RESEARCH LETTER
Khaled EZZEDINE1, Julien SENESCHAL2, Florence CORGIBET3, Bruno HALIOUA4,5, Francesca SAMPOGNA6, Stéphanie MERHAND7, Charbel SKAYEM8,9, Yaron BENHAYOUN10, Charles TAIEB4,11*, Laurent MISERY4,12, Delphine STAUMONT-SALLÉ13 and Marie Aleth RICHARD14
1EA 7379 EpidermE, University Paris-Est Créteil (UPEC), Créteil, France, 2Dermatology Department, Saint-André Hospital, CHU of Bordeaux, Bordeaux, France, 3Dermatologist, Dijon, France, 4Société Française des Sciences Humaines de la Peau [SFSHP, French Society of Human Skin Sciences], Maison de la dermatologie,Paris, France, 5Dermatologist, Paris, France, 6Dermatological Institute « Istituto Dermopatico dell’Immacolata » (IDI)-IRCCS, Rome, Italy, 7Association Française de l’Eczéma (French Eczema Association), Redon, France, 8Sorbonne University, Faculty of Medicine, Paris, France, 9Paris Hospitals (Assistance Publique-Hôpitaux de Paris, AP-HP), Ambroise Paré Hospital, Boulogne-Billancourt, France, 10European Market Maintenance Assessment (EMMA), Tel Aviv, Israel, 11European Market Maintenance Assessment (EMMA), Paris, France, 12Dermatology Department, CHU of Brest, Brest, France, 13Dermatology Department, CHU of Lille, Lille, France, and 14Dermatology Department, CHU La Timone, Marseille, France. *E-mail: charles.taieb@emma.clinic
Citation: Acta Derm Venereol 2025; 105: adv42734. DOI: https://doi.org/10.2340/actadv.v105.42734.
Copyright: © 2025 The Author(s). Published by MJS Publishing, on behalf of the Society for Publication of Acta Dermato-Venereologica. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/).
Submitted: Dec 15, 2024. Accepted after revision: Jan 23, 2025. Published: Feb 18, 2025.
Competing interests and funding: The authors have no conflicts of interest to declare.
This project was funded by Pfizer France.
Dear Editor,
Atopic dermatitis (AD) is a chronic inflammatory skin condition that mainly affects children, but it can persist or even appear in adulthood. In the French population aged > 15 years, its prevalence has been estimated as 4.6% (1). In adults with AD, health-related quality of life (HRQoL) can be markedly impaired (2), mainly due to symptoms such as itch, sore, painful and stinging skin, and feelings such as embarrassment and self-consciousness. The social life of patients with AD may be disrupted, and an association with sleep disturbance and psychological problems is frequently observed (3). Work is an important aspect of life and an integral component of HRQoL. A systematic review (4) documented a noteworthy impact of AD on work life, in particular with regard to sick leave.
In the present study, we aimed to investigate work impairment in patients with AD. Adults (≥ 18 years) reporting a diagnosis of AD were selected from a representative sample of the French general population recruited by a polling institute (HC Conseil Paris, France) using stratified, proportional sampling with a replacement design (5). Work impairment was evaluated by 3 questions: Q1. Were you absent from work due to your AD? Q2. Did you need to stop working due to your AD? Q3. Were you required to decrease your workload because of your AD? For each question, respondents were asked to state the number of days per year.
From a total of 2,530 patients with AD identified in the sample, 1,905 (75.3%) were active, i.e., currently engaged in employment or seeking employment, according to the definition of the International Labour Organization (ILO). Among these individuals, 1,654 were employed, 70 on sick leave, and 181 were seeking employment. There were 749 men (39.3%). Clinical severity was moderate/severe (Patient-Oriented Eczema Measure [POEM] score ≥ 8) in 53.9% of patients. The percentage of individuals who had to be absent from work (Q1) was 25.9%, with a mean of 20.6 days per year (Table I). The frequency, as well as the number of days, was higher in patients with clinically moderate/severe AD compared with mild severity. Men reported absence at work more significantly frequently than women in the group with moderate/severe condition, but not for mild AD. As to question Q2, 18.6% reported they had to interrupt their work due to AD, and more men did so (24.3%) than women (15.0%). The mean number of days of interruption was 26.3. The frequency was significantly higher when the disease was moderate/severe compared with mild. As for Q1, the difference between men and women was significant only for moderate/severe AD. Reduction of workload (Q3) was reported by 16.1% of individuals, with a mean of 5.9 days per year. Similar to the other questions, the frequency was higher in men than in women, and the difference between men and women was significant only for moderate/severe AD. A correlation between clinical severity and HRQoL impairment has been generally observed (2), and in particular with the work/school domain of the Dermatology Life Quality Index (DLQI) (6). Andersen et al. (7) observed that work productivity decreased with increasing clinical severity. In respondents with mild AD, an average of 0.1 days of work per week were missed due to AD, while in patients with moderate AD the average was 0.2, and with severe AD it was 0.8. Different factors may contribute to the higher impact observed in men than in women. For example, social expectations may make it more difficult for men to discuss their situation and seek support at work, leading to increased stress and difficulties in managing symptoms at work. Different aspects of work life have been evaluated in previous studies, and significant work impairment was consistently reported in patients with AD (4). Absence from work has an impact on work productivity with consequent economic impact on the society. An analysis of the effect of AD on adult patient performance at work and occupational absence (8) estimated the social cost of lost productivity across the European Union at €2 billion per year.
