TY - JOUR
T1 - Clinical phenotyping of atopic dermatitis using combined itch and lesional severity
T2 - A prospective observational study
AU - Chovatiya, Raj
AU - Lei, Donald
AU - Ahmed, Adnan
AU - Chavda, Rajeev
AU - Gabriel, Sylvie
AU - Silverberg, Jonathan I.
N1 - Funding Information:
Funding: This publication was made possible with support from the Agency for Healthcare Research and Quality (grant number K12 HS023011), the Dermatology Foundation, and a research grant from Galderma.Northwestern Medicine Enterprise Data Warehouse was supported, in part, by the Northwestern University Clinical and Translational Science Institute, funded, in part, by grant number UL1TR000150 from the National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Clinical and Translational Science Award is a registered trademark of the Department of Health and Human Services.
Funding Information:
Funding: This publication was made possible with support from the Agency for Healthcare Research and Quality (grant number K12 HS023011 ), the Dermatology Foundation , and a research grant from Galderma .
Funding Information:
Northwestern Medicine Enterprise Data Warehouse was supported, in part, by the Northwestern University Clinical and Translational Science Institute , funded, in part, by grant number UL1TR000150 from the National Center for Advancing Translational Sciences , Clinical and Translational Sciences Award. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The Clinical and Translational Science Award is a registered trademark of the Department of Health and Human Services.
Publisher Copyright:
© 2021 American College of Allergy, Asthma & Immunology
PY - 2021/7
Y1 - 2021/7
N2 - Background: Patients with atopic dermatitis (AD) have heterogeneous clinical phenotypes, including different combinations of itch and lesional severity. Little is known about the characteristics and course of these subtypes. Objective: To determine the characteristics, associations, burden, and course of patients with AD using combined itch and lesional severity. Methods: A prospective practice-based study was performed using questionnaires and physical examination (n=592). AD subsets were defined using verbal rating scale for average itch combined with either eczema area and severity index, objective—scoring atopic dermatitis (SCORAD), or validated investigator's global assessment as follows: mild-moderate itch and lesions (MI-ML), mild-moderate itch and severe lesions (MI-SL), severe itch and mild-moderate lesions (SI-ML), and severe itch and lesions (SI-SL). Results: At baseline, there were only weak-moderate correlations of numerical rating scales for worst itch or average itch or SCORAD itch with eczema area and severity index, objective-SCORAD, body surface area, and validated investigator's global assessment (Spearman's rho = 0.32-0.62). Most patients had MI-ML (59.4%-62.3%), followed by SI-ML (21.3%-29.1%), SI-SL (6.0%-12.9%), and MI-SL (3.8%-6.4%). Patients with SI-SL, followed by SI-ML and MI-SL, described their AD as being more severe overall and had worse impairment in sleep, mental health, and quality of life. However, those with MI-SL or SI-SL were far more likely to be classified as severe by a physician (multivariable logistic and linear regression, P <.005 for all). Baseline MI-SL, SI-ML, and SI-SL were associated with similar longitudinal courses over time and more AD flares and itch triggers than MI-ML. Conclusion: Combined itch and lesional severity seem to describe unique AD phenotypes. Further studies are needed to confirm these findings and understand the optimal treatments for these groups.
AB - Background: Patients with atopic dermatitis (AD) have heterogeneous clinical phenotypes, including different combinations of itch and lesional severity. Little is known about the characteristics and course of these subtypes. Objective: To determine the characteristics, associations, burden, and course of patients with AD using combined itch and lesional severity. Methods: A prospective practice-