Atopic Dermatitis on Head, Face, Neck and Hands Linked to Worsened Quality of Life

Jonathan Silverberg, MD, PhD, MPH

Head, neck, face and hand involvement is associated with more significantly impacted health-related quality of life among patients with atopic dermatitis, according to findings from a cross-sectional analysis.

In new data presented at the 2022 Fall Clinical Dermatology Meeting this week, investigators from the TARGET-DERM trial reported that cases of atopic dermatitis to involve more frequently exposed areas of the skin correlate with worsened measures of patient livelihood burden—and even more severe, extensive manifestation of the disease itself.

The findings from cohort data highlight the impact of individualized atopic dermatitis burden, location and visibility on the average patient.

Investigators led by Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology at George Washington University, conducted a cohort analysis of the ongoing longitudinal, observational TARGET-DERM AD trial, in which patients with atopic dermatitis or other Immune-Mediated Inflammatory Skin Conditions (IMISC) from 44 US community or academic sites are being observed while receiving current or future therapy for their skin disease.

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

They noted that limited data exist interpreting both the scale of extremity involvement in atopic dermatitis, as well as how it impacts patients uniquely.

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

A total of 533 patients were included in the assessment; three-fourths (n = 400; 75%) were adult patients at enrollment, and 55.2% were female. Patients were primarily non-Hispanic White (46.9%); approximately two-thirds (63.4%) had private insurance, and came from a community treatment site (64.5%).

Approximately 9 in 10 patients were treating their atopic dermatitis with topical therapies at baseline. The most common comorbities included allergies, hypersensitivities, and asthma.

Investigators observed head, neck, face or hand involvement in 453 patients. Such patients were more likely to have severe disease per validated Investigator Global Assessment (vIGA) scale than those without involvement (28.5% vs 16.3%; P = .02). Patients with involvement additionally had greater median total body surface area (15%) than patients without (15.0% vs 10.0%; P <.001).

Health-related quality of life burden was approximately two-fold more likely among patients with atopic dermatitis involvement in the head, neck, face or hands versus those without, per both DLQI (odds ratio [OR], 2.09) and POEM (OR, 2.51).

Female patients with involvement in a body region were about 71% more likely to report poor DLQI versus control (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 versus control (OR, 1.60; 95% CI, 1.04 - 2.45).

Investigators concluded from their real-world analysis that patients with atopic dermatitis involvement in the head, neck, face and had were linked to significantly more impacted quality of life due to their disease.

“These findings highlight the importance of detailed assessment of specific areas affected by atopic dermatitis to personalize treatment approaches to the needs of patients,” they wrote.

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