Impact of atopic dermatitis lesion locations and extent on patient burden: A real-world study

BackgroundAtopic dermatitis (AD) is associated with patient burden, but few studies describe the anatomic distribution of the disease or the impact of number of lesion locations.ObjectivesTo describe lesion locations and assess the relationship between the number of lesion locations (disease extent) and disease burden in patients with AD.MethodsThis cross-sectional study included adults with dermatologist- or dermatology practitioner-diagnosed AD enroled in the CorEvitas AD Registry (2020-2021) who initiated systemic therapy within 12 months prior to or at enrolment or had moderate-to-severe AD (vIGA-AD (R) >= 3 and EASI >= 12) at enrolment. Thirteen areas of lesion involvement were assessed using a body map, and numbers of lesion locations were categorised as: 0, 1, 2-3, 4-6 and >= 7. Demographics, disease characteristics, PROs by number of lesion locations were descriptively compared using effect sizes (ES). The ES thresholds for small, medium, and large differences, respectively, were 0.10, 0.30, and 0.50 for phi (categorical outcomes) and 0.10, 0.25 and 0.40 for Cohen's f (continuous outcomes).ResultsAmong 1211 patients, lesion involvement was most frequent on the arms (69.5%) and lower limbs (61.7%). A total of 10.6%, 9.3%, 20.1%, 26.3% and 33.8% of patients had 0, 1, 2-3, 4-6 and >= 7 lesion locations, respectively. Current use of systemic (>= 81.2%) and topical ( >= 74.7%) therapies was common, irrespective of lesion location. Disease severity increased with number of lesion locations: mean total BSA (ES = 1.17), EASI (ES = 1.11), and SCORAD (ES = 1.21). vIGA-AD >= 3 was observed in 28.3%, 45.3%, 78.0%, and 93.9% of patients with 1, 2-3, 4-6 and >= 7 locations, respectively (ES = 0.63). Greater number of lesion locations was associated with worse PROs: mean POEM (ES = 0.57), sleep loss (ES = 0.41), peak pruritus (ES = 0.50), DLQI (ES = 0.40), and ADCT (ES = 0.53). Uncontrolled AD (ADCT >= 7) was observed in 48.2%, 52.9%, 70.4%, 81.6% of patients with 1, 2-3, 4-6 and >= 7 locations, respectively (ES = 0.42).ConclusionsAD lesions were reported for each body area assessed. Greater number of lesion locations was associated with increased disease severity, poor disease control, and decreased quality of life. Patients experienced substantial disease burden regardless of number of lesion locations involved. What is this study about?Atopic dermatitis (AD; also known as eczema) is a skin disease that causes redness, flaky skin, and itching. Lesions can affect any part of the body, and can reduce quality of life for patients with AD. This study aimed to identify the areas impacted by AD lesions, and assessed the relationship between the number of lesion locations (0, 1, 2-3, 4-6, or >= 7) and disease burden in patients with AD.What were the results?A total of 1211 adult patients with AD were included in the study from the CorEvitas AD Registry. Patients most frequently reported lesions on the arms and lower limbs (legs and feet). Most patients were receiving systemic therapy or topical therapy, regardless of lesion location. Three out of five patients had >= 4 locations with lesions. Among patients who had >= 7 lesion locations, 94% reported moderate-to-severe AD and 80% said that their AD was not in control. Patients with fewer lesion locations also reported substantial disease burden. Nearly half of the patients who had one lesion location reported uncontrolled AD. Patients also experienced more loss of work productivity and poor quality of life with an increase in number of lesion locations.What do the study results mean?AD impacts all body areas. Greater number of lesion locations are related to more severe disease and poor disease control. Regardless of number of lesion locations, patients experience substantial disease burden and need effective therapies to manage AD. In this real-world study in patients with atopic dermatitis (AD), majority of the patients had lesions in >= 4 locations. Greater number of lesion locations correlated with severe disease burden, poor disease control, and decreased patient-reported quality of life. Disease burden was substantial in all the lesion location categories, suggesting an unmet need still exists in patients with AD. image