Understanding

Burden

Atopic dermatitis is associated with substantial burdens, impacting significantly on the quality of life (QoL) of patients and their families. The disease is also associated with considerable socioeconomic costs both from the perspective of society and from healthcare providers. Infants in the early stages of developing atopic dermatitis may exhibit – in addition to primary symptoms such as rash, pruritus and erythema¹¹ – affected sleep patterns, disruptive daytime behaviour and may become irritable and unable to stop scratching.¹² Secondary bacterial and fungal infections are common in atopic dermatitis patients, usually in those areas most affected or scratched, adding considerably to the burden experienced. In childhood, the impact of the disease includes physical symptoms such as intense discomfort and pruritus during flares; psychosocial problems such as the constant worry of flare recurrence, reduced self-esteem, poor self-image, low confidence; and the increased risk of developing anxiety and depressive symptoms.^{12, 13} Many of these difficulties can persist into adolescence and adulthood, and academic development and social functioning can be adversely affected. So significant are these effects, both in children and adults, that several studies report that moderate and severe atopic dermatitis has a much higher impact on QoL than other common chronic diseases such as acne, diabetes, asthma and hypertension.¹⁴ The graph below (figure 3) shows the results from a 2006 study comparing Children’s Life Quality Index^© scores (a new generic health related QoL measurement tool) from children with chronic skin diseases with those of children with other chronic diseases. Generalised atopic dermatitis scored second only to cerebral palsy, confirming the high degree of health related QoL impairment experienced by children with this condition.¹⁵

Figure 3. Children’s Life Quality Index^© scores for children with chronic diseases¹⁵

Reproduced from Beattie and Lewis-Jones Br J Dermatol 2006;155:145–51 with the permission of the
publisher, John Wiley and Sons. ^©2006 British Association of Dermatologists

The Dermatology Life Quality Index (DLQI) and Children’s Dermatology Life Quality Index (CDLQI) have been widely used to assess the impact of atopic dermatitis in adults and children.¹⁶ Consisting of 10 questions examining different aspects of living with atopic dermatitis, these assessments demonstrate significant differences in atopic dermatitis patients’ quality of life compared with control groups.^17-19 Mozaffari et. al. report that the QoL areas most affected in children with atopic dermatitis are friendships, meal times, dressing/undressing and bathing, whereas adults with atopic dermatitis were principally affected in the dressing/undressing and bathing QoL areas. For both children and atopic adults there was a good correlation between DLQI/CDLQI scores and disease severity (p< 0.001).¹⁹

Although estimates vary, there is a substantial body of evidence showing atopic dermatitis imposes serious financial burdens on industrialised nations. As shown in the figure below (figure 4), the annual personal cost to atopic dermatitis patients in the UK is approximately £297 million. Healthcare provider costs of up to £125 million per year were demonstrated in the same study, and approximately £43 million in annual costs to society due to lost schooling and lost working days.²⁰ In the US, the cost of treating a single atopic dermatitis patient is estimated at US$219 with costs increasing in line with disease severity.²¹ Similarly, in Australia, the annual costs of treating a child with mild atopic dermatitis was estimated to be Aus$1,142, increasing to more than Aus$6,000 in patients with severe exacerbations.²² Canadian estimates of the annual costs incurred to society by atopic dermatitis are in the region of Cnd$1.4 billion with the largest part of this cost burden reportedly being absorbed by the patients, families and employers.²³

Figure 4. Total Annual Cost of Atopic Dermatitis in the UK²⁰