Atopic dermatitis (AD) can impact many aspects of an individual’s life, beyond the skin alone. Itching, sleep disturbances, social isolation, anxiety, depression, and more can all be present alongside AD, and can affect an individual’s quality of life. These quality of life-reducing issues can be burdensome for those living with the condition. Recently, two studies investigating the quality of life-altering effects and burden of AD on adults were published.1,2 These studies found that quality of life is impacted for individuals with varying severities of AD, including for those with mild AD. Additionally, the burden of AD may be just as great as, if not greater than, the burden of other chronic conditions such as high blood pressure, diabetes, or heart disease.
Measuring AD severity
The first of these studies, led by Dr. Eric Simpson of the Oregon Health and Science University, collected data on 1,519 adults with AD across six academic sites in the United States. These individuals were separated and evaluated based on the severity of their AD (mild AD versus moderate to severe AD) and how well they felt their AD was controlled (adequately or inadequately controlled). The researchers used several different commonly used scales to assess AD severity, AD symptoms, mental health, and health-related quality of life. Several of these included the PO-SCORAD itch visual analog scale, PO-SCORAD sleep visual analog scale, Hospital Anxiety and Depression Scale, and the Dermatology Life Quality Index. The results indicated that the individuals with moderate/severe AD had a higher prevalence of depression and anxiety, a lower quality of life that was directly related to their health, a greater incidence of sleep-related difficulties, and more severe pain and itching when compared to those with mild AD.1
Is your AD controlled?
Additionally, when analyzing these results further based on each individual’s perception of how well their AD was controlled, those who felt their moderate/severe AD was inadequately controlled, despite treatment with phototherapy or immunomodulators, reported having a higher AD-related burden than those who felt their AD was adequately controlled. These individuals with inadequately controlled AD also reported having more sleep disturbances as well as a greater number of days per week with itchy skin and a longer duration of itch than those who felt their AD was adequately controlled. All of these issues may contribute to a decreased quality of life and increased burden of AD for those with moderate/severe AD, especially those who feel as though their current treatment regimen is ineffective.1
How AD impacts quality of life
The second recently published study on the burden and quality of life impacts on adults with AD was led by Dr. Jonathan Silverberg of the Northwestern University Feinberg School of Medicine. Dr. Silverberg and his team analyzed data collected from 602 adults with AD and asked the participants about the severity of their AD, AD-related symptoms including itch and sleep disturbances, health-related quality of life, and their overall physical and mental health. The data collected indicated that these adults did have burdensome symptoms, with the most burdensome being itching, excessive dryness, red or inflamed skin, and sleep disturbances. Those with moderate to severe AD more commonly reported burdensome blisters, pain, open sores, or oozing when compared to their counterparts with mild AD.2
Overall, 51% of these adults with varying severities of AD reported that their lifestyle was limited as a result of their condition, and 39% reported that they avoided social interactions because of their appearance. These burdens were found to be the most harmful in those with moderate to severe AD, however, those with mild AD also commonly reported these quality of life-impacting issues, indicating that AD can be a burden and impact daily life across all severity levels.2
Mental health and AD
Negative mental health impacts were also reported by the adults with AD, with the most severe scores being reported by those with moderate to severe AD, further demonstrating the burden of AD on those with the condition. Additionally, the mental health scores reported by those with AD were lower than the scores for other chronic conditions such as high blood pressure, diabetes, and heart disease, especially for those with moderate to severe AD. These results indicate that the burden of AD may be just as severe, if not more severe, than other commonly encountered chronic health conditions.2
If you or a loved one are experiencing a significant burden as a result of your AD, feel as though your AD is inadequately managed, or are experiencing impaired mental health or signs of mental health distress, contact your healthcare provider as soon as possible.
Simpson EL, Guttman-Yassky E, et al. Association of inadequately controlled disease and disease severity with patient-reported disease burden in adults with atopic dermatitis. JAMA Dermatology. https://jama.jamanetwork.com/article.aspx?doi=10.1001/jamadermatol.2018.1572&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jamadermatol.2018.1572. Published online on July 3, 2018. Accessed July 25, 2018.
Silverberg JI, Gelfand JM, et al. Patient-burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Annals of Allergy, Asthma and Immunology. https://www.annallergy.org/article/S1081-1206(18)30567-2/fulltext. Published online on July 16, 2018. Accessed July 25, 2018.