Effectiveness of Inpatient Treatment on Quality of Life and Clinical Disease Severity in Atopic Dermatitis and Psoriasis Vulgaris – A Prospective Study

Abstract

Background: Financial constraints challenge evidence of the effectiveness of dermatological inpatient management. Objective: To evaluate the effectiveness of hospitalization in atopic dermatitis and psoriasis regarding initial and sustained benefits. Methods: Prospective study on adults with psoriasis vulgaris (n = 22) and atopic dermatitis (n = 14). At admission, discharge, and 3 months after discharge, validated outcomes of objective and subjective disease severity were assessed by trained investigators. Results: Hospitalization resulted in substantial benefit in quality of life and clinical disease severity. Looking at mean scores, the observed benefit appeared stable until 3-month follow-up. The analysis of individual patient data revealed significant changes in disease severity between discharge and 3-month follow-up with some patients relapsing, others further improving. Reasons for hospitalization and treatment performed were not related to sustained benefit. Conclusions: In psoriasis vulgaris and atopic dermatitis, hospitalization effectively improved quality of life and clinical disease severity. Further research should focus on prognostic factors for sustained improvement.

The Price for Treatment of Chronic Skin Diseases: Different Approaches

“…The data from the present study of Schmitt et al [3] do not show factors allowing prediction of relevant worsening after discharge. Factors that might poThe prevalence of atopic dermatitis (AD), the most frequent relapsing inflammatory skin disease, has increased in the developed countries during recent decades.…”

“…Thus health systems like that in Germany need to justify the hospitalization of patients with psoriasis and AD and the significant benefit in the relevant dimensions of quality of life. The study of Schmitt et al [3] in this issue extends previous research on the effectiveness of hospitalization as it focuses on the 3-month period after discharge. Interestingly the research and publications on cost of illness are shifting from the costs directly related to the patients' expenses towards those related to the costs for the general health care system and its efficacy.…”

“…Schmitt et al [3] were able to show an overall benefit of hospitalization, which appears to be both substantial and stable for at least 3 months after discharge. A conclusion for an individual patient is that hospitalization is likely to improve his quality of life as well as the extent and intensity of the skin lesions.…”

The Practical Reality of Using a Patient-Reported Outcome Measure in a Routine Dermatology Clinic

“…They can be used, for example, to assess the patient benefit from a particular intervention: inpatient care of patients with atopic dermatitis and psoriasis results in an overall sustained benefit for at least 3 months after discharge. DLQI scores from individual patients can, however, also be used to identify patients who relapse [11]. The value and relevance of patient-reported health-related QoL measures has recently been further emphasised: in psoriasis health-related QoL (using the DLQI) is an independent predictor of work productivity, in contrast to objective measures of clinical disease severity [12].…”

Extracorporeal Photopheresis as a Treatment for Patients with Severe, Refractory Atopic Dermatitis

“…In adults, AD typically has a chronic relapsing course associated with significant physical as well as psychological disability, and depending on clinical severity it can lead to hospitalization [3]. The disease usually responds adequately to topical corticosteroids, emollients or phototherapy [4].…”