Patients With Atopic Eczema Report Significantly Varying Healthcare Needs

Eczema on a woman's hand
Eczema on a woman’s hand
Identification of patient-specific needs may support personalized, patient-centered care and shared decision making in the treatment of atopic eczema.

Patients with atopic eczema (AE) see their general health as significantly deteriorating as a result of their condition, according to study data published in the Journal of the European Academy of Dermatology and Venerology.

The cross-sectional study evaluated 1678 patient responses (60.5% women; mean age 38.35+15.92 years) to a questionnaire administered by 91 dermatology practices and outpatient clinics between January and December of 2010. All patients were >18 years and had been clinically diagnosed with AD.

The majority of patients reported having dry skin (93.2%) and itching while sweating (72.5%), affecting on average of 10.4% of the surface area of the body. Treatment with corticosteroids was indicated by 85.5% of patients and basic topical care using ointments by 90.4% of patients. Patients rated the quality of treatment as 2.6+0.9, where 1 was very good and 5 was insufficient.

Using the Dermatology Life Quality Index (DLQI) to rate their health-related quality of life (HRQoL) during the past 7 days, the total skin-generic score was 8.49+6.45, signifying a high disease burden. Nearly a third of the cohort (32.1%) reported high or very high impairment of QoL (measured as DLQI scores ranging from 11 to 20 and 21 to 30, respectively). General health status, measured by the EQ visual analog scale (0 to 100 from worst to best) was a mean of 63.62+21.98.

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More than 50% of the cohort responded positively to a list of 25 potential goals of therapy. Categories that applied to 90% of patients included needing to “have confidence in therapy,” “get better quickly,” “be healed of all skin defects,” and “be free of itching,” which were also rated as “very important” by more than 90% of patients. Other important needs included getting a clear diagnosis, regaining control over the disease, and no longer having burning sensations.

The importance of all these needs increased with age. Adults younger than 30 years rated all treatment goals as less important than adults aged 31 to 54 years rated the same treatment goals, and patients 65 years and older rated them as most important, such as “the need to have fewer side effects,” and “to experience a greater enjoyment of life.” The oldest patient group showed less concern for having a normal sex life than younger patients.

Female patients also rated 21 of the 25 items as more significant than male patients. For patients who had been most recently diagnosed, 4 items were specifically of greater concern: the need to “have no fear of disease worsening,” “to be healed of all skin defects,” “to find a clear diagnosis and therapy,” and “to have confidence in the therapy.”

The researchers concluded that various factors — including age, sex, and duration of AE symptoms — need to be considered in developing a treatment plan that will address the needs of individual patients.

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Augustin M, Langenbruch A, Blome C, et al. Characterizing treatment-related patient needs in atopic eczema: insights for personalized goal orientation [published online August 29, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15919