Quality of Life in Patients with Atopic Dermatitis: Disease Burden, Measurement, and Treatment Benefit

Blome, Christine; Radtke, Marc Alexander; Eissing, Leah; Augustin, Matthias

doi:10.1007/s40257-015-0171-3

Cited by 93 publications

(74 citation statements)

References 43 publications

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“…[13][14][15] Contrary to allergic bronchial asthma and allergic rhinoconjunctivitis ('hay fever'), the aetiopathogenesis of atopic eczema is still not well established. [23][24][25][26][27][28] A study measuring quality of life in children with AE showed that those with generalized eczema had an impaired quality of life score similar to children affected with cystic fibrosis, severe renal disease or cerebral palsy, while more localized forms showed similar scores to rheumatoid arthritis or diabetes. 16 2 The deviated immune response towards Th2-dominant responses with increased immunoglobulin E production and distinct inflammatory events leading to allergic reactions against a multitude of environmental allergens from the air or from foods.…”

Section: Introductionmentioning

confidence: 99%

“…21,22 The disease goes along with a remarkable economic burden both for the affected individual and for society and with marked impairment in quality of life. [23][24][25][26][27][28] A study measuring quality of life in children with AE showed that those with generalized eczema had an impaired quality of life score similar to children affected with cystic fibrosis, severe renal disease or cerebral palsy, while more localized forms showed similar scores to rheumatoid arthritis or diabetes. 29 Furthermore, there are deficits in quality of health care for the affected persons and their families.…”

Section: Introductionmentioning

confidence: 99%

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Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults

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Arents

et al. 2019

Acad Dermatol Venereol

128

112

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Background Atopic eczema (AE, atopic dermatitis) is one of the most common non‐communicable inflammatory skin diseases affecting 1–5% of the adult population in Europe with marked impairment in quality of life. In spite of great progress in understanding the pathophysiology of disturbed skin barrier and immune deviation, AE still represents a problem in daily clinical practice. Furthermore, the true impact of AE on individual suffering is often not recognized. Objectives With a large European study, we wanted to provide insights into the actual suffering and individual burden of disease in adult patients with AE. Methods A total of 1189 adult patients (18–87 years, 56% female) with moderate to severe AE were recruited in nine European countries by dermatologists or allergists together with the help of patient organizations. A computer‐assisted telephone interview was performed by experienced interviewers between October 2017 and March 2018. The following instruments were used to assess severity or measure quality of life: Patient‐Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS‐D) and a newly developed Atopic Eczema Score of Emotional Consequences (AESEC). Patients were also asked to self‐assess the severity of their disease. Results Despite current treatment, 45% of participants still had actual moderate to very severe AE in POEM. Due to their skin disease, 57% missed at least 1 day of work in the preceding year. DLQI showed moderate to extremely large impairment in 55%. According to HADS‐D, 10% scored on or above the threshold of eight points with signs of depressive symptoms. Assessed with AESEC, 57% were emotionally burdened with feelings such as ‘trying to hide the eczema’, ‘feeling guilty about eczema’, having ‘problems with intimacy’ and more. Of persons actually suffering from severe AE, 88% stated that their AE at least partly compromised their ability to face life. Conclusions This real‐life study shows that adults with a moderate to severe form of AE are suffering more than what would be deemed acceptable. There is a need for increased awareness of this problem among healthcare professionals, policymakers and the general public to support research in the development of new and more effective treatments and provide access to better and affordable health care for affected patients.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults

Ring

Zink

Arents

et al. 2019

Acad Dermatol Venereol

128

112

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“…Atopic dermatitis (AD) is the most common chronic inflammatory disorder of the skin in children. Although not life‐threatening, AD hugely alters quality of life due to pruritus that may constitute a disabling condition affecting sleep as well as daily or social activities . Furthermore, the financial burden of the disease should not be underestimated: for example, in the United Kingdom, AD costs the healthcare system around £125 million annually .…”

Section: Introductionmentioning

confidence: 99%

New insights into the phenotypes of atopic dermatitis linked with allergies and asthma in children: An overview