| Question | n (%) | Men n (%) | Women n (%) | p-value§ |
| Total (n = 1,905) | ||||
| Q1. Absence from work | 494 (25.9%) | 234/749 (31.2%) | 260/1,156 (22.5%) | < 0.001* |
| Number of days | 20.6 (18.0–23.1) | 21.8 (18.2–25.5) | 19.5 (15.9–23.3) | 0.228** |
| Mild (n = 878) | ||||
| Absence from work | 114 (13.0%) | 48/334 (14.4%) | 66/544 (12.1%) | 0.393* |
| Number of days | 15.0 (11.0–19.0) | 13.5 (8.5–18.5) | 16.0 (10.0–22.1) | 0.394** |
| Moderate/severe (n = 1,027) | ||||
| Absence from work | 380 (37.0%) | 186/415 (44.8%) | 194/612 (31.7%) | < 0.001* |
| Number of days | 22.2 (19.2–25.3) | 23.9 (19.6–28.2) | 20.6 (16.3–24.9) | 0.157** |
| Total (n = 1,905) | ||||
| Q2. Work interruption | 355 (18.6%) | 182/749 (24.3%) | 173/1156 (15.0) | < 0.001* |
| Number of days | 26.3 (13.7–18.9) | 15.4 (12.0–18.8) | 17.3 (13.3–21.2) | 0.345** |
| Mild (n = 878) | ||||
| Work interruption | 72 (8.2%) | 32/314 (9.6%) | 40/544 (7.4%) | 0.298* |
| Number of days | 12.9 (8.3–17.6) | 10.3 (5.8–14.8) | 15.0 (7.2–22.8) | 0.158** |
| Moderate/severe (n = 1,027) | ||||
| Work interruption | 283 (27.6%) | 150/415 (36.1%) | 133/612 (21.7%) | < 0.001* |
| Number of days | 17.2 (14.2–20.2) | 16.5 (12.5–20.4) | 17.9 (13.3–22.6) | 0.528** |
| Total (n = 1,905) | ||||
| Q3. Reduction of work | 307/1,095 (16.1%) | 150/749 (20.0%) | 157/1,156 (13.6%) | < 0.001* |
| Number of days | 5.9 (5.5–6.4) | 6.2 (5.5–6.8) | 5.8 (5.0–6.4) | 0.254** |
| Mild (n = 878) | ||||
| Reduction of work | 68/878 (7.7%) | 30/334 (9.0%) | 38/544 (7.0%) | 0.344* |
| Number of days | 5.1 (4.0–6.2) | 5.0 (3.2–6.8) | 5.2 (3.7–6.7) | 0.783** |
| Moderate/severe (n = 1,027) | ||||
| Reduction of work | 239/1,027 (23.3%) | 120/415 (28.9%) | 119/612 (19.4%) | < 0.001* |
| Number of days | 6.2 (5.7–6.7) | 6.4 (5.7–7.2) | 5.9 (5.2–6.6) | 0.170** |
| §for the comparison between men and women. *Chi-square test; **independent sample t-test. | ||||
A limitation of the present study is that we used single questions to assess work impairment and not a validated instrument. In conclusion, adults with AD are noticeably affected and limited in their work life. Our hypothesis is that the impact of AD on work life may be due to several factors: symptoms causing discomfort that makes it difficult to focus on work tasks; appearance concerns, which may affect interactions with others; sleep disturbances that may lead to fatigue and decreased work productivity; frequent medical consultations that may disrupt work schedules; and the psychological impact, which may affect overall well-being.
The authors would like to thank the patients who took the time to complete the questionnaires.
Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.
Ethics committee: The study was approved by a local ethics committee at CHU de Grenoble, France (reference number 20.04.18.61210) and was conducted according to the principles of the Declaration of Helsinki.