The Psychosocial Burden Associated With and Effective Treatment Approach for Atopic Dermatitis: A Literature Review

October 2021 | Volume 20 | Issue 10 | Original Article | 1046 | Copyright © October 2021

Published online September 16, 2021

Hira Ghani BAa, Marielle Jamgochian MBSb, Amy Pappert MDb, Raphia Rahman MBSc, Stefanie Cubeli d

aNYIT College of Osteopathic Medicine, Old Westbury, NY
bCenter for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, NJ
cRowan School of Osteopathic Medicine, Stratford, NJ
dSt. John’s Episcopal Hospital, Far Rockaway, NY

Atopic Dermatitis (AD) is chronic relapsing inflammatory skin condition that is marked by a high degree of psychosocial and emotional burden in both pediatric and adult populations. In addition to physical symptoms of pruritus and visible skin lesions, AD is associated with decreased quality of life, psychosocial stress, low self-esteem, low work productivity, irritability, decreased physical intimacy, disturbed sleep, depression, anxiety, and suicidal ideation. Since AD is a chronic disease, treatment includes achieving long-term disease control for noticeable symptom reduction. For mild symptoms of AD, dermatologists should recommend basic skin care maintenance, use of emollients, and avoidance of triggers. If that fails, treatment with TCS, TCIs, phototherapy, and systemic immunosuppressants is generally advised. Dupilumab is the most effective immunomodulating therapy available for treating moderate-to-severe symptoms associated with AD, including itching, poor sleep quality, anxiety, and depression. Topical agents and phototherapy have been shown to be less efficacious and more suited for achieving remission in mild-to-moderate disease. Overall, the treatment of emotional and psychosocial factors linked with moderate to severe AD remains challenging and calls for more research. The purpose of our review is to explore the extent and severity of psychosocial and emotional burden that patients with atopic dermatitis may potentially experience, and list up-to-date treatment choices available for symptoms associated with AD.

J Drugs Dermatol. 2021;20(10): 1046-1050.doi:10.36849/JDD.6328


INTRODUCTION Atopic dermatitis (AD), also known as eczema, is a chronic inflammatory relapsing skin disorder that is characterized by pruritus and recurrent eczematous lesions and is a disease that is prevalent in both children and adults.1 AD presents as an erythematous rash and usually involves the skin of face and flexor surfaces.2 The strongest risk factor for AD is a family history of atopic diseases, particularly for atopic dermatitis.3 AD is associated with other atopic responses, such as allergic rhinitis, asthma, and food allergy.4,5 Genetic risk factors for AD include null mutations in filaggrin (FLG), which encodes for a key epidermal structural protein.6 Environmental risk factors include a western diet, living in urban settings with low humidity or UV radiation exposure, a small family size, and a high education level within the household.7

AD is predominantly an early onset disease, with 60% of cases arising in the first year of life.8 According to global burden of skin diseases research in 2010, AD is in the top 10 most prevalent skin diseases worldwide.9 In the United States, the prevalence of AD is 11.3–12.7% in the pediatric and adolescent population, and 6.9–7.6% in the adult population.10 The incidence of AD has increased by 2–3 fold during the past decades.5 AD is a clinical diagnosis, and is diagnosed using various diagnostic criteria, including the Hanifin and Rajka criteria.11 Criteria include pruritus and dermatotic lesions with xerosis or generalized skin dryness.1 Associated features include hyperlinearity of the palms and soles, thinning or complete loss of the lateral one-third of the eyebrows (Herthoge sign), and creases under the lower eyelids (Dennie-Morgan lines), which are strongly associated with AD.1,12,13 To help measure disease severity, quality of life, and long-term control, the Eczema Area Severity Index and the Scoring of Atopic Dermatitis Index are used.14

AD is associated with increased risk of psychosocial stress and development of mental health disorders. It has the greatest impact on disability-adjusted life years (DALY) among amongst all existing dermatological cutaneous disorders.9 AD can impact quality of life as well as the social, academic, and occupational areas of those affected.15 The purpose of this review is to explore the extent and severity of psychosocial burden that patients with atopic dermatitis may experience, with focus on up-to-date treatment options available for symptoms associated with AD.


Emotional and Psychosocial Burden of AD
AD is reported to have the greatest impact on childhood quality