Severe Pruritus Predicts Worse QoL in Mild to Moderate Atopic Dermatitis

Woman itching arm.
Woman itching arm.
Investigators evaluated the association between pruritus and quality of life, using data from 2 phase 3 studies.

In patients with mild to moderate atopic dermatitis (AD), more severe pruritus is associated with greater effects on quality of life (QoL), according to study results published in the Journal of the European Academy of Dermatology and Venereology.

Patients with mild to moderate AD (age ≥ 2 years) were randomly assigned to either twice-daily crisaborole ointment 2% (n=1016) or a vehicle control (n=506) for a total of 28 days. The researchers assessed QoL at baseline and on day 29, using the Dermatology Life Quality Index (DLQI) in patients aged ≥16 years, the Children’s Dermatology Life Quality Index in patients aged 2 to 15 years, and the Dermatitis Family Impact (DFI) in caregivers of patients aged 2 to 17 years. In addition, changes in pruritus were assessed with the 4-point Severity of Pruritus Scale (SPS), ranging from 0 (“no itching”) to 3 (“bothersome itching/scratching that disturbs sleep”). Data from the SPS were captured in an electronic diary in the morning and evening.

In the pooled analysis, there were positive correlations between SPS and the DLQI (Pearson correlation coefficients, 0.46 [baseline] vs 0.59 [day 29]; both P <.0001). In addition, positive associations were observed between SPS and the Children’s Dermatology Life Quality Index (Pearson correlation coefficients, 0.47 [baseline] vs 0.58 [day 29]; both P <.0001). There was also a positive correlation between SPS and the DFI (Pearson correlation coefficients, 0.38 [baseline] vs 0.53 [day 29]; both P <.0001). Overall, more severe pruritus was associated with worsening QoL (ie, SPS score of 0 = “no negative effect on patient QoL” vs SPS score of 3 = negative “very large effect on patient QoL”).

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Limitations of the analysis were the inclusion of only patients with mild to moderate AD and the short follow-up.

“Although severity bands for DFI are unavailable,” the researchers wrote, “the results with [Children’s Dermatology Life Quality Index] and DLQI support the likelihood that SPS score could similarly be linked to severity bands once they are determined for DFI.”

The study was funded by Pfizer Inc, and the researchers reported financial conflicts of interest with Allergan, Inc; Almirall Prodesfarma, SA; Beiersdorf AG; Celgene Corporation; Eli Lilly and Company; Galderma Laboratories, LP; Helsinn Healthcare SA; Kiniksa Pharmaceuticals, Ltd; Kneipp GmbH; Menlo Therapeutics; NeRRe Therapeutics; Novartis Pharmaceuticals Corporation; Pierre Fabre; Sienna Biopharmaceuticals, Inc; and Ziarco, Inc.

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Ständer S, Yosipovitch G, Bushmakin AG, et al. Examining the association between pruritus and quality of life in patients with atopic dermatitis treated with crisaborole [published online May 27, 2019]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.15712