Quality of Life in Patients With Atopic Dermatitis
Atopic dermatitis (AD) is a chronic disease that impairs the patient’s quality of life (QOL) given its impact on sleep, work productivity, emotional and mental health, physical activity, and social functioning. In this review, the most important findings about QOL in AD are summarized. We also aim to demonstrate the most commonly used methods for measuring QOL and to give practical advice on using these instruments in clinical practice and research. Furthermore, AD puts a great burden on patients, and the degree of this burden is related to disease severity.
Practice Points
- For assessing quality of life (QOL) in atopic dermatitis (AD), it is recommended that researchers use a combination of a generic and a dermatology-specific or AD-specific instrument, whereas clinicians should apply a dermatology-specific or an AD-specific method or both.
- Anxiety and depression are common comorbidities in AD; patients also may need psychological support.
- Patient education is key for improving QOL in AD.
- Financial aspects of the treatment of AD should be taken into consideration because AD requires constant care, which puts a financial burden on patients.
In contrast, several other methods that also are administered by a parent/guardian assess how the parent perceives the QOL of their child with AD; these methods are essential for small children and infants who cannot answer questions themselves. The IDQOL9 was designed to assess the QOL of patients younger than 4 years using a parent-completed questionnaire. For older children and adolescents aged 4 to 16 years, the CDLQI10 is a widely used instrument; the questionnaire is completed by the child and is available in a cartoon format.10
For patients older than 16 years, 2 important instruments are the DLQI, a generic dermatology instrument, and the Quality of Life Index for Atopic Dermatitis (QoLIAD).11
,Clearly it can be troublesome for researchers and clinicians to find the most suitable instrument to evaluate QOL in AD patients. To make this task easier, the European Academy of Dermatology and Venereology Task Force released a position paper with the following recommendations: (1) only validated instruments should be used, and (2) their use should be based on the age of the patients for which the instruments were designed. It is reommended that researchers use a combination of a generic and a dermatology-specific or AD-specific instrument, whereas clinicians should apply a dermatology-specific or AD-specific method, or both.5
Alterations of QOL in AD
Sleep Disturbance in AD
Sleep disorders observed in AD include difficulty falling asleep, frequent waking episodes, shorter sleep duration, and feelings of inadequate sleep, which often result in impairment of daily activity.12,13 Correlation has been found between sleep quality and QOL in both children and adults.14 Approximately 60% of children affected by AD experience a sleep disturbance,15 which seems to correlate well with disease severity.16 A US study found that adults with AD are more likely to experience a sleep disturbance, which often affects daytime functioning and work productivity.13
Financial Aspects and Impact on Work
The financial burden of AD is extensive.17 There are direct medical costs, including medication, visits to the physician, alternative therapies, and nonprescription products. Patients tend to spend relevant money on such items as moisturizers, bath products, antihistamines, topical steroids, and topical antibiotics.18,19 However, it seems that most of the cost of AD is due to indirect and nonmedical costs, including transportation to medical visits; loss of work days; extra childcare; and expenditures associated with lifestyle changes,19,20 such as modifying diet, wearing special clothes, using special bed linens, and purchasing special household items (eg, anti–dust mite vacuum cleaner, humidifier, new carpeting).17,19
Absenteeism from work often is a consequence of physician appointments; in addition, parents/guardians of a child with AD often miss work due to medical care. Even at work, patients (or parents/guardians) often experience decreased work productivity (so-called presenteeism) due to loss of sleep and anxiety.21 In addressing the effects of AD on work life, a systematic literature review found that AD strongly affects sick leave and might have an impact on job choice and change or loss of job.22
