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Impact of steroid responsive dermatoses

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Impact on quality of life

Atopic dermatitis (AD) and psoriasis significantly impact the lives of patients and family members, both physically and psychosocially.

  • “I was itchy everywhere . . . I would get little skin tears and bleed through my clothes . . . these things made it impossible to go out in public . . . my peeling body and face scared my daughter and her friends,”. Quote from a 35-year old female patient with atopic dermatitis, cited in Ahmed, 2013 1
  • "It's itching instead of falling asleep" Quote from a patient with severe psoriasis, cited in Globe 2009 2

The majority of patients with AD have mild disease which can be managed with a skincare regimen including hydrating topical therapies. 3 However:

  • Patients and family members can feel burdened by treatment regimens and many need to implement dietary and household changes 4
  • There is a stigma associated with the visibility of each disease which can be difficult to cope with 567
  • Anxiety is a prevalent psychosocial factor and is not always associated with severity of disease 9
  • Patients often report reduced quality of life and greater psychological distress than the general population and those with other medical conditions 4


It has been found that patients with AD over the age of 16 years have significantly lower scores on sub-scales of vitality, social functioning and mental health versus the general population. 4 Furthermore, psoriasis has also been shown to have a similar impact on patient quality of life as other chronic major medical conditions such as breast cancer, heart disease and type-2 diabetes. 1

Impact of atopic dermatitis on quality of life 7910

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Burden of flares

The International Study of Life with Atopic Eczema (ISOLATE) assessed the impact of AD flares on patients and society. 11

Flare was found to have a negative effect on work/school, home and social lives of 33% of AD patients (44% for severe AD). The same study also reported that patients were taking approximately 2.5 days off work or school per year due to flares, where concentration was impacted 9% of the time. 11 This may lead to patients having to re-consider their careers.

Impact of atopic dermatitis flares on quality of life 11

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Impact of psoriasis on quality of life 12

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Impact on family life

Given that AD most commonly affects children, parents and other family members are also affected by the disease as they are often involved in caregiving. 4Families of children with AD often experience lower quality of life than families of healthy children, 13, 14 and AD severity positively correlates with increased family disruption.

In addition, relatives of patients with psoriasis report a significant impact on their quality of life too. The impact on family members, includes psychological pressures such as worries about their relative’s future with the disease, the feeling of embarrassment due to the amount of time required for care duties, and many feel that their close relationships deteriorate. 15

NICE has recognised the importance of minimising the impact of AD on quality of life for both patients and families/carers. Thorough assessment of the psychological and psychosocial well-being of patients and their families is recommended, and these results should be taken into account when deciding on a treatment strategy for the patient. 16

Comorbidities

Atopic dermatitis

The most common comorbidities associated with AD are respiratory disorders, such as allergic rhinitis, and asthma (40% to 60% overall for respiratory diseases, 42% for pollen allergy). 17

In contrast, among the general population worldwide, approximately 10–30% suffer from allergic rhinitis. 18

Other less-common comorbidities associated with AD, include: 19

  • Food allergy
  • Infections
  • Attention problems and restlessness
  • Potential increased risk of obesity (further investigation is necessary)

Psoriasis

Psoriatic arthritis is one of the key comorbidities of psoriasis, with a prevalence of 10–30%. 20

Other comorbidities associated with psoriasis, include: 20

  • Inflammatory bowel disease (in particular, Crohn’s disease)
    • An immune-mediated disorder
    • Seven times more likely to occur in those with psoriasis, than in the general population
  • Increased prevalence of cardiovascular risk factors (diabetes, hypertension and hyperlipidaemia)
  • Obesity
    • More prevalent in patients with psoriasis of any severity, than in the general population
    • More prevalent in patients with severe psoriasis than in those with milder forms of the disease
  • Hypertension
  • Myocardial infarction
  • Atherosclerosis
  • Metabolic syndrome
  • Psychological disorders
  • Psychiatric disorders


References:

  1. Ahmed Semin Cutan Med Surg 2013;32:101–9

  2. Globe D et al. Health Qual Life Outcomes 2009;7:62

  3. Ring J, et al. J Eur Acad Dermatol Venereol 2012;26:1045–60

  4. Carroll C et al. Pediatr Dermatol 2005;22:192–9

  5. Watson W, Kapur S. Allergy Asthma Clin Immunol 2011;7(Suppl 1):S4

  6. Atopic eczema. NHS choices. Available at: http://www.nhs.uk/conditions/Eczema- (atopic)/Pages/Introduction.aspx (Last accessed October 2015)

  7. Basra MKA, et al. Expert Rev Pharmacoeconomics Outcomes Res 2009;9:271–83

  8. Ginsberg IH, et al. Int J Dermatol 1993;32:656–60

  9. Yosipovitch et al Int J Dermatol 2002; 41: 212–16

  10. Anderson RT et al. Curr Allergy Asthma Rep 2001; 1: 309–315

  11. Zuberbier T, et al. J Allergy Clin Immunol 2006;118:226–232

  12. IFPMA: Psoriasis infographic. Available at: www.ifpma.org/fileadmin/content/Publication/2014/IFPMA_Psoriasis_Infographic_M ay2014.pdf. (Last accessed August 2015)

  13. Lapidus CS, Kerr PE. Med Health R I 2001;84:294–5

  14. Lawson V, et al. Br J Dermatol 1998;138:107–13

  15. Eghlileb AM et al. Br J Dermatol 2007;156:1245–50

  16. NICE Clinical Guidelines 57 (2007): Atopic eczema in children. Available at: http://www.nice.org.uk/guidance/cg57 (Laccessed August 2015)

  17. Wϋthrich B. Ann Allergy Asthma Immunol 1999;83:464–70

  18. World Allergy Organisation. WAO White Book on Allergy 2011-2012. Available at: http://www.worldallergy.org/publications/wao_white_book.pdf (Last accessed August 2015)
  19. Simpson EL. Curr Dermatol Rep 2012;1:29–38

  20. Gulliver W. Brit J Dermatol 2008;159:2–9

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