The patient‐reported disease burden in adults with atopic dermatitis: a cross‐sectional study in Europe and Canada

Abstract

Background Cross-sectional data on patient burden in adults with atopic dermatitis (AD) from real-world clinical practice are limited.Objective This study compared patient-reported burden associated with adult AD across severity levels from clinical practices in Canada and Europe.Methods This study included adults (18-65 years) diagnosed with AD by dermatologists, general practitioners or allergists. Participants categorized as mild (n = 547; 37.3%), moderate (n = 520; 35.4%) or severe (n = 400; 27.3%) based on Investigator's Global Assessment completed a questionnaire that included pruritus and pain numerical rating scales, Patient-Oriented-Scoring of Atopic Dermatitis (PO-SCORAD) itch and sleep visual analogue scales, Dermatology LifeQuality Index (DLQI), and the Hospital Anxiety and Depression Scale (HADS). Participants were also stratified by inadequate efficacy/intolerance/contraindication to cyclosporine [Cyclo; n = 62 (4 mild, 18 moderate, 40 severe)] and any systemic immunomodulatory agent [IMM; n = 104 (13 mild, 31 moderate, 60 severe)] and compared with the severe group excluding participants identified as Cyclo/IMM. ResultsAge was similar across severity groups; the proportion of women was higher in the mild group relative to severe (61.2% vs. 50.5%; P < 0.001). Compared with moderate and mild, participants with severe AD had more comorbidities, higher itch and pain severity, worse sleep and higher levels of anxiety and depression (all P < 0.001). Mean AE SD DLQI score among participants with severe AD (16.2 AE 6.9) showed a large effect on quality of life that was higher than those with moderate (10.2 AE 6.3) and mild (5.5 AE 4.9) (both P < 0.001). The burden among Cyclo and IMM subgroups was generally similar to that of participants with severe AD.Conclusions Adults with AD reported a substantial burden across multiple domains that was significantly higher in those with severe disease. The burden among participants in the Cyclo/IMM subgroups was similar to those with severe AD.

Disease burden and treatment history among adults with atopic dermatitis receiving systemic therapy: baseline characteristics of participants on the EUROSTAD prospective observational study

“…The high clinical and patient-reported burden of AD in this population despite prevalent use of topical drugs/emollients and systemic therapies is consistent with recent studies of the burden of moderate-to-severe AD in adults (7,19,46,47). Eckert et al reported a higher prevalence of anxiety, depression, sleep impairment, QoL, and work productivity among European adults with AD compared with their peers without AD, particularly among those with inadequately controlled disease (17).…”

“…The prevalence of AD in adults ranges from 2% to 7% worldwide, with the highest rates in Europe (4%) and the USA (5%-7%) (12,13). Clinical presentation is marked by cutaneous inflammation and intense pruritus often associated with chronic sleep disturbance and profound effects on daily functioning, quality of life (QoL), social interactions and psycho-social health (14)(15)(16)(17)(18)(19). AD onset most often occurs during early childhood and remains a long-term condition for most patients (20,21), bearing substantial burden and risk of comorbid type 2 inflammatory diseases such as asthma and allergic rhinitis (22).…”

The burden in chronic prurigo: patients with chronic prurigo suffer more than patients with chronic pruritus on non‐lesional skin

“…Patients with CPG were significantly more likely to suffer from skin pain and they weighted the goal of having no longer other skin sensations like burning and pain as more important than CP‐NL patients. This may lead to additional burden in our patient cohort, since in a previous study on atopic dermatitis, skin pain was associated with increased burden 26 . One possible cause for the occurrence of skin pain in CPG is an impaired descending neuronal inhibition of spinal interneurons, leading to pain facilitation, 27 possibly indicating for the development of centrally mediated chronicity mechanisms in CPG.…”

Pruritus as a Distinctive Feature of Type 2 Inflammation

“…In contrast, in other Th1/ILC1, Th17/ILC3-, and iTreg-mediated skin diseases (e.g., lupus erythematosus, hidradenitis suppurativa, acne, scleroderma), pruritus is milder and inconstant. Irrespective of the original cause and underlying pathophysiology, chronic pruritic conditions determine profound suffering of the affected individuals on multiple dimensions, with significant emotional–psychological burden, sleep interference, work impairment, and loss of productivity [ 45 ]. In the next section, we describe the role of type-2 inflammation as the main driver of pruritus associated with both communicable and non-communicable skin conditions, briefly pointing at therapeutic–translational aspects (summarized in Table 3 ) [ 46 ].…”