Quality of Life in Adults with Atopic Dermatitis in Relation to Disease Severity: Nationwide Data in Japan.

Introduction: The impact of atopic dermatitis (AD) on daily life and different levels of quality of life (QOL) according to AD severity has not been fully elucidated. This study aimed to assess QOL in relation to the AD severity in Japan.

Methods: This observational study used anonymized data of health insurance association members and their families registered to a mobile health app. The QOL measures included the Dermatology Life Quality Index (DLQI), EuroQol five-dimensional five-level descriptive system (EQ-5D-5L), Work Productivity and Activity Impairment (WPAI), and sleep disturbance Numerical Rating Scale (NRS). The data were assessed according to AD severity: the Patient-Oriented Eczema Measure (POEM: 0-2, "clear/almost clear"; 3-7, "mild"; 8-16, "moderate"; 17-24, "severe"; 25-28, "very severe"); and itch NRS (0-10).

Results: Of 1507 adults with AD symptoms or undergoing treatments, 882 were identified with AD diagnosis records. Of those, 229 (26.0%), 242 (27.4%), 273 (31.0%), and 138 (15.6%) were included in the clear/almost clear, mild, moderate, and severe/very severe POEM groups, with mean ± standard deviation DLQI scores of 2.0 ± 2.7, 3.6 ± 3.3, 6.1 ± 4.4, and 10.4 ± 5.7, respectively. Higher DLQI scores were observed with increasing POEM severity and itch NRS (Spearman's rank correlation coefficient 0.629 and 0.615, respectively). EQ-5D-5L scores slightly lowered with increasing POEM severity, whereas WPAI percentage slightly increased. Sleep disturbance NRS increased with increasing AD severity in terms of POEM and itch NRS. Adults identified with AD diagnosis records (n = 882) yielded higher WPAI percentages than those without (n = 1204) in all four domains (Wilcoxon rank sum test, p < 0.001 for all).

Conclusion: This study, using real-world data in Japan, presented valuable data on the relationship between AD severity and various aspects of QOL. The data suggested greater QOL impairment with increasing AD severity; even at lower severity levels, QOL was impacted to some extent. The results highlight the need for careful consideration during clinical practice.