Impact of Atopic Dermatitis Lesion Location on Quality of Life in Adult Patients in a Real-world Study

October 2020 | Volume 19 | Issue 10 | Original Article | 943 | Copyright © October 2020


Published online September 25, 2020

Peter A. Lio MDa, Andreas Wollenberg MDb, Jacob P. Thyssen MD PhD DmScic, Evangeline J. Pierce PhDd, Maria Jose Rueda MDd, Amy M. DeLozier MPHd, Jorge Alfonso Ross Terres MDd, Peter Anderson BSc,e, Gary Milligan BSc,e, James Piercy MSc,e, Jonathan I. Silverberg MD Phd MPHf, Carle Paul MDg

aNorthwestern University, Chicago, IL bLudwig Maximilians University, Munich, Germany cUniversity of Copenhagen, Hellerup, Denmark dEli Lilly and Company, Indianapolis, IN eAdelphi Real World, Manchester, UK fGeorge Washington University School of Medicine and Health Sciences, Washington, DC gPaul Sabatier University, Toulouse, France

Abstract
Background: Atopic dermatitis (AD) has a negative impact on patients’ quality of life (QoL).
Objective: To report the impact of specific AD lesion locations on QoL in adult patients with AD using real-world data.
Methods: The Adelphi US Disease Specific Programme was conducted between January–April 2018. Physicians documented patient demographics/characteristics, AD lesion locations, and body surface area; patients completed questionnaires reporting the impact of lesion locations on QoL.
Results: AD severity was moderate in 51.6% of patients and severe in 6.0%. Lesions were commonly identified in more than one location. All AD lesion locations impacted QoL. Visible areas were most bothersome, including head/neck (68%), hands/fingers (58%), front (30%), upper extremities (22%), and lower extremities (16%), with statistically significant associations for a number of Dermatology Life Quality Index (DLQI) items. Itch, soreness, pain, and stinging are also associated with a number of body areas but in particular with those that are most visible/accessible. Lesions on the head/neck and hands/fingers (58%) demonstrated an increased impact on the anxiety and depression dimension of the EuroQol 5-Dimension tool.
Conclusions: In patients with AD, quality of life was most affected in patients with lesions in visible areas, including head/neck, hands/fingers, and upper extremities, with statistically significant associations for a number of DLQI domains. Physicians should be aware of the burden of AD lesions on QoL and consider having conversations with patients to better understand the impact of these lesions.
Prior presentation: 28th Annual European Academy of Dermatology and Venereology Congress; 9–13 October 2019, Madrid, Spain. Poster number P0233.

J Drugs Dermatol. 2020;19(10): 943-948. doi:10.36849/JDD.2020.5422

INTRODUCTION

Atopic dermatitis (AD) is a chronic, inflammatory skin disease affecting 2%–7% of adults globally.1-3 While itch has been reported as the hallmark and most burdensome symptom of AD,4 other symptoms include skin pain and sleep disturbance,5-8 which have all been shown to negatively impact patients’ physical and psychosocial well-being.9 AD limits lifestyle, activities, and social interactions in 40%–50% of patients and 17% are dissatisfied with life, compared with 11% of adults without AD.4 Taken together, patients with AD experience significant impairment of quality of life (QoL).

Assessing QoL in AD is important from both patients’ and physicians’ perspectives in clinical practice and clinical studies,10 and is ultimately beneficial for tailoring treatment. Recently, there has been an increase in the assessment of QoL and patient-reported outcomes, in addition to disease severity assessments in clinical studies with AD patients.9 Functional and emotional QoL is reportedly impaired in AD patients and correlates with disease severity.4,11 Silverberg et al found significantly high Dermatology Life Quality Index (DLQI) scores with increasing severity as assessed by SCORing Atopic Dermatitis (SCORAD) where patients with more severe