Atopic Dermatitis Associated With Heterogeneous Lesion Distribution, Distinct Phenotypes

Close-up of atopic dermatitis on the back of the knee
Close-up of atopic dermatitis on the back of the knee
Atopic dermatitis is associated with a heterogeneous distribution of lesions and several distinct patterns of lesional distribution, which were associated with poorer quality of life.

An analysis of patients with atopic dermatitis (AD) has found that the disease is associated with a heterogeneous lesion distribution with several distinct distribution patterns of lesions in most patients. Findings from this study were published in the Journal of European Academy of Dermatology and Venereology.

Researchers from the United States used cross-sectional data from the Atopic Dermatitis in America survey, composed of individuals from the probability-based web GfK Knowledge Panel (n=602). The sample was considered representative of the US population. During the first stage of the sampling process, researchers identified participants with AD, using the UK Diagnostic Criteria. The second stage consisted of screening to identify an additional AD group.

Participants’ quality of life (QoL) was evaluated with the Dermatology Life Quality Index (DLQI), and researchers performed a latent class analysis to determine distinct phenotypes of AD lesional distribution. An adjusted multivariable analysis was also performed to determine whether an association between DLQI and distinct AD phenotypes exist.

Among the 602 patients with AD and 2291 control patients without AD who were included in the final cohort, the prevalence of AD was 7.39% (95% CI, 5.9%-8.8%). The popliteal fossae, lower legs, antecubital fossae, and dorsal feet were the most common sites of skin lesions. Trunk lesions were more common in black and Hispanic patients (60.9% and 55.8%, respectively, vs 41.9% for white, 40.0% for Asian, and 49.7% for other; P =.02). Patients aged ≥60 years had lower proportions of active lesions on the face (P =.01) and scalp (P =.02), as well as a higher proportion of buttocks/genital lesions (P =.04).

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There were 5 classes of lesional distribution: class 1, lower probabilities of lesions affecting any site; class 2, higher probabilities of lesions on the anterior and posterior neck and trunk; class 3, lesions on the antecubital fossae and upper extremities; class 4, lesions on the arms, posterior hands, genitals and buttocks, and even the face, palms and legs; and class 5, lesions affecting all sites. Compared with class 1, classes 2 through 5 were associated with higher DLQI scores (class 2: adjusted odds ratio [aOR], 7.19; [95% CI, 3.21-16.07]; 3: aOR, 7.11 [95% CI, 3.20-15.80]; 4: aOR, 6.90 [95% CI, 3.07-15.50]; 5: aOR, 7.92 [95% CI, 3.54-17.71]).

Limitations of the study include its cross-sectional nature, as well as the use of self-reported AD distribution data.

On the basis of their findings, the researchers indicated that “the heterogeneous distribution of AD should be considered in the diagnosis and assessment of AD in clinical practice.”

Disclosure: Atopic Dermatitis in America Study is sponsored by Sanofi Genzyme and Regeneron. All authors reported associations with pharmaceutical companies. For a full list of disclosures, see the reference.

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Silverberg JI, Margolis DJ, Boguniewicz M, et al. Distribution of atopic dermatitis lesions in United States adults [published online March 18, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15574