Factors Associated with Affective Symptoms and Quality of Life in Patients with Atopic Dermatitis
DOI:
https://doi.org/10.2340/00015555-3922Keywords:
atopic dermatitis, depression, anxiety, quality of lifeAbstract
The aim of this study was to detect demographic and clinical factors associated with affective symptoms and quality of life in patients with severe atopic dermatitis. First, one-way analyses of variance and correlations were performed to compare a large set of qualitative and quantitative clinical variables. Three final multivariable regression models were performed, with depression/anxiety subscales and Dermatology Life Quality Index scores as dependent variables, and the factors that were statistically significant on univariate analyses as independent ones. More severe anxiety symptoms and poorer quality of life (p < 0.01) were significantly associated with more severe depressive symptoms. Female sex and disturbed sleep (p = 0.03) were significantly associated with more severe anxiety. Finally, previous treatment with cyclosporine (p = 0.03) or methotrexate (p = 0.04), more severe depressive symptoms (p < 0.01), itch (p = 0.03), impaired sleep (p < 0.01) and perceived severity of dermatological illness (p < 0.01) were significant predictors of low quality of life. This study shows a complex interplay between the severity of atopic dermatitis, poor quality of life and presence of clinically relevant affective symptoms. These results will help dermatologists to identify patients who need psychiatric consultation within the framework of a multidisciplinary approach.
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Gittler JK, Shemer A, Suárez-Fariñas M, Fuentes-Duculan J, Gulewicz KJ, Wang CQ, et al. Progressive activation of T (H)2/T (H)22 cytokines and selective epidermal proteins characterizes acute and chronic atopic dermatitis. J Allergy Clin Immunol 2012; 130: 1344-1354.
https://doi.org/10.1016/j.jaci.2012.07.012 DOI: https://doi.org/10.1016/j.jaci.2012.07.012
Kowalska-Olędzka E, Czarnecka M, Baran A. Epidemiology of atopic dermatitis in Europe. J Drug Assess 2019; 8: 126-128.
https://doi.org/10.1080/21556660.2019.1619570 DOI: https://doi.org/10.1080/21556660.2019.1619570
Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab 2015; 66: 8-16.
https://doi.org/10.1159/000370220 DOI: https://doi.org/10.1159/000370220
Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy 2018; 73: 1284-1293.
https://doi.org/10.1111/all.13401 DOI: https://doi.org/10.1111/all.13401
Mayba JN, Gooderham MJ. Review of atopic dermatitis and topical therapies. J Cutan Med Surg 2017; 21: 227-236.
https://doi.org/10.1177/1203475416685077 DOI: https://doi.org/10.1177/1203475416685077
Margolis JS, Abuabara K, Bilker W, Hoffstad O, Margolis DJ. Persistence of mild to moderate atopic dermatitis. JAMA Dermatol 2014; 150: 593-600.
https://doi.org/10.1001/jamadermatol.2013.10271 DOI: https://doi.org/10.1001/jamadermatol.2013.10271
Cheng BT, Silverberg JI. Depression and psychological distress in US adults with atopic dermatitis. Ann Allergy Asthma Immunol 2019; 123: 179-185.
https://doi.org/10.1016/j.anai.2019.06.002 DOI: https://doi.org/10.1016/j.anai.2019.06.002
Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol 2017; 137: 26-30.
https://doi.org/10.1016/j.jid.2016.07.012 DOI: https://doi.org/10.1016/j.jid.2016.07.012
Berruyer M, Delaunay J. Atopic dermatitis: a patient and dermatologist's perspective. Dermatol Ther (Heidelb) 2021; 11: 347-353.
https://doi.org/10.1007/s13555-021-00497-w DOI: https://doi.org/10.1007/s13555-021-00497-w
Cheng CM, Hsu JW, Huang KL, Bai YM, Su TP, Li CT, et al. Risk of developing major depressive disorder and anxiety disorders among adolescents and adults with atopic dermatitis: a nationwide longitudinal study. J Affect Disord 2015; 178: 60-65.
