Factors associated with severity of atopic dermatitis – a Finnish cross‐sectional study

Abstract

Background Severity‐associated factors in atopic dermatitis (AD) have focussed on early onset, concomitant atopic diseases, markers of Th2‐shifted inflammation and filaggrin mutations. Objectives To investigate factors associated with severe AD in Finnish patients. Methods We conducted a single‐centre, cross‐sectional observational study with 502 AD patients aged 4.79 to 79.90 years (mean 32.08 years). Disease severity was assessed with the Rajka–Langeland severity score and EASI and associated clinical signs were evaluated. Data regarding onset, relatives, atopic and other comorbidities was gathered retrospectively. We investigated total serum IgE‐levels, a panel of filaggrin null mutations and functional variants of genes associated with skin barrier defects. Results Factors more frequent in severe AD included early onset (P = 0.004, 95%CI 0.000–0.024), male sex (P = 0.002, 95%CI 0.000–0.11), history of smoking (P = 0.012, 95%CI 0.000–0.024), concomitant asthma (P = 0.001, 95%CI 0.000–0.011), palmar hyperlinearity (P = 0.013, 95%CI 0.014–0.059), hand dermatitis (P = 0.020, 95%CI 0.000–0.029) and history of contact allergy (P = 0.042, 95%CI 0.037–0.096). Body mass indices (P < 0.000, 95%CI 0.000–0.011) and total serum IgE‐levels (P < 0.000, 95%CI 0.000–0.011) were higher in severe AD. No differences were observed for allergic rhinitis, allergic conjunctivitis, food allergy, peanut allergy, prick positivity, keratosis pilaris, history of herpes simplex infections, filaggrin null mutations and other gene variants. Conclusions Severity determinants in Finnish patients seem to be early‐onset, male sex, smoking, overweight, concomitant asthma, palmar hyperlinearity, hand dermatitis and high IgE‐levels. A sub‐typing of patients in relation to confirmed severity determinants may be useful for course prediction, prognosis and targeted AD management.

Real‐world treatment patterns of Finnish adult patients with atopic dermatitis: From topicals to systemic therapy

“…Overall, patients with severe AD and systemic medication were found older, more often male, and with lower educational level than those without systemic medication. Previously, male gender was shown to be a risk factor for more severe AD and male AD patients were suggested to have a lower tendency to seek healthcare services 21 . In our study, systemically treated patients were detected with more cases of sepsis after initiation of systemic therapy, which may indicate increased susceptibility for severe infections in this patient group.…”

Link between obesity and atopic dermatitis: Does obesity predispose to atopic dermatitis, or vice versa?

“…20 BMI is higher in patients with severe AD than in those with mild AD. 22 In children aged >2 years, BMI > 24 is positively correlated with AD severity scores. 49 Similar results were also observed in a group of patients aged 1-46 years.…”

“…The association of AD with obesity has been fairly well documented, although the conclusions among studies are not consistent (Table 1). 12,19–64 In children, prevalence of obesity is significantly higher in individuals with AD than in those without AD 24 . Also in children, the presence of AD/eczema is positively associated with obesity, while negatively associated with underweight subjects 30 .…”

“…Likewise, obesity is also associated with AD in adults 20 . BMI is higher in patients with severe AD than in those with mild AD 22 . In children aged >2 years, BMI > 24 is positively correlated with AD severity scores 49 .…”

Disease burden of moderate–severe atopic dermatitis by use of systemic treatment: Results from the Danish Skin Cohort

“…A recent Finnish study showed that early disease onset, male gender and comorbid asthma were determinants of AD severity. 5 It is unknown why men seem to have more severe disease, but low topical treatment adherence or healthcare consumption could explain it. 6 Also, results suggest that women are more adherent to topical treatments and maybe less prone to accept the potential side-effects of systemic medication.…”