Amat

Soria

Tallon

et al. 2018

Clin Experimental Allergy

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Atopic dermatitis (AD) is a complex disease with multiple causes and complex mechanistic pathways according to age of onset, severity of the illness, ethnic modifiers, response to therapy and triggers. A group of difficult-to-manage patients characterized by early-onset AD and severe lifelong disease associated with allergic asthma and/or food allergy (FA) has been identified. In this study, we focus on these severe phenotypes, analysing their links with other atopic comorbidities, and taking into account the results from recent cohort studies and meta-analyses. The main hypothesis that is currently proposed to explain the onset of allergic diseases is an epithelial barrier defect. Thus, the atopic march could correspond to an epithelial dysfunction, self-sustained by a secondary allergenic sensitization, explaining the transition from AD to allergic asthma. Furthermore, AD severity seems to be a risk factor for associated FA. Results from population-based, birth and patient cohorts show that early-onset and severe AD, male gender, parental history of asthma, and early and multiple sensitizations are risk factors leading to the atopic march and the development of asthma. The importance of environmental factors should be recognized in these high-risk children and prevention programs adapted accordingly. Effective targeted therapies to restore both barrier function and to control inflammation are necessary; early emollient therapy is an important approach to prevent AD in high-risk children. Clinicians should also keep in mind the specific risk of atopic comorbidities in case of filaggrin loss-of-function mutations and the rare phenotypes of orphan syndromes due to heritable mutations in skin barrier components.

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“…DLQI is a 10‐item questionnaire that assesses QoL across dermatological disease in general . DLQI is the most frequently used QoL instrument in AD studies, with established interpretability bands for severity and extensive validation and use across a wide array of dermatological diseases. These are potential advantages for its use in clinical practice.…”

mentioning

confidence: 99%

Measurement properties of three assessments of burden used in atopic dermatitis in adults

Patel¹,

Singam²,

Vakharia³

et al. 2018

Br J Dermatol

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Background Standardized quality-of-life (QoL) assessments can provide important and clinically relevant information. There is currently a lack of standardization in QoL assessments used in atopic dermatitis (AD). Objectives To determine the content validity, construct validity, internal consistency, differential reporting, responsiveness, floor or ceiling effects and feasibility of the Dermatology Life Quality Index (DLQI), Itchy Quality of Life (ItchyQoL) and 5-dimensions (5-D) itch scales for assessing burden of AD in adults and to compare their performance. Methods Self-administered questionnaires and skin examination were performed in 340 adults with AD in a dermatology practice setting. Results DLQI, ItchyQoL and 5-D all had good content validity. DLQI, mean ItchyQoL and 5-D itch all had strong correlations with frequency of AD symptoms (Patient-Oriented Eczema Measure) and intensity of itch (numerical rating scale for itch), and moderate correlations with AD severity (Eczema Area and Severity Index and Scoring Atopic Dermatitis) (Spearman correlations, P < 0Á001 for all). DLQI and 5-D itch showed good internal consistency (Cronbach's alpha = 0Á89 and 0Á84), although ItchyQoL appeared to have several redundant items (alpha = 0Á96). Uniform and nonuniform differential item functioning by age, sex and/or race/ethnicity was found for multiple items in DLQI, ItchyQoL and 5-D itch. DLQI, ItchyQoL and 5-D itch scores all demonstrated responsiveness, although ItchyQoL demonstrated the greatest responsiveness. There were no floor or ceiling effects for total scores. The median times for completion of DLQI, ItchyQoL and 5-D itch were 2 min. Conclusions The DLQI, ItchyQoL and 5-D itch scales all showed good content and construct validity, and responsiveness in the assessment of AD in adults, and were feasible for use in clinical trials and practice.What's already known about this topic?• Dermatology Life Quality Index (DLQI), 5-dimensions (5-D) itch and ItchyQoL are quality-of-life assessments that have been used to assess the burden of inflammatory and/or pruritic skin disorders. • Conflicting and/or limited results have been demonstrated about their validity, reliability and feasibility, particularly in atopic dermatitis.What does this study add?• This study demonstrates that DLQI, ItchyQoL and 5-D itch had good construct validity and responsiveness, and similar amounts of time for completion in the assessment of adult atopic dermatitis, with no observed floor or ceiling effects.

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Quality of Life in Patients with Atopic Dermatitis: Disease Burden, Measurement, and Treatment Benefit

Cited by 93 publications

References 43 publications

Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults

Atopic eczema: burden of disease and individual suffering – results from a large EU study in adults

New insights into the phenotypes of atopic dermatitis linked with allergies and asthma in children: An overview

Measurement properties of three assessments of burden used in atopic dermatitis in adults

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