https://doi.org/10.1016/j.jad.2015.02.025 DOI: https://doi.org/10.1016/j.jad.2015.02.025
Patel KR, Immaneni S, Singam V, Rastogi S, Silverberg JI. Association between atopic dermatitis, depression, and suicidal ideation: a systematic review and meta-analysis. J Am Acad Dermatol 2019; 80: 402-410.
https://doi.org/10.1016/j.jaad.2018.08.063 DOI: https://doi.org/10.1016/j.jaad.2018.08.063
Kiebert G, Sorensen SV, Revicki D, Fagan SC, Doyle JJ, Cohen J, et al. Atopic dermatitis is associated with a decrement in health-related quality of life. Int J Dermatol 2002; 41: 151-158.
https://doi.org/10.1046/j.1365-4362.2002.01436.x DOI: https://doi.org/10.1046/j.1365-4362.2002.01436.x
Peng W, Novak N. Recent developments in atopic dermatitis. Curr Opin Allergy Clin Immunol 2014; 14: 17-22.
https://doi.org/10.1097/ACI.0000000000000094 DOI: https://doi.org/10.1097/ACI.0000000000000094
Honda T, Kabashima K. Reconciling innate and acquired immunity in atopic dermatitis. J Allergy Clin Immunol 2020; 145: 1136-1137.
https://doi.org/10.1016/j.jaci.2020.02.008 DOI: https://doi.org/10.1016/j.jaci.2020.02.008
Raison CL, Miller AH. Role of inflammation in depression: implications for phenomenology, pathophysiology and treatment. Mod Trends Pharmacopsychiatry 2013; 28: 33-48.
https://doi.org/10.1159/000343966 DOI: https://doi.org/10.1159/000343966
Buoli M, Grassi S, Serati M, Altamura AC. Agomelatine for the treatment of generalized anxiety disorder. Expert Opin Pharmacother 2017; 18: 1373-1379.
https://doi.org/10.1080/14656566.2017.1359257 DOI: https://doi.org/10.1080/14656566.2017.1359257
Troubat R, Barone P, Leman S, Desmidt T, Cressant A, Atanasova B, et al. Neuroinflammation and depression: a review. Eur J Neurosci 2021; 53: 151-171.
https://doi.org/10.1111/ejn.14720 DOI: https://doi.org/10.1111/ejn.14720
Senra MS, Wollenberg A. Psychodermatological aspects of atopic dermatitis. Br J Dermatol 2014; 170: 38-43.
https://doi.org/10.1111/bjd.13084 DOI: https://doi.org/10.1111/bjd.13084
Ferrucci S, Casazza G, Angileri L, Tavecchio S, Germiniasi F, Berti E, et al. Clinical response and quality of life in patients with severe atopic dermatitis treated with dupilumab: a single-center real-life experience. J Clin Med 2020; 9: 791.
https://doi.org/10.3390/jcm9030791 DOI: https://doi.org/10.3390/jcm9030791
Rehal B, Armstrong AW. Health outcome measures in atopic dermatitis: a systematic review of trends in disease severity and quality-of-life instruments 1985-2010. PLoS One 2011; 6: e17520.
https://doi.org/10.1371/journal.pone.0017520 DOI: https://doi.org/10.1371/journal.pone.0017520
Charman CR, Venn AJ, Ravenscroft JC, Williams HC. Translating Patient-Oriented Eczema Measure (POEM) scores into clinical practice by suggesting severity strata derived using anchor-based methods. Br J Dermatol 2013; 169: 1326-1332.
https://doi.org/10.1111/bjd.12590 DOI: https://doi.org/10.1111/bjd.12590
Phan NQ, Blome C, Fritz F, Gerss J, Reich A, Ebata T, et al. Assessment of pruritus intensity: prospective study on validity and reliability of the visual analogue scale, numerical rating scale and verbal rating scale in 471 patients with chronic pruritus. Acta Derm Venereol 2012; 92: 502-507.
