.89; 95% CI, 1.51-10.03), Patient-Oriented Eczema Measure (aOR, 7.22; 95% CI, 4.06-10.37), and PO-SCORAD (aOR, 14.86; 95% CI, 6.79-22.93) were all significantly associated with poor health.
Furthermore, adults with AD vs those without the disease reported lower weighted mean SF-12 mental (45.9±9.9 vs 50.9±9.2, respectively) and physical health subscores (53.0±2.5 vs 53.5±2.3, respectively), as well as higher Dermatology Life Quality Index scores (4.9±6.5 vs 1.1±2.8, respectively).
SF-12 physical health scores were associated only with moderate AD. Concomitantly severe PO-SCORAD, Patient-Oriented Eczema Measure, and/or PO-SCORAD-itch was linked to very low mean SF-12 mental health (34.7) and high Dermatology Life Quality Index (24.7) scores. The presence of AD was shown to limit lifestyle in 51.3% of participants, to lead to avoidance of social interactions in 39.1%, and to affect activities in 43.3%. The most burdensome symptoms of AD included itch in 54.4% of patients, excessive dryness/scaling in 19.6%, and red/inflamed skin in 7.2%.
The investigators concluded that the study findings support the heavy burden that AD places on patients, particularly those with moderate and severe disease. They recommend that clinicians incorporate QoL assessments in clinical practice to identify those patients who require step-up treatment of their skin disease, determine the burden of disease, and potentially screen for those individuals with associated mental health disturbances.
Silverberg JI, Gelfand JM, Margolis DJ, et al. Patient-burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study [published online July 16, 2018]. Ann Allergy Asthma Immunol. doi: 10.1016/j.anai.2018.07.006