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Atopic Dermatitis: Multidimensional Disease Burden
A recent survey study published in JAMA Dermatology aimed to describe the multidimensional burden of atopic dermatitis (AD) in adult patients.1 To better understand the lived experience of patients with AD, The Dermatologist spoke with Aaron Drucker, MD, one of the study’s authors.
The Dermatologist: Your study analyzed data from an online survey of adults with AD to understand its association with quality of life and treatment preferences. You note that there are knowledge gaps surrounding the disease burden of AD, including “a poor understanding of symptoms other than itch, patients’ treatment experience, and how different elements of burden of disease interact.” Why do you think these gaps exist and how will increasing our knowledge of these factors positively impact patients’ quality of life?
Hospital; scientist at the Women’s College Research Institute; associate professor in the department of medicine and Institute of Health Policy, Management and Evaluation at the University of Toronto; and adjunct scientist at ICES in Toronto, Ontario, Canada.
Dr Drucker: AD is a complex condition that is experienced differently by different people living with it. We have known for a long time how burdensome it can be with regards to debilitating itch and having a visible rash, but there are many aspects of the disease burden where relatively little data are available. Conducting research into how people experience living with AD and its treatments, which can be burdensome themselves, gives clinicians a better understanding of where their patients are coming from, which should improve communication, shared decision-making, and ultimately outcomes, including quality of life.
The Dermatologist: Your analysis revealed that AD severity and time spent managing symptoms were strongly associated with disease burden. Can you describe your results in this area?
Dr Drucker: It is no surprise that having more severe AD would be associated with increased self-perceived burden of disease. Our finding that the time spent managing AD is associated with increased burden is more interesting but should not be surprising in retrospect. Drs Raj Chovatiya and Jonathan Silverberg published a paper in 2021 describing the “Iatrogenic Burden of Atopic Dermatitis,”2 meaning the burden brought on by medical management, and I think this is relevant here. Our study was cross-sectional, so we cannot say whether time spent managing AD increased burden because people felt the treatment was burdensome or whether increased burden of AD led people to spend more time managing it. In either case, if we can provide treatment plans that manage eczema more efficiently (that is, effectively with less time spent), it ought to decrease the burden of disease.
The Dermatologist: You also found that most participants reported current mood changes ranging from mild to severe, and current AD severity was strongly associated with mood changes. Can you speak more about the psychological burden of AD?
Dr Drucker: Imagine being itchy all the time. Or not participating in school, work, or social activities because you do not want others to see your skin. Or feeling exhausted because your itch is keeping you up at night. Or feeling worried that an eczema flare may be coming at any moment, despite your best efforts to manage your AD. All these aspects and more could contribute to an individual’s mood being low in connection with their eczema.
The Dermatologist: Your study suggests that more effective treatment strategies are needed to reduce patients’ time spent managing their AD. What future research is required and what goals should dermatologists be aiming for to improve patients’ quality of life?
Dr Drucker: It would be wonderful if we had a 100% safe, effective, and one-time treatment to manage AD. In other words, a cure. I am skeptical that we will see a true cure for AD in our lifetime but basic, translational, and clinical researchers continue to work toward the goal of creating treatments that are more effective, efficient, and safe. Whether it be new, more effective, and longer-lasting topical medications, pills, or injections, we hope that treatments will get increasingly better.
The Dermatologist: What can your fellow clinicians/dermatologists take from this for use in their own practices?
Dr Drucker: What is most bothersome about the condition for some will be a minor issue for others and vice versa. It is a good idea to talk about treatment goals and important treatment targets with each patient. If someone with AD expresses that they are having a hard time dealing with the treatment itself, then a change in management strategy for that patient could be considered.
References
1. Elsawi R, Dainty K, Begolka Smith W, et al. The multidimensional burden of atopic dermatitis among adults: results from a large national survey. JAMA Dermatol. 2022;158(8):887-892. doi:10.1001/jamadermatol.2022.1906
2. Chovatiya R, Silverberg JI. Iatrogenic burden of atopic dermatitis. Dermatitis. Published online September 27, 2021. doi:10.1097/DER.0000000000000799
