Disease Severity Is Associated with Alexithymia in Patients with Atopic Dermatitis

Abstract

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder that is associated with higher rates of psychological disorders, but limited evidence supported the association with alexithymia, a psychoaffective dysfunction. Objectives: This study was aimed to investigate the occurrence of alexithymia in AD patients, compared to healthy subjects. Methods: This cross-sectional study assessed AD severity by the Eczema Area and Severity Index (EASI) score, sleeplessness and itch by a numeric rating scale (NRS), and alexithymia by the 20-item Toronto Alexithymia Scale (TAS-20) score. The association between disease characteristics and alexithymia was evaluated through several logistic regression models. Results: 202 AD patients and 240 healthy subjects were included in this study. The alexithymic personality trait (TAS-20 ≥51) was more frequently observed among AD patients compared to the control group (62.4% [126/202] vs. 29.2% [70/240], p < 0.0001). In particular, alexithymia (TAS-20 score ≥61) was detected in a significantly higher number of AD patients than in the controls (27.7% [56/202] vs. 7.5% [18/240]; p < 0.0001), whereas borderline alexithymia was detected in 34.6% (70/202) of AD patients compared to 21.7% of healthy controls. Alexithymia was more common among severe AD patients (43.6%) compared to mild AD patients (15.6%) and correlated with itch intensity and sleep disturbances. Among clinical variables, ordered logistic regression analyses revealed disease severity as predictor of alexithymia. Indeed, univariate analysis showed EASI score, sleep NRS, and itch NRS being significantly associated with alexithymia, while a multivariate model identified increased EASI score values as predicting factor. Conclusion:This study described alexithymia in AD patients correlating its occurrence with clinical AD severity markers (EASI score, itch, and sleeplessness) and identifying the increase in EASI score as predicting factor.

Multi-Method Approach in the Assessment of Alexithymia in Patients With Scleroderma: Use of Two Different Tools

“…When considering only established alexithymia (i.e., TAS-20 score ≥61), the prevalence of 22.4% seen among our SSc patients was quite similar to that of patients with psoriasis (24.8%) (Sampogna et al, 2017) and atopic dermatitis (27.7%) (Chiricozzi et al, 2020), while it was lower than the one reported for patients with hidradenitis suppurativa (37.2%) (Chiricozzi et al, 2018). In the general population of other European countries the prevalence of alexithymia is approximately 10% (Mattila et al, 2006;Franz et al, 2008).…”

“…Cronbach’s alpha was calculated to evaluate the internal consistency of the instruments. As to sample size, we hypothesized a prevalence of alexithymia of 25%, on the basis of data from other chronic dermatological diseases, such as psoriasis (24.8%) ( Sampogna et al, 2017 ) and atopic dermatitis (27.7%) ( Chiricozzi et al, 2020 ). In a sample of 60 patients, the 90% confidence interval is within ±8.5% of the measured value.…”

“…The presence of alexithymia in dermatological patients is controversial. A high prevalence of alexithymia has been observed in patients with psoriasis ( Sampogna et al, 2017 ), hidradenitis suppurativa ( Chiricozzi et al, 2018 ; Quinto et al, 2021 ), and atopic dermatitis ( Chiricozzi et al, 2020 ). However, no association has been found between alexithymia and acne ( Sunay et al, 2011 ) or seborrhoeic dermatitis ( Cömert et al, 2013 ).…”

Prevalence and Associated Factors of Alexithymia in Patients with Hidradenitis Suppurativa: A Cross-sectional Study

“…Moreover, alexithymia was also assessed in other chronic inflammatory dermatoses. In patients with psoriasis the prevalence of alexithymia was 24.8% ( 10 ), whereas a similar percentage was observed in patients with atopic dermatitis (27.7%) ( 11 ). The inclusion of emotionalizing and fantasizing in BVAQ is a distinguishing factor between BVAQ and the commonly used TAS-20 ( 12 ).…”

Alexithymia and Cutaneous Disease Morbidity: A Systematic Review

“…Studies revealed a greater prevalence of clinically significant alexithymia in patients with AD compared to controls, up to 66.7% [34, 51]. Further, data suggest disease severity may predict alexithymia severity: for every one-point increase in Eczema Area and Severity Index (EASI), patients had a 9% enhanced likelihood of having a higher TAS-20 total score and an 11% increase in likelihood of having a clinically significant TAS-20 total score [51]. In terms of alexithymia’s psychosocial implications in AD patients, a correlation between TAS-20 total score and greater family dysfunction was reported [34].…”