https://doi.org/10.2340/00015555-1246 DOI: https://doi.org/10.2340/00015555-1246
Gooderham MJ, Bissonnette R, Grewal P, Lansang P, Papp KA, Hong CH. Approach to the assessment and management of adult patients with atopic dermatitis: a consensus document. Section II: tools for assessing the severity of atopic dermatitis. J Cutan Med Surg 2018; 22: 10S-16S.
https://doi.org/10.1177/1203475418803628 DOI: https://doi.org/10.1177/1203475418803628
Hanifin JM, Thurston M, Omoto M, Cherill R, Tofte SJ, Graeber M. The Eczema Area and Severity Index (EASI): assessment of reliability in atopic dermatitis. EASI Evaluator Group. Exp Dermatol 2001; 10: 11-18.
https://doi.org/10.1034/j.1600-0625.2001.100102.x DOI: https://doi.org/10.1034/j.1600-0625.2001.100102.x
Rishi P, Rishi E, Maitray A, Agarwal A, Nair S, Gopalakrishnan S. Hospital Anxiety and Depression Scale assessment of 100 patients before and after using low vision care: a prospective study in a tertiary eye-care setting. Indian J Ophthalmol 2017; 65: 1203-1208.
https://doi.org/10.4103/ijo.IJO_436_17 DOI: https://doi.org/10.4103/ijo.IJO_436_17
Martin S, Chandran A, Zografos L, Zlateva G. Evaluation of the impact of fibromyalgia on patients' sleep and the content validity of two sleep scales. Health Qual Life Outcomes 2009; 7: 64.
https://doi.org/10.1186/1477-7525-7-64 DOI: https://doi.org/10.1186/1477-7525-7-64
Birdi G, Cooke R, Knibb RC. Impact of atopic dermatitis on quality of life in adults: a systematic review and meta-analysis. Int J Dermatol 2020; 59: e75-e91.
https://doi.org/10.1111/ijd.14763 DOI: https://doi.org/10.1111/ijd.14763
Weidinger S, Novak N. Atopic dermatitis. Lancet 2016; 387: 1109-1122.
https://doi.org/10.1016/S0140-6736(15)00149-X DOI: https://doi.org/10.1016/S0140-6736(15)00149-X
Lim GY, Tam WW, Lu Y, Ho CS, Zhang MW, Ho RC. Prevalence of depression in the community from 30 countries between 1994 and 2014. Sci Rep 2018; 8: 2861.
https://doi.org/10.1038/s41598-018-21243-x DOI: https://doi.org/10.1038/s41598-018-21243-x
Remes O, Brayne C, van der Linde R, Lafortune L. A systematic review of reviews on the prevalence of anxiety disorders in adult populations. Brain Behav 2016; 6: e00497.
https://doi.org/10.1002/brb3.497 DOI: https://doi.org/10.1002/brb3.497
Ingegnoli F, Schioppo T, Ubiali T, Bollati V, Ostuzzi S, Buoli M, Caporali R. Relevant non-pharmacologic topics for clinical research in rheumatic musculoskeletal diseases: the patient perspective. Int J Rheum Dis 2020; 23: 1305-1310.
https://doi.org/10.1111/1756-185X.13932 DOI: https://doi.org/10.1111/1756-185X.13932
Březinová E, Nečas M, Vašků V. Quality of life and psychological disturbances in adults with atopic dermatitis in the Czech Republic. J Biol Regul Homeost Agents 2017; 31: 227-233.
Kwak Y, Kim Y. Health-related quality of life and mental health of adults with atopic dermatitis. Arch Psychiatr Nurs 2017; 31: 516-521.
https://doi.org/10.1016/j.apnu.2017.06.001 DOI: https://doi.org/10.1016/j.apnu.2017.06.001
Guo F, Yu Q, Liu Z, Zhang C, Li P, Xu Y, et al. Evaluation of life quality, anxiety, and depression in patients with skin diseases. Medicine (Baltimore) 2020; 99: e22983.
https://doi.org/10.1097/MD.0000000000022983 DOI: https://doi.org/10.1097/MD.0000000000022983
Wittkowski A, Richards HL, Griffiths CE, Main CJ. The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis. J Psychosom Res 2004; 57: 195-200.
