Atopic Dermatitis on Head, Face, Neck, and Hands May Present Greater Burden

Atopic dermatitis (AD) with head, face, neck, and hand involvement is associated with worse quality of life and more severe disease. These are the findings of a study published in the Journal of the American Academy of Dermatology.

Quality of life among patients with AD can be influenced by affected areas, as some areas can be more bothersome, respond differently to treatment, and be more noticeable. For the study, researchers hypothesized that AD with head, face, neck, and hand involvement may be associated with worse outcomes.

To test their hypothesis, the researchers sourced data from the TARGET-DERM AD study (ClinicalTrials.gov Identifier: NCT03661866), which is a longitudinal, real-world study that enrolled patients at 44 sites in the United States. Patients (N=541) who were enrolled as of September 2021 and met the criteria for moderate-to-severe disease were evaluated by Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI) or Children’s DLQI (CDLQI), and Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD) instruments. Scores were compared between patients with and without head, face, neck, and hand involvement.

Overall, 391 patients had head, neck, or face involvement and 303 had hand involvement. The patients with and without head, face, neck, and hand involvement were adults (53.4%-62.7%); women or girls (56.3%-61.1%); and White (46.2%-51.7%).

Adults with hand involvement were more likely to have very severe (12.8% vs 4.8%) or severe (35.0% vs 16.7%) POEM scores compared with those without involvement (P <.0001), respectively. Adults with head, face, or neck involvement tended to be more likely to have very severe (11.3% vs 4.8%) or severe (30.7% vs 20.2%) POEM scores compared with those without involvement (P =.0524), respectively. Conversely, children with head, face, or neck involvement were more likely to have very severe (10.5% vs 0.0%) or severe (24.6% vs 12.0%) POEM scores compared with those without involvement (P =.039), respectively, but children with hand involvement were not (P =.1203).

Among adults, POEM scores were associated with hand involvement (odds ratio [OR], 2.71; 95% CI, 1.557-4.727). Whereas among the pediatric patients, POEM scores were associated with head, face, or neck involvement (OR, 2.69; 95% CI, 1.326-5.453) and use of systemic therapies (OR, 0.42; 95% CI, 0.187-0.922).

Adults with both head, neck, or face and hand involvement were more likely to report that AD had an extreme or very large effect on their life (head: 41.5% vs 23.9%; hand: 44.3% vs 24.4%; both P ≤.0075), according to the DLQI compared with unaffected patients, respectively.

Similar findings were observed for the CDLQI among children with and without involvement (head: 24.4% vs 7.1%; hand: 26.3% vs 13.6%; both P ≤.0135), respectively.

Significant predictors for CDLQI scores included head, face, or neck involvement (OR, 2.11; 95% CI, 1.177-3.782); hand involvement (OR, 1.79; 95% CI, 1.077-2.972); and gender (OR, 1.73; 95% CI, 1.055-2.829).

Both head, neck, or face (median, 43.6 vs 30.5; P <.0001) and hand (median, 44.7 vs 32.8; P <.0001) involvement were associated with higher PO-SCORAD scores compared with no involvement, respectively.

“These findings highlight the importance of detailed clinical assessment of specific areas affected by AD to personalize treatment approaches to the needs of patients,” the researchers concluded.

Disclosures: This research was supported by TARGET PharmaSolutions, Inc. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Dermatology Advisor