The multidimensional burden of atopic dermatitis: An update

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Introduction

Atopic dermatitis (AD) is a chronic, inflammatory skin disease that affects 11% of children1 and 5% to 7% of adults[2], [3] in the United States. Consequences of AD include itching, sleep disturbances, and impairment in physical activity and social functioning, affecting both patients and their families.4 AD may also affect academics and choice of occupation. The total annual burden of AD in 2004 US dollars was estimated to be $4,228 billion, combining direct and indirect costs of care, but this is likely an underestimate of present day costs.5 The goal of this review is to provide an update on the multidimensional burden of AD (Fig 1). In 2015, the National Eczema Association (NEA) funded a comprehensive review of the burden of AD, including quality of life (QoL), social functioning, and academic, economic, and occupational burden.4 A number of gaps were identified in that review,6 some of which have been addressed by new studies.

A thorough search of the literature was performed in December 2017 in Embase, MEDLINE, and PubMed from January 2016 to the present, using atopic dermatitis OR eczema as search terms. We included articles that related to the burden of AD. We excluded studies on other types of dermatitis, validation studies of outcome measures, and nonsystematic review articles. Additional articles were retrieved through hand-searching of reference lists. Full-text articles were reviewed and data were extracted by one author (A.C.B.). Some articles were excluded at that stage if they were not relevant to burden of disease.

Section snippets

QoL in Children with AD

Sleep is a major driver of the morbidity and detriments in QoL associated with AD. Fishbein et al7 completed a cross-sectional study in 19 children with AD compared with 19 matched controls. Characteristics of sleep using actigraphy and sleep diaries were measured, as well as itch and QoL. Time (in minutes) awake after sleep onset was higher and sleep efficiency was lower in children with AD, and parents of children with AD reported their child had significantly more restless sleep and daytime

Social Effects

Little has been recently published on the social effect of AD. However, one study conducted by Seneschal and colleagues16 focused on sexuality in adults with AD, a topic that has not been extensively explored. Of 1,024 French adults with AD, 65% claimed that their AD negatively affected their sexuality, and 40% of those with severe AD claimed that their libido was affected. Unsurprisingly, the effect was significantly greater for those who had genital AD involvement. More research is needed on

Academic and Occupational Effects

A recent systematic review was conducted by Von Kobyletzki et al17 on educational attainment in individuals with AD. However, because of the limited amount of evidence available, only one study fulfilled the eligibility criteria, and no association was found between educational attainment and AD. Conclusions are not able to be drawn on this topic with such limited evidence.

A systematic review by Norreslet et al18 did not find any consistent conclusions on the effect of AD on work life and

Conclusion

Althuogh significant progress has been made during the last few years to illuminate the multidimensional burden of AD, several gaps still remain. Sleep is profoundly affected in AD, but longitudinal data on this subject are still required. More research is needed on the effect of AD on self-esteem, socialization, and academic and occupational success in children and adults, as well as the effect on partners and families of adult patients.4 Although itch is more prominent, skin pain in AD is

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    Epidemiology of atopic dermatitis in adults: results from an international survey [published online January 10, 2018]

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    Research gaps in quality of life and economic burden of atopic dermatitis: the National Eczema Association burden of disease audit

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    Disclosures: The National Eczema Association receives grants from industry partners to support our mission as listed on the National Eczema Association website (nationaleczema.org). Dr Drucker has served as an investigator and has received research funding from Sanofi and Regeneron and has been a consultant for Sanofi, RTI Health Solutions, and Eczema Society of Canada. He has received honoraria from Astellas Canada, Prime Inc, Spire Learning, and Eczema Society of Canada. No other disclosures were reported.

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