Head and neck severity index is associated to a significant worsening of quality of life in atopic dermatitis patients.

Abstract

Experimental DermatologyVolume 30, Issue 11 p. 1717-1718 CORRESPONDENCEFree Access Head and neck severity index is associated to a significant worsening of quality of life in atopic dermatitis patients Simone Ribero, Corresponding Author Simone Ribero simone.ribero@unito.it orcid.org/0000-0002-0098-1406 Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy Correspondence Simone Ribero, Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy. Email: simone.ribero@unito.itSearch for more papers by this authorBruna Puglisi, Bruna Puglisi Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorMaria Teresa Giura, Maria Teresa Giura Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorRiccardo Viola, Riccardo Viola Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorNiccolo Siliquini, Niccolo Siliquini Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorPietro Quaglino, Pietro Quaglino Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorMichela Ortoncelli, Michela Ortoncelli Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this author Simone Ribero, Corresponding Author Simone Ribero simone.ribero@unito.it orcid.org/0000-0002-0098-1406 Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, Italy Correspondence Simone Ribero, Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy. Email: simone.ribero@unito.itSearch for more papers by this authorBruna Puglisi, Bruna Puglisi Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorMaria Teresa Giura, Maria Teresa Giura Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorRiccardo Viola, Riccardo Viola Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorNiccolo Siliquini, Niccolo Siliquini Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorPietro Quaglino, Pietro Quaglino Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this authorMichela Ortoncelli, Michela Ortoncelli Dermatology Clinic, Medical Sciences Department, University of Turin, Turin, ItalySearch for more papers by this author First published: 02 May 2021 https://doi.org/10.1111/exd.14368 Pietro Quaglino and Michela Ortoncelli contribute equally. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Atopic dermatitis (AD) is a chronic inflammatory disease that affects approximately 5–10% of the child population and 3–10% of the adult population worldwide.1 It can affect any part of the body indifferently, having a different distribution of eczematous lesions depending on the patient's period of life; in adults, it is common to see lesions on the neck, limbs and trunk; in particular, some patients report involvement of specific sites such as the head and neck region. Based on our clinical experience and the reported data on AD, we have analysed the impact on quality of life according to the Dermatology Life Quality Index (DLQI) to look at the repercussions of the disease on personal and social life.2 Our study analysed the global Eczema Area and Severity Index (EASI) and the partial EASIs related to the different body areas in order to understand which of them is the more predictive of DLQI and if, consequently, the involvement of a single body site could be able to predict the severity of the disease by itself. The involvement of the head and neck site has been previously studied in a Delphi, as indicator of a higher burden of disease,3 and its involvement has been associated with a worsening of the quality of life.4 Patients were prospectively enrolled in the moderate-severe atopic dermatitis service between April 2019 and May 2020 accordingly to the previously described criteria.5 Setting the DLQI > 10 as a cut-off, the different partial EASI was analysed by relating them to the total EASI score with logistic regression analysis. The model was adjusted for the global EASI. The sample examined was composed of 192 patients ≥18 years with AD symptoms for at least 6 months. There were 104 males and 88 females mostly affected by the disease from early childhood (67%). 97% had a history of immunosuppressive systemic drug; 173 (90% of the total) were treated with cyclosporine. Mean eosinophils count was 0.43 (±0.37 109/L). The mean global EASI score was 23.6 (±11.88), the EASI of the specific head-neck site (H&N) was 3.2 (±1.9), the trunk EASI was 6.3 (±4.6), the upper limbs EASI was 5 (±3.2) and the lower limbs EASI was 8.8 (±6.5). The average DLQI in the sample was 15.3 (±6.9). Concerning the trunk, upper and lower limbs, there was no statistically significant association between partial EASI and the perceived quality of life, assessed with DLQI (Table 1). On the other hand, there was a statistically significant association with the DLQI and the H&N EASI (OR = 1.27, p = 0.027; IC 1.02–1.57) (Table 1). TABLE 1. Logistic regression looking at the association between EASI in different body sites and DLQI > 10a a All the logistic regression at the different body sites were adjusted for the global EASI score. OR ES p IC EASI head & neck 1.27 0.14 0.027 1.02–1.57 EASI trunk 0.91 0.06 0.24 0.79–1.05 EASI upper limbs 0.98 0.08 0.82 0.82–1.16 EASI lower limbs 1.00 0.05 0.96 0.9–1.11 a All the logistic regression at the different body sites were adjusted for the global EASI score. In clinical practice, many authors have assisted to a low DLQI even in EASI score lower than 24.3 Since in some countries a EASI score lower than 24 will block the access to biologic new drug for AD, QoL can be strongly impacted. EASI of the H&N has a larger impact on the measured quality of life in these subjects than the trunk and limbs. In daily practice, patients with no H&N involvement should still be assessed using the global EASI score to best quantify the severity of the disease from a clinical point of view. However, when evaluating AD specifically involving the H&N site, we have to consider the DLQI impact and the risk of decreasing the perceived quality of life due to the specific involvement of this site. Therefore, in assessing AD, it could be suggested to consider patients with H&N involvement as suffering from more severe atopic dermatitis than their global EASI score suggests; therefore, the considered treatment options should account for this when pondering about indication to biologic drugs. ACKNOWLEDGEMENT This study was partially supported by an unconditioned grant from Leo Pharma. CONFLICT OF INTEREST The authors have no conflict of interest. AUTHOR CONTRIBUTION SR, BP, MTG, RV, NS and MO performed the research. SR and PQ designed the research study. SR analysed the data. SR, NS, MO and BP wrote the paper. REFERENCES 1Moyle M, Cevikbas F, Harden JL, Guttman-Yassky E. Understanding the immune landscape in atopic dermatitis: the era of biologics and emerging therapeutic approaches. Exp Dermatol. 2019; 28(7): 756- 768. https://doi.org/10.1111/exd.13911Wiley Online LibraryPubMedWeb of Science®Google Scholar 2Thomas KS, Apfelbacher CA, Chalmers JR, et al. 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CrossrefPubMedWeb of Science®Google Scholar 5Ribero S, Giura MT, Viola R, et al. Effectiveness and safety of dupilumab for the treatment of atopic dermatitis in adult cohort: a real-life Italian tertiary centre experience. J Eur Acad Dermatol Venereol. 2020; 34(8): e380- e383. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Volume30, Issue11November 2021Pages 1717-1718 ReferencesRelatedInformation