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Visible AD affects romantic relationships, employment and sexual health of French patients

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Visible atopic dermatitis (AD) has a greater impact on the romantic relationships, occupation and sexual health of French adult patients, according to a study published in Acta Dermato Venereologica.1

Although AD often begins in early childhood, researchers say it increasingly persists or begins in adulthood. Despite the higher prevalence of AD in boys during infancy and childhood, AD is more common in girls during puberty and adulthood. A recent population-based European study found a higher adult prevalence of AD in women than in men (6.6% and 4.4%, respectively).2

AD also impacts every patient’s quality of life, as it has been found to have “the highest disease burden in disability-adjusted life years of any non-malignant skin disease in the world.”3 Therefore, it is associated with anxiety, depression and reduced work productivity, which imposes additional economic and health burdens on patients.1

The researchers noted that most studies on negative aspects of AD focused primarily on children, meaning the effects on adult women were poorly studied. Therefore, they created an anonymous questionnaire to assess how AD affects the daily lives of adult French patients, particularly the social, personal and professional aspects of their lives.

Patient with atopic dermatitis (AD) in the neck | Image credit: isavira – stock.adobe.com

To formulate their questionnaire, the researchers surveyed dermatologists and patients with AD to collect patients’ perceptions, concerns and initial data. They used this information to create a semi-structured questionnaire with closed-ended questions about the impact of AD on different stages of a woman’s life.

Researchers analyzed the objective clinical severity of AD using the Patient-Oriented Eczema Measure (POEM), “a self-assessment tool for monitoring disease activity in children and adults with AD.”4 The POEM asked patients how frequently seven specific symptoms occurred in the previous week, namely sleep, bleeding, crying, skin cracking, itching, skin peeling, and skin dryness. POEM scores ranged from 0 to 28, which researchers used to create mild (0-7), moderate (8-16), and severe (17-28) AD severity levels. In the questionnaire, patients were also asked to anonymously provide personal information such as age, occupation, relationship status, atopic comorbidities, and AD presence in visible and/or sensory areas.

Between March and May 2022, researchers enrolled survey participants from a representative sample of adult French women.1 Eligible participants had a diagnosis of AD, were older than 18 years, could understand French, and agreed to participate in surveys. Therefore, they enrolled 1009 French adult women with AD with a mean (SD) age of 41.8 (14.2) years.

Of the study population, 67.7% reported having AD in a visible area such as the face, neck, and hands, while 19.6% reported having AD in a sensory area, such as breasts, buttocks, or genital area. According to POEM, the study population consisted of 511 women (50.5%) with mild AD, 397 (39.3%) with moderate AD, and 101 (10.0%) with severe AD.

In addition, 719 (71.4%) women in the study population had menstrual cycles, 58.7% (n = 422) of them reported AD exacerbations before (50.6%; n = 364) and during (48.3 %; n = 347) of menstruation. Regarding pregnancy, 7.3% (n = 74) reported fear of becoming pregnant due to their Alzheimer’s disease. Of this subgroup, 91% (n = 67/74) were afraid of passing on AD to their child. Similarly, 26% (n = 243/935) of the 92.7% (n = 935) who were not worried about pregnancy also expressed fear of passing on Alzheimer’s disease.

Additionally, 21.8% reported that their Alzheimer’s disease had affected previous romantic relationships; This was highest in those with visible AD (31.4%; P = .0005). Likewise, AD negatively impacted the sexuality of 14.3% of sexually active women in the study population, with the location of AD having a significant impact. Therefore, AD negatively affected the sexuality of 16.8% of individuals with AD in the visible range (P < .0001) and 23.1% of those with AD in a sensory area (P = .0001).

The majority of the study population reported being employed (N = 669; 66.3%). Of this subgroup, 20.9% (N = 140/669) had difficulties at work due to their AD. Consequently 37.2% (N = 249) of women reported thinking about their AD at work, particularly those with visible areas of AD (42.6%; P < .0001). In addition, 210 women (31.4%) reported taking leave from work at least once to see a doctor for their Alzheimer's disease, and 19.6% (n = 131) reported taking sick leave for their AD to be.

The researchers acknowledged its limitations, including recall bias due to the retrospective, self-reported nature of the study. In addition, questions about treatment options were missing from the questionnaire. Despite these limitations, researchers made future treatment suggestions to providers based on their findings.

“Special attention should be paid to patients in whom AD is localized to the face, neck, or hands as they are at higher risk of social exclusion,” the authors concluded. “In addition, these results should encourage health professionals to question patients with AD about the possible involvement of sensory areas.”

reference

  1. Fougerousse AC, Alexandre M, Darrigade AS, et al. Impact of atopic dermatitis on the lives of adult women: a survey of 1,009 French women. Acta Derm Venereol. 2024;104:adv10321. doi:10.2340/actadv.v104.10321
  2. Richard MA, Paul C, Nijsten T, et al. Prevalence of the most common skin diseases in Europe: a population-based study. J Eur Acad Dermatol Venereol. 2022;36(7):1088-1096. doi:10.1111/jdv.18050
  3. Laughter MR, Maymone MBC, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017. Br J Dermatol. 2021;184(2):304-309. doi:10.1111/bjd.19580
  4. Charman CR, Venn AJ, Williams HC. Patient-oriented eczema measurement: Development and initial validation of a new tool for measuring the severity of atopic eczema from the patient’s perspective. Arch Dermatol. 2004;140(12):1513-1519. doi:10.1001/archderm.140.12.1513

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