https://doi.org/10.1016/S0022-3999(03)00572-5 DOI: https://doi.org/10.1016/S0022-3999(03)00572-5
Falissard B, Simpson EL, Guttman-Yassky E, Papp KA, Barbarot S, Gadkari A, et al. Qualitative assessment of adult patients' perception of atopic dermatitis using natural language processing analysis in a cross-sectional study. Dermatol Ther (Heidelb) 2020; 10: 297-305.
https://doi.org/10.1007/s13555-020-00356-0 DOI: https://doi.org/10.1007/s13555-020-00356-0
Bredewold R, Veenema AH. Sex differences in the regulation of social and anxiety-related behaviors: insights from vasopressin and oxytocin brain systems. Curr Opin Neurobiol 2018; 49: 132-140.
https://doi.org/10.1016/j.conb.2018.02.011 DOI: https://doi.org/10.1016/j.conb.2018.02.011
Kouris A, Platsidaki E, Kouskoukis C, Christodoulou C. Psychological parameters of psoriasis. Psychiatriki 2017; 28: 54-59.
https://doi.org/10.22365/jpsych.2017.281.54 DOI: https://doi.org/10.22365/jpsych.2017.281.54
Ando S, Nishida A, Usami S, Koike S, Yamasaki S, Kanata S, et al. Help-seeking intention for depression in early adolescents: associated factors and sex differences. J Affect Disord 2018; 238: 359-365.
https://doi.org/10.1016/j.jad.2018.05.077 DOI: https://doi.org/10.1016/j.jad.2018.05.077
Yin H, Wardenaar KJ, Xu G, Tian H, Schoevers RA. Help-seeking behaviors among Chinese people with mental disorders: a cross-sectional study. BMC Psychiatry 2019; 19: 373.
https://doi.org/10.1186/s12888-019-2316-z DOI: https://doi.org/10.1186/s12888-019-2316-z
Li JC, Fishbein A, Singam V, Patel KR, Zee PC, Attarian H, et al. Sleep disturbance and sleep-related impairment in adults with atopic dermatitis: a cross-sectional study. Dermatitis 2018; 29: 270-277.
https://doi.org/10.1097/DER.0000000000000401 DOI: https://doi.org/10.1097/DER.0000000000000401
Silverberg JI, Chiesa-Fuxench Z, Margolis D, Boguniewicz M, Fonacier L, Grayson M, et al. Sleep disturbances in atopic dermatitis in US adults. Dermatitis 2021 Mar 5. [Epub ahead of print].
https://doi.org/10.1097/DER.0000000000000731 DOI: https://doi.org/10.1097/DER.0000000000000731
Chiesa Fuxench ZC, Block JK, Boguniewicz M, Boyle J, Fonacier L, Gelfand JM, et al. Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J Invest Dermatol 2019; 139: 583-590.
https://doi.org/10.1016/j.jid.2018.08.028 DOI: https://doi.org/10.1016/j.jid.2018.08.028
Weidinger S, Beck LA, Bieber T, Kabashima K, Irvine AD. Atopic dermatitis. Nat Rev Dis Primers 2018; 4: 1.
https://doi.org/10.1038/s41572-018-0001-z DOI: https://doi.org/10.1038/s41572-018-0001-z
Artz MA, Boots JM, Ligtenberg G, Roodnat JI, Christiaans MH, Vos PF, et al. Conversion from cyclosporine to tacrolimus improves quality-of-life indices, renal graft function and cardiovascular risk profile. Am J Transplant 2004; 4: 937-945.
https://doi.org/10.1111/j.1600-6143.2004.00427.x DOI: https://doi.org/10.1111/j.1600-6143.2004.00427.x
Flytström I, Stenberg B, Svensson A, Bergbrant IM. Methotrexate vs. ciclosporin in psoriasis: effectiveness, quality of life and safety. A randomized controlled trial. Br J Dermatol 2008; 158: 116-121.
