INTRODUCTION
Atopic dermatitis (AD) is a skin disorder characterized by chronic relapsing pruritic eczema resulting from altered skin barrier function and neuroimmune dysregulation.1 Moderate-to-severe AD can result in functional impairment, sleep disturbance, and anxiety and depressive symptoms.2,3 While nearly all people with AD suffer from the hallmark symptom of itch,3-5 skin pain is another sensory symptom of the condition, but one that is less recognized by dermatologists and treatment guidelines. Skin pain in AD has been underappreciated for multiple reasons including: a lack of awareness by patients and clinicians; a lack of a common lexicon for describing skin pain; a view that skin pain is a corollary of physical signs of AD that will improve after treating skin lesions; and the assumption that skin pain and itch cannot be experienced simultaneously.
Until recently, little was known about the frequency of skin pain, its causes, and its impact on the quality of life (QoL) for patients with AD. In this article, we establish the clinical relevance of skin pain in AD by reviewing new evidence of its nature, pathophysiology, prevalence, and consequences. We also detail why this symptom should be considered in AD assessment and treatment.
What is meant by skin pain in AD?
The concept of pain, including skin pain, is complex and multifactorial. How pain is experienced differs among individuals, and what a dermatologist conceptualizes as skin pain may vary widely from the patient’s experience of this symptom.
Qualitative studies provide greater patient insight into skin pain. In a natural language processing and centrality analysis, word choice and experiences of patients with AD were examined from an international cross-sectional, open-ended survey.6 Itch was the most impactful symptom, but pain also led to a significant, distinct burden for patients. Pain was linked to itch in some patients, and to embarrassment and annoyance in others, suggesting both physical and emotional consequences.
Patients with AD use different words to describe their experience of skin pain. Many use neuropathic descriptors, such as “burningâ€, “stingingâ€, “tinglingâ€, and “pinprick-likeâ€.7-10 In one study, 36 of 43 (84%) patients with AD reported skin pain, with 67% of them describing it as a “burning sensation†or “soreness or discomfortâ€. Others characterized it as a “stinging sensation†(47%), “sensitivity†(44%), or “stabbing feelingâ€
Until recently, little was known about the frequency of skin pain, its causes, and its impact on the quality of life (QoL) for patients with AD. In this article, we establish the clinical relevance of skin pain in AD by reviewing new evidence of its nature, pathophysiology, prevalence, and consequences. We also detail why this symptom should be considered in AD assessment and treatment.
What is meant by skin pain in AD?
The concept of pain, including skin pain, is complex and multifactorial. How pain is experienced differs among individuals, and what a dermatologist conceptualizes as skin pain may vary widely from the patient’s experience of this symptom.
Qualitative studies provide greater patient insight into skin pain. In a natural language processing and centrality analysis, word choice and experiences of patients with AD were examined from an international cross-sectional, open-ended survey.6 Itch was the most impactful symptom, but pain also led to a significant, distinct burden for patients. Pain was linked to itch in some patients, and to embarrassment and annoyance in others, suggesting both physical and emotional consequences.
Patients with AD use different words to describe their experience of skin pain. Many use neuropathic descriptors, such as “burningâ€, “stingingâ€, “tinglingâ€, and “pinprick-likeâ€.7-10 In one study, 36 of 43 (84%) patients with AD reported skin pain, with 67% of them describing it as a “burning sensation†or “soreness or discomfortâ€. Others characterized it as a “stinging sensation†(47%), “sensitivity†(44%), or “stabbing feelingâ€