Atopic dermatitis: Clinical outcomes assessment recommendations

For the general management of patients with atopic dermatitis, available patient quality of life measurement scales are not recommended for routine clinical practice.

Level of Evidence: II Strength of Recommendation: C

It is recommended that clinicians ask general questions about itch, sleep, impact on daily activity, and persistence of disease, and currently available scales be used mainly when practical.

Level of Evidence: III Strength of Recommendation: C

Read more about these recommendations

Twenty-two different AD-specific, dermatology-specific, and generic scales were identified that measure quality of life and other psychological outcomes in patients with atopic dermatitis.^43,58-66 These scales have been used to assess the impact of the disease and the effects of interventions, as well as to make comparisons with the impact of other disorders. Careful consideration of the scale properties should occur prior to use, including validity (content, construct, concurrent, discriminative), reliability (test-retest and internal consistency), responsiveness to change, and minimal clinically important difference.^58,60,67,68 In clinical trials, the most commonly used scale is the Children's Dermatology Life Quality Index (CDLQI), followed by the Dermatitis Family Impact (DFI), the Dermatology Life Quality Index (DLQI), and the Infant's Dermatology Life Quality Index.⁴³ But these scales were not generally designed for use in routine clinical practice.⁶⁹

Further development and evaluation of practical clinical quality of life scales are needed. This could be done by modifying existing scales into short clinical versions or by testing existing scales in a clinic population. Of note, inclusion of patient assessment of pruritus is critical given its central contribution to the morbidity of AD.^70,71 Ratings of itch intensity, whether made by parents for young children or by older individuals for themselves, significantly and inversely correlate with quality of life.^72,73 The difficulties due to itching and the resultant scratching are typically the first to be mentioned by parents when asked about the effects of their child's disease.⁷⁴The mechanisms underlying AD-associated itch remain unclear, and are an area of much active research. Sleep disturbance, impedance of daily activities (including effects on work or school performance), and persistence of disease are other key measures of disease impact, and represent a patient’s status and overall well-being.^69,75,76

References

Rehal B, Armstrong AW. Health outcome measures in atopicdermatitis: a systematic review of trends in disease severity andquality-of-life instruments 1985-2010. PloS one 2011;6: e17520.
Chamlin SL, Lai JS, Cella D, Frieden IJ, Williams ML, Mancini AJ, et al. Childhood Atopic Dermatitis Impact Scale: reliability, discriminative and concurrent validity, and responsiveness. Arch Dermatol 2007;143:768-72.
Lewis-Jones MS, Finlay AY, Dykes PJ. The Infants’ Dermatitis Quality of Life Index. Br J Dermatol 2001;144:104-10.
Augustin M, Lange S, Wenninger K, Seidenglanz K, Amon U, Zschocke I. Validation of a comprehensive Freiburg Life Quality Assessment (FLQA) core questionnaire and development of a threshold system. Eur J Dermatol 2004;14:107-13.
Evers AW, Duller P, van de Kerkhof PC, van der Valk PG, de Jong EM, Gerritsen MJ, et al. The Impact of Chronic Skin Disease on Daily Life (ISDL): a generic and dermatology-specific health instrument. Br J Dermatol 2008;158:101-8.
Smidt AC, Lai JS, Cella D, Patel S, Mancini AJ, Chamlin SL. Development and validation of Skindex-Teen, a quality-of-life instrument for adolescents with skin disease. Arch Dermatol 2010;146:865-9.
Kondo-Endo K, Ohashi Y, Nakagawa H, Katsunuma T, Ohya Y, Kamibeppu K, et al. Development and validation of a questionnaire measuring quality of life in primary caregivers of children with atopic dermatitis (QPCAD). Br J Dermatol 2009;161:617-25.
Chren MM, Lasek RJ, Sahay AP, Sands LP. Measurement properties of Skindex-16: a brief quality-of-life measure for patients with skin diseases. J Cutan Med Surg 2001;5:105-10.
Wittkowski A, Richards HL, Griffiths CE, Main CJ. The impact of psychological and clinical factors on quality of life in individuals with atopic dermatitis. J Psychosom Res 2004;57: 195-200.
Linnet J, Jemec GB. An assessment of anxiety and dermatology life quality in patients with atopic dermatitis. Br J Dermatol 1999;140:268-72.
Hon KL, Kam WY, Lam MC, Leung TF, Ng PC. CDLQI, SCORAD and NESS: are they correlated? Qual Life Res 2006;15:1551-8.
Misery L, Finlay AY, Martin N, Boussetta S, Nguyen C, Myon E, et al. Atopic dermatitis: impact on the quality of life of patients and their partners. Dermatology 2007;215:123-9.
Chamlin SL, Mattson CL, Frieden IJ, Williams ML, Mancini AJ, Cella D, et al. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med 2005;159:745-50.
Hon KL, Leung TF, Wong KY, Chow CM, Chuh A, Ng PC. Does age or gender influence quality of life in children with atopic dermatitis? Clin Exp Dermatol 2008;33:705-9.
Dawn A, Papoiu AD, Chan YH, Rapp SR, Rassette N, Yosipovitch G. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol 2009;160:642-4.
Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. Int J Clin Pract 2006;60:984-92.
Weisshaar E, Diepgen TL, Bruckner T, Fartasch M, Kupfer J, Lob-Corzilius T, et al. Itch intensity evaluated in the German Atopic Dermatitis Intervention Study (GADIS): correlations with quality of life, coping behaviour and SCORAD severity in 823 children. Acta Derm Venereol 2008;88:234-9.
Ricci G, Bendandi B, Bellini F, Patrizi A, Masi M. Atopic dermatitis: quality of life of young Italian children and their families and correlation with severity score. Pediatr Allergy Immunol 2007;18:245-9.
Bender BG, Ballard R, Canono B, Murphy JR, Leung DY. Disease severity, scratching, and sleep quality in patients with atopic dermatitis. J Am Acad Dermatol 2008; 58:415-20.
Ben-Gashir MA, Seed PT, Hay RJ. Are quality of family life and disease severity related in childhood atopic dermatitis? J Eur Acad Dermatol Venereol 2002;16:455-62.

Citation note

When referencing this guideline in a publication, please use the following citation: Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014 Feb;70(2):338-51.

View the AAD guidelines disclaimer.

Practice Management Center

Atopic dermatitis: Clinical outcomes assessment recommendations

Read more about these recommendations

References

Navigate section 1 of the AD guideline: Diagnosis and assessment

Citation note