Disease severity, time management Symptoms contribute to high disease burden for patients with AD

A majority of patients with moderate or severe atopic dermatitis (AD) reported moderate to high adverse effects on quality of life.

According to a recent study published in JAMA Dermatology

The burden of disease appeared to be multidimensional and heterogeneous, without any driving factor.

“Research has documented the disease burden of AD, including its apparent nature and effect on itching and sleep, but gaps in the knowledge remain,” the authors wrote.

To describe the multidimensional burden of AD in adults, the researchers collected data from the FDA’s patient-centered electronic drug development survey. The survey collected responses from patients with AD on quality of life and treatment preference.

The researchers used data from adult participants with AD for their analysis of associations between demographic and clinical variables and patient-reported overall AD impact scores on an ordinal scale (1 = no impact, 5 = significant impact on a patient’s life).

Clinical variables included in the study were time between symptom onset and diagnosis, current and worst AD severity, history of changes in severity, areas affected and frequency of flare-ups, comorbid conditions such as depression, current and historical use of AD treatments, time spent managing AD and symptom control.

Of the 1065 respondents, 83% were women and the ages ranged from 18 to 65 years and older.

According to the survey, most adults with mostly moderate or severe AD rated the negative impact on their lives as moderate to high. Only 3% of participants reported no association of AD with disease burden. About half (51%) of respondents reported high significant impact scores and 46% reported low moderate AD impact scores.

Severity of atopic dermatitis was found to be associated with overall impact scores (moderate: odds ratio [OR], 4.13; 95% CI, 2.94-5.79; severe: OR, 13.63; 95% CI, 8.65-21.50 vs light).

Spending more time managing the symptoms of AD was also found to be strongly associated with an overall higher burden of disease (11-20 hours: OR 2.67; 95% CI 1.77-4.03, 21 hours: OR 5, 34; 95% CI 3.22-8.85, vs < 5 hours).

However, no element of disease burden correlated particularly strongly with total disease burden, suggesting that AD burden is multidimensional and driven by a combination of factors.

These findings are consistent with previous research indicating that respondents with moderate to severe AD had a higher disease burden than respondents with mild AD; although it contrasts with previous research emphasizing the effects of itching and disturbed sleep on the burden of disease.

Time spent managing AD was strongly associated with mood changes in addition to the disease burden of AD. The authors suggest there is a need for more efficient therapies that improve symptoms and reduce the time spent managing AD for both patients and caregivers.

“Further work to address the complex burden of AD, including strategies to reduce the time spent managing AD, and understanding the comprehensiveness of the patient experience is needed,” the authors concluded.

The study faced limitations due to study design, which may have contributed to selection bias for patients more willing to use technology. In addition, patients with more severe AD burdens may have been more likely to participate.


Elsawi R, Dainty K, Begolka WS, et al. The multidimensional burden of atopic dermatitis in adults: results of a large national study. JAMA-dermatol. Published online June 29, 2022. doi:10.1001/jamadermatol.2022.1906.

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