Atopic Dermatitis Negatively Affects Health-Related Quality of Life

Atopic dermatitis across all severity levels has a negative impact on health-related quality of life among adult patients in the US, according to survey findings published in the Journal of Dermatological Treatment.

Researchers conducted a cross-sectional, US population-based survey from September 2020 to February 2021 among 186 patients aged 18 years and older (mean age, 39.7±15.3 years; 79.6% women) with an AD diagnosis for at least 12 months. Participants (53.2% White; 29.0% Asian; 12.4% Black; 9.7% Hispanic or Latino; 49.5% single and never married; 37.1% married; 18.8% living alone) were recruited through the National Eczema Association and clinical sites.

The participants answered questions concerning treatment goals and history, and clinician visits and completed questionnaires (Patient-Oriented SCORing Atopic Dermatitis [PO-SCORAD], Treatment Satisfaction Questionnaire for Medication [TSQM], Work Productivity and Activity Impairment Questionnaire-Atopic Dermatitis, and Dermatology Life Quality Index [DLQI]) that comprised approximately 100 to 150 questions.

Not being offered or recommended systemic AD therapy in the past 2 years was used as proxy for mild AD. Being offered or recommended systemic therapy was used as proxy for moderate-to-severe AD. Enrollment was monitored to ensure no more than 25% of participants had mild AD.

The participants with moderate or severe AD tended to be younger than those with mild AD. A total of 70.0% of participants with mild AD and 56.6% with moderate AD were White. The greatest proportion of participants with severe AD were Asian (44.9%). Overall, 42.5% of participants reported having light skin tone, 36.6% reported having medium skin tone, and 20.4% reported having dark stone.

Severity of AD according to PO-SCORAD showed 26.9% mild, 44.6% moderate, 26.3% severe and correlations between greater severity with impact on daily life and work, increased clinician visits, and decreased medication treatment satisfaction. Declining, stopping, or changing AD treatment was common among participants, and corticosteroid topical cream or ointment (53.8%) and oral antihistamines (31.2%) were the most common treatments.

Treatment was declined at least once by 38.7% of participants. Unsuccessful treatment or side effects of treatment were the most common reasons for stopping or changing treatment. The most important treatment and symptom management goals were to be free of itching (33.9%) and to have clear skin (32.3%). The most important treatment daily life or social activities goal was to lead a normal everyday life (28.0%).

Quality of life measured by the DLQI (10-item questionnaire scored 0-30; greater impairment with higher scores) showed scores increased with disease severity (mild, 2.9; moderate, 9.7; severe, 17.7; P <.0001). Among participants who were not employed (n=47), 5 reported unemployment due to moderate or severe AD. Overall, 48.4% of participants reported no effect on career or work life due to AD. No effect on career or work life varied by severity (mild AD, 78%; moderate AD, 41.0%; severe AD, 30.6%; P <.0001).

No effect of AD on leisure activities, family plans, relationships, or educational activities was reported by 40.3% of participants, with the no-effect scale sliding with severity (mild AD, 62.0%; moderate AD, 37.3%; severe AD, 22.4%; P =.0002).

Dermatologists treated 71.5% of participants for AD, with 26.9% of participants visiting a clinician every 3 months and 24.6% every 6 months, visit incidence increasing with disease severity (P =.0045). Overall, medications taken as prescribed by 47.3% of participants.

Survey limitations include a lack of clinical diagnosis verification with anonymous web-based data collection, the possibility of recall bias with self-reported data, and limited generalizability with convenience sampling.

“In this real-world cross-sectional study of participants with AD, negative humanistic findings were found across all AD severities but were higher in those with more severe AD,” the study authors conclude. “Treatment satisfaction with topical and systemic medications generally decreased with increasing disease severity.”

Disclosure: This research was supported by Eli Lilly and Company. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.