Assessing Disease Control in Patients with Atopic Dermatitis by Using the Atopic Dermatitis Control Tool in Daily Practice

Rui Chen, Laura Loman, Lian F. van der Gang, Manon M. Sloot, Marjolein S. de Bruin-Weller, Marie L.A. Schuttelaar; Dermatology 2024; https://doi.org/10.1159/000541466

ABSTRACT

INTRODUCTION: Atopic dermatitis (AD) is a chronic inflammatory skin disease, placing a significant burden on patients' quality of life (QoL). The validated Atopic Dermatitis Control Tool (ADCT) is recommended to assess AD control in adults. The aim of this study was to assess AD control and explore associations with demographic characteristics, patient-reported outcome measures (PROMs), and treatment.

METHODS: In this cross-sectional study, questionnaires were sent to 2,066 adults from two tertiary referral centers who had previously physician-diagnosed AD and had visited the outpatient clinic at least once between 2020 and 2022. Questionnaires were completed between May and October 2022. AD control was assessed by the ADCT, with a score ≥7 indicating uncontrolled AD. AD severity, QoL, and weekly average pruritus were simultaneously measured using the Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), and numeric rating scale (NRS), respectively, with higher scores indicating more severe symptoms.

Moreover, treatment-related questions were included. Associations between uncontrolled AD, age, sex, and treatment were explored using multivariate logistic regression analysis.

Binary logistic regression analysis of factors associated with uncontrolled
AD according to the Atopic Dermatitis Control Tool (ADCT)

RESULTS: In total, 863 patients (41.8%) filled out the questionnaire and 812 were included in the analysis, of which 59% reported controlled AD. Uncontrolled AD was associated with higher PROM scores and receiving topical anti-inflammatories only (adjusted odds ratio [95% confidence interval] ranged from 1.33 [0.995-1.88] to 2.55 [2.21-2.86]). Of those treated with topical anti-inflammatories only, 54% reported uncontrolled AD.

CONCLUSION: The majority of the patients reported controlled AD. Patients with uncontrolled AD often reported more severe symptoms and were more likely to receive topical anti-inflammatories only. It could be considered to shift patients with uncontrolled AD from topical to systemic treatment.

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