AD Burden May Be Greater When Head, Neck, Face, Hands Affected

Involvement of the head, neck, face, and hands with atopic dermatitis (AD) was associated with a significantly higher impact on health-related quality of life and appeared to be associated with more severe AD, according to a large, cross-sectional study of patients with AD.

"While we know that head, neck, face, and hands seem to be significantly affected by patients with AD, there is a limited evidence basis regarding the prevalence and health-related quality-of-life impact of AD in these areas," presenting author Lawrence F. Eichenfield, MD, said during a late-breaking abstract session at the Revolutionizing Atopic Dermatitis virtual symposium.

For the study, Eichenfield, professor of dermatology and pediatrics at the University of California San Diego School of Medicine, and colleagues evaluated 533 patients from the TARGET-DERM AD cohort, an ongoing, longitudinal, observational study launched in 2019 that captures patients with AD in 44 community or academic sites in the US.

Adult, adolescent, and pediatric patients with moderate or severe Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD) scores at enrollment were included in the analysis. The researchers used the Patient-Oriented Scoring AD (PO-SCORAD) index to gather information on involvement of the head, neck, face, hands, or other areas, and the Patient-Oriented Eczema Measure (POEM) and Dermatology Life Quality Index (DLQI)/Children’s DLQI (CDLQI) to measure health-related quality of life outcomes.

Of the 533 study participants, 453 (85%) had AD affecting the head, neck, face, hands, and other areas, while 80 (15%) had AD located in other body regions not including the head, neck, face, or hands. About 38% of all patients were using systemic treatments; most were using topical treatments.

Comorbid immune system disorders (including allergic and hypersensitivity disorders) were noted in 44.8% of patients, infections in 32.5%, asthma in 26.5%, hypertension in 18.6%, depression in 15.8%, and anxiety in 12.4%, with similar proportions observed in those with or without head, neck, face, and hand involvement.

However, patients with head, face, neck, and hand involvement, when compared with patients without those affected areas, were more likely to have severe vIGA scores (28.5% vs. 16.3%, P = .02) and a higher median total body surface area (BSA) affected (15% vs. 10%, P ≤ .01). Also, while bivariable analyses did not detect statistical differences in POEM and DLQI/CDLQI by body region involvement, multivariable-adjusted models showed that patients with head, neck, face, and hand involvement were more than twice as likely to report higher DLQI/CDLQI (odds ratio, 2.09) and POEM (OR, 2.51) scores than those without head, face, neck, and hand involvement.

"These findings highlight the importance of detailed assessment of specific areas affected by AD to personalize treatment approaches to the needs of patients," Eichenfield concluded.

Raj Chovatiya MD, PhD, assistant professor of dermatology at Northwestern University Feinberg School of Medicine, Chicago, who was asked to comment on the study, said that the findings confirm clinical suspicions about the unique and heightened impact of facial, head/neck, and hand dermatitis. "These data show that a detailed skin examination is necessary for a complete assessment of AD," he said. "Future studies should focus on characterizing the optimal treatment approaches for each of these special sites."

"This is important data," added primary study author Jonathan I. Silverberg, MD, PhD, MPH, director of clinical research in the division of dermatology at George Washington University School of Medicine and Health Sciences, Washington, DC. "We need more high-quality studies like this; we need to create long-term longitudinal data to better understand [the impact of AD on] this and other cohorts."

TARGET-DERM is sponsored by Target RWE , a health evidence solutions company based in Durham, North Carolina. Eichenfield disclosed that he has served as a consultant to or investigator for AbbVie; Almirall; Arcutis; Arena; Aslan; Dermavant; Forte Biosciences; Galderma Laboratories; Glenmark; Incyte; Leo Pharma; Eli Lilly; Novartis; Ortho Dermatology; Otsuka; Pfizer; Regeneron, and Sanofi-Genzyme.

Chovatiya disclosed that he is a consultant to, a speaker for, and/or a member of the advisory board for AbbVie, Arena, Arcutis, Incyte, Pfizer, Regeneron, and Sanofi-Genzyme.

Silverberg disclosed that he is a consultant to numerous pharmaceutical companies, receives fees for non-CME/CE services from Eli Lilly, Leo Pharma, Pfizer, Regeneron Pharmaceuticals, and Sanofi Genzyme, as well as contracted research fees from Galderma.

The Revolutionizing Atopic Dermatitis symposium: Abstract 632. Presented December 13, 2021.

Doug Brunk is a San Diego-based award-winning reporter for MDedge and Medscape who began covering healthcare in 1991. He is the author of two books related to the University of Kentucky Wildcats men’s basketball program.

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