Abstract
Pain is an underappreciated symptom of atopic dermatitis that can affect the health-related quality of life (HRQL) of patients. The aim of this study is to understand the effect of pain on patients with atopic dermatitis and their family members and to recognize how this symptom affects HRQL. We conducted focus groups and interviews with patients with atopic dermatitis and their family members. Researchers independently coded the transcripts and reached a consensus on the major themes. A total of 33 adult participants, consisting of 21 patients with atopic dermatitis (median age 47 years, range 22-77) and 12 family members (median age 50, range 22-72), attended either focus groups (23/33, 70%) or interviews (10/33, 30%), where we assessed their experiences of pain. Four themes emerged in our study. Itchiness and pain can be intertwined: pain was often caused by or otherwise associated with itchiness and could result from open sores and excoriated skin. Characteristics of pain: pain was most often described as burning. Other descriptors included mild, persistent discomfort; stinging; and stabbing. Effects of pain: pain negatively affected various aspects of daily life, including choice of clothing, sleep, social activities, and relationships. The location of painful areas could also limit physical activity, including sex. Pain management: pain from atopic dermatitis could be managed to varying degrees with different over-the-counter and prescription treatments. Systemic agents that cleared the skin also resolved the pain associated with atopic dermatitis. Pain can be a significant factor in the HRQL of patients with atopic dermatitis and should be considered by clinicians when caring for patients with atopic dermatitis.
Highlights
BackgroundAtopic dermatitis is a chronic inflammatory skin disease with a highly symptomatic clinical course [1]
Atopic dermatitis is known for its itchiness; our study found that focusing only on itchiness does not capture the full range of experiences of patients with atopic dermatitis and their family members
This study found that pain could coincide with itchiness, be difficult to describe, and influence all aspects of daily life for patients
Summary
Atopic dermatitis is a chronic inflammatory skin disease with a highly symptomatic clinical course [1]. Pain has been recognized as an important and highly prevalent symptom in patients with atopic dermatitis [2]. Several studies have analyzed the effect of chronic pain on the lives of patients, highlighting the strong correlation between pain and the deterioration of health-related quality of life (HRQL) [5,6,7,8], and atopic dermatitis is no exception. Some patients with atopic dermatitis find that their pain is related to scratching, fissures on the skin, inflamed red skin, or burning from creams or ointments [2]. Pain from atopic dermatitis can have a negative impact on the ability of patients to shop, make clothing decisions, and maintain relationships, among other aspects of daily life [4]. Pain is not universally experienced, one study found that the proportion of patients with moderate or severe atopic dermatitis who reported pain as the most burdensome symptom was more than six times the proportion of patients with mild atopic dermatitis who reported the same [9]
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