Heterogeneous Distribution of Lesions Among Persons With Atopic Dermatitis

Researchers identified different phenotypes of atopic dermatitis lesions and their effects on quality of life in adults with atopic dermatitis in the United States.

Distribution of lesions has shown significant heterogeneity among individuals with atopic dermatitis, according to study results recently published in the Journal of the European Academy of Dermatology and Venereology. Associations were found between lesion patterns and quality of life (QoL).

This population-based, cross-sectional study included 602 adult participants who met criteria for atopic dermatitis as defined by the UK working party. Lesional distribution was assessed, with the Patient-Oriented Scoring Atopic Dermatitis (PO-SCORAD) index used to determine self-reported lesions and the Dermatology Life Quality Index (DLQI) used to determine the effect on QoL. Differing phenotypes of atopic dermatitis lesional distribution were identified using latent class analysis whereas the association between these phenotypes and DLQI score was examined using multivariable linear regression.

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There was a 7.39% (95% CI, 5.9%-8.8%) overall prevalence of atopic dermatitis, with a mean PO-SCORAD score of 27.5 (95% CI, 25.7-29.3) and a mean DLQI score of 4.9 (95% CI, 4.2-5.5). Popliteal fossae, dorsal feet, antecubital fossae, and lower legs were the most common areas for skin lesions, with most participants reporting complete (63%) or partial (19%) lesional symmetry on their extremities. Hispanics and blacks showed higher rates of lesions on the trunk, otherwise ethnicity-related distributional variations were insignificant. Those age ≥60 years had fewer facial and scalp lesions but proportionally more lesions on the genitals or buttocks.

The 5 lesional distribution classes identified by latent class analysis were: “1. lower probabilities of lesions affecting any sites; 2. Higher probability of lesions involving the anterior and posterior neck and trunk; 3. lesions involving the antecubital fossae and upper extremities; 4. lesions involving the arms, posterior hands, genitals and buttocks, and to a lesser extent face, palms and legs; 5. lesions affecting all sites.”

Multivariable logistic regression showed a more significant association with higher DLQI score among class 2 (adjusted odds ratio [aOR] 7.19; 95% CI, 3.21-16.07), class 3 (aOR 7.11; 95% CI, 3.2-15.8), class 4 (aOR 6.9; 95% CI, 3.07-15.5), and class 5 (aOR 7.92; 95% CI, 3.54-17.71) compared with class 1.

Limitations to this study included the use of self-report to assess atopic dermatitis, a cross-sectional study design, and the potential for lesional distribution to change over time.

The study researchers concluded, “[Atopic dermatitis] is associated with a heterogeneous distribution of lesions. There were also several distinct patterns of lesional distribution, which were associated with poorer QoL. While flexural lesions were most common, they were not reported to be active in a large subset of [atopic dermatitis] patients. The heterogeneous distribution of [atopic dermatitis] should be considered in the diagnosis and assessment of [atopic dermatitis] in clinical practice.”

Several authors reported financial associations with pharmaceutical companies. For a full list of author disclosures, see the reference.


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