Vilsbøll AW, Anderson P, Piercy J, Milligan G, Kragh N. Extent and impact of inadequate disease control in us adults with a history of moderate to severe atopic dermatitis following introduction of new treatments. Dermatol Ther (Heidelb) 2021; 11: 475-486.
https://doi.org/10.1007/s13555-021-00488-x DOI: https://doi.org/10.1007/s13555-021-00488-x
Leibovici V, Canetti L, Yahalomi S, Cooper-Kazaz R, Bonne O, Ingber A, et al. Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study. J Eur Acad Dermatol Venereol 2010; 24: 897-903.
https://doi.org/10.1111/j.1468-3083.2009.03542.x DOI: https://doi.org/10.1111/j.1468-3083.2009.03542.x
Pompili M, Bonanni L, Gualtieri F, Trovini G, Persechino S, Baldessarini RJ. Suicidal risks with psoriasis and atopic dermatitis: systematic review and meta-analysis. J Psychosom Res 2021; 141: 110347.
https://doi.org/10.1016/j.jpsychores.2020.110347 DOI: https://doi.org/10.1016/j.jpsychores.2020.110347
Guenzani D, Buoli M, Caldiroli L, Carnevali GS, Serati M, Vezza C, et al. Malnutrition and inflammation are associated with severity of depressive and cognitive symptoms of old patients affected by chronic kidney disease. J Psychosom Res 2019; 124: 109783.
https://doi.org/10.1016/j.jpsychores.2019.109783 DOI: https://doi.org/10.1016/j.jpsychores.2019.109783
Torales J, Echeverría C, Barrios I, García O, O'Higgins M, Castaldelli-Maia JM, et al. Psychodermatological mechanisms of psoriasis. Dermatol Ther 2020; 33: e13827.
https://doi.org/10.1111/dth.13827 DOI: https://doi.org/10.1111/dth.13827
Ingegnoli F, Schioppo T, Ubiali T, Ostuzzi S, Bollati V, Buoli M, et al. Patient perception of depressive symptoms in rheumatic diseases: a cross-sectional survey. J Clin Rheumatol 2020 Sep 10. [Epub ahead of print].
https://doi.org/10.1097/RHU.0000000000001564 DOI: https://doi.org/10.1097/RHU.0000000000001564
Dai YX, Tai YH, Chang YT, Chen TJ, Chen MH. Increased risk of atopic diseases in the siblings of patients with autism spectrum disorder: a nationwide population-based cohort study. J Autism Dev Disord 2019; 49: 4626-4633.
https://doi.org/10.1007/s10803-019-04184-w DOI: https://doi.org/10.1007/s10803-019-04184-w
Chang TH, Tai YH, Dai YX, Chang YT, Chen TJ, Chen MH. Risk of atopic diseases among siblings of patients with attention-deficit hyperactivity disorder: a nationwide population-based cohort study. Int Arch Allergy Immunol 2019; 180: 37-43.
https://doi.org/10.1159/000500831 DOI: https://doi.org/10.1159/000500831
Li Y, Chen L, Du Y, Huang D, Han H, Dong Z. Fluoxetine Ameliorates atopic dermatitis-like skin lesions in BALB/c mice through reducing psychological stress and inflammatory response. Front Pharmacol 2016; 7: 318.
https://doi.org/10.3389/fphar.2016.00318 DOI: https://doi.org/10.3389/fphar.2016.00318
Schonmann Y, Mansfield KE, Hayes JF, Abuabara K, Roberts A, Smeeth L, et al. Atopic eczema in adulthood and risk of depression and anxiety: a population-based cohort study. J Allergy Clin Immunol Pract 2020; 8: 248-257.e16.
https://doi.org/10.1016/j.jaip.2019.08.030 DOI: https://doi.org/10.1016/j.jaip.2019.08.030
Vakharia PP, Silverberg JI. Adult-onset atopic dermatitis: characteristics and management. Am J Clin Dermatol 2019; 20: 771-779.
https://doi.org/10.1007/s40257-019-00453-7 DOI: https://doi.org/10.1007/s40257-019-00453-7
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