Atopic dermatitis of the head, face, neck and hands associated with deterioration in quality of life

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Involvement of the head, neck, face, and hands is associated with a more significant impairment in health-related quality of life in patients with atopic dermatitis, according to the results of a cross-sectional analysis.

In new data presented this week at the Fall Clinical Dermatology Meeting 2022, researchers from the TARGET-DERM study reported that cases of atopic dermatitis affecting more commonly exposed skin areas correlate with a deteriorated measurement of patients’ livelihood burden – and even more serious, extensive manifestation of the disease itself.

Findings from cohort data underscore the impact of individualized atopic dermatitis burden, location and visibility on the average patient.

Researchers led by Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology at George Washington University, conducted a cohort analysis of the ongoing observational, longitudinal TARGET-DERM AD study enrolling patients with atopic dermatitis or other immune-mediated inflammatory skin diseases Conditions (IMISC) from 44 US community or academic sites are being followed while receiving current or future therapy for their skin disease.

Silverberg and colleagues attempted to estimate the prevalence of atopic dermatitis affecting the head, neck, face and hands and its impact on health-related quality of life in patients with moderate to severe disease.

They noted that there is limited data interpreting both the extent of limb involvement in atopic dermatitis and the individual impact on patients.

The team included adult, adolescent and pediatric patients with moderate to severe atopic dermatitis in the evaluation. Relevant area involvement was recorded at study enrollment using the Patient-Oriented Scoring AD (PO-SCORAD) test; Health-related quality of life outcomes were measured using the Patient-Oriented Eczema Measure (POEM) and Dermatology Life Quality Index (DLQI).

A total of 533 patients were included in the assessment; three quarters (n=400; 75%) were adult patients at admission and 55.2% were female. Patients were primarily non-Hispanic white (46.9%); about two-thirds (63.4%) were privately insured and came from an outpatient treatment facility (64.5%).

Approximately 9 out of 10 patients were treating their atopic dermatitis with topical therapies at baseline. The most common comorbidities were allergies, hypersensitivity and asthma.

Investigators observed head, neck, face, or hand involvement in 453 patients. These patients were more likely to have severe disease according to the validated Investigator Global Assessment (vIGA) scale than unenrolled patients (28.5% vs. 16.3%; P = 0.02). Additionally, patients with involvement had a greater median total body surface area (15%) than patients without (15.0% vs. 10.0%; P <.001>

Patients with atopic dermatitis of the head, neck, face, or hands were about twice as likely to have a health-related burden on quality of life as compared to those without, both on the DLQI (odds ratio [OR]2.09) and POEM (OR, 2.51).

Female patients with involvement in a body region reported a poor DLQI about 71% more often than controls (OR, 1.71; 95% CI, 1.07-2.72). Patients with both an immune system disorder and involvement in a body region were 60% more likely to report poor POEM scores compared to controls (OR, 1.60; 95% CI, 1.04-2.45).

The researchers concluded from their real-world analysis that patients with atopic dermatitis of the head, neck and face were associated with a significantly greater impairment in quality of life due to their disease.

“These results underscore the importance of detailed assessment of specific areas affected by atopic dermatitis to tailor treatment approaches to patient needs,” they wrote.

The Epidemiology and Burden of Atopic Dermatitis Involving the Head, Neck, Face, and Hand: A Cross Sectional Study from the TARGET-DERM AD Cohort study was presented at Fall Clinical 2022.

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