Acta Dermato-Venereologica 98-7CompleteContent | Page 23

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Advances in dermatology and venereology Acta Dermato-Venereologica

Patient Burden is Associated with Alterations in Quality of Life in Adult Patients with Atopic Dermatitis : Results from the ECLA Study

Laurent MISERY 1 , 2 , Julien SENESCHAl 3 , Ziad REGUIAI 4 , Stéphanie MERHAND 5 , Stéphane HÉAS 6 , Flavien HUET 1 , 2 , Charles TAIEB 7 and Khaled EZZEDINE 8 , 9

1

Department of Dermatology , University Hospital of Brest , FR-29609 Brest , 2 Laboratory Interactions Neurons-Keratinocytes ( LINK ), University of Western Brittany , Brest , 3 Deparment of Dermatology , University Hospital of Bordeaux , Bordeaux , 4 Courlancy Polyclinic , Reims ,

5

Association Française de l ’ Eczéma , Redon , 6 EA4636 , University of Rennes 2 , Rennes , 7 European Market Maintenance Assessment , Vincennes ,

8

EA EpiDermE , University Paris-Est , Paris , 9 Department of Dermatology , University Hospital Henri Mondor , Créteil , France . E-mail : laurent . misery @ chu-brest . fr Accepted Apr 12 , 2018 ; Epub ahead of print Apr 12 , 2018

Atopic dermatitis ( AD ) profoundly alters quality of life in adults . There are few studies concerning patient burden in AD ( 1 ), since burden of disease is a recent concept that includes broader aspects of disease-related disability ( 2 ), such as psychological , physical , social , and economic factors ( 2 – 4 ). It is possible that the burden of skin diseases may be as great as that of other chronic diseases ( 5 ).

This study ( Eczema Cohorte Longitudinale Adultes ; ECLA ) assessed the burden of AD using the Atopy Burden Score – Adult ( ABS-A ), a recently developed specific tool , and compared the results with those obtained with 3 different quality of life scales .

PATIENTS AND METHODS

Patients with AD were members of the French Association of Eczema ( Association Française de l ’ Eczéma ) or outpatients recruited in 4 dermatology centres in France ( Brest – Bordeaux – Créteil – Reims ).

The patients answered questions on their socio-demographic data , disease history and management data ; location of lesions ; impact on sexuality , partners and family , and professional life ; and the financial cost of the disease . Disease severity was evaluated using the Patient-Oriented SCORing Atopic Dermatitis ( PO- SCORAD ) index . In addition , patients were asked to complete 3 generic quality of life questionnaires ( Short Form-12 ( SF-12 ), Dermatology Quality of Life Index ( DLQI ) and Euro-QoL-5 Dimensions ( EQ-5D )) and an AD-specific burden questionnaire , the ABS-A .

The PO-SCORAD index has a self-assessment score of AD ( 6 ). Although the PO-SCORAD is not recommended to assess clinical signs of AD , it is convenient to define the following large classes of severity : mild ( PO-SCORAD score < 25 ), moderate ( between 25 and 50 ) and severe (> 50 ).

The SF-12 is a short version of the Short Form-36 ( SF-36 ), a generic measure enabling assessment of health status in the general population ( 7 ). Two scores , the Physical Component Summary ( PCS-12 ) and the Mental Component Summary ( MCS-12 ), can be calculated from the 12 questions of the SF-12 . There is no overall score . A higher score indicates a better quality of life ( 8 ).

The DLQI is a health quality of life scale specific to dermatological disorders ( 9 ). A total score ( between 0 and 30 ) is calculated and can be expressed as a percentage . A higher score indicates a worse quality of life .

The EQ-5D has 5 dimensions ( Mobility , Self-care , Usual activities , Pain / Discomfort , Anxiety / Depression ) ( 10 ). At the end of the questionnaire , a visual analogue scale ( EuroQoL-visual analogic scale ; EQ-VAS ) records the respondent ’ s self-rated health on a 20-cm vertical scale ( score range 0 – 100 ).

The ABS-A is an 18-item questionnaire specifically developed to evaluate the burden of AD in daily life ( 11 ). Each of the 18 items is rated with a 7-level scoring system and evaluates specific aspects of the burden of AD during the past 7 days . A higher score indicates a higher burden .

Statistical analysis was performed using Student ’ s t-test , analysis of variance ( ANOVA ) or non-parametric tests ( Wilcoxon or Kruskal – Wallis ) for quantitative variables . For qualitative variables , intergroup comparisons were performed with the χ 2 test , or Fisher ’ s test . The level of significance was set at 5 %. Data were analysed using SAS ® software version 8.2 ( SAS Institute , Inc ., Cary , NC , USA ).

RESULTS

A total of 1,024 patients ( 596 women ( 58.3 %) and 427 men ; mean ± standard deviation ( SD ) age : 42.7 ± 15.2 years ) answered the questionnaire . Of these patients , 283 ( 27.6 %; 50 ± 13.9 years ) had mild AD , 414 ( 40.4 %; 41.1 ± 14.8 years ) moderate AD and 327 ( 31.9 %; 38.5 ± 14.6 years ) severe AD ( p < 0.001 ). There was no significant difference between the 3 latter groups with respect to body mass index ( BMI ), economic income , academic level and family situation .

The quality of life and burden scores were higher when disease severity measured with the PO-SCORAD was increased ( p < 0.001 ) ( Table I ). There were no significant differences between men and women . Changes in quality of life and burden were higher in patients who also presented with asthma ( p < 0.001 ), with the exception of the MCS ( p < 0.05 ), and in patients with hay fever ( p < 0.001 ), with the exception of the EQ-VAS .

Table I . Assessment of burden and alterations in quality of life in patients with atopic dermatitis ( AD ) with regard to different test scores ( p < 0.001 )

Mild AD n = 283 Mean ± SD

Moderate AD n = 414 Mean ± SD

Severe AD n = 327 Mean ± SD

Global n = 1,024 Mean ± SD

DLQI : Dermatology Quality of Life Index ; PCS : Physical Component Summary ; MCS : Mental Component Summary ; SF : Short Form ; EQ-5D : Euro-QoL-5 Dimensions ; EQ-VAS : EuroQoL-visual analogic scale ; ABS-A : Atopy Burden Score – Adult ; PO- SCORAD : Patient-Oriented SCORing Atopic Dermatitis .

This is an open access article under the CC BY-NC license . www . medicaljournals . se / acta Journal Compilation © 2018 Acta Dermato-Venereologica . doi : 10.2340 / 00015555-2940 Acta Derm Venereol 2018 ; 98 : 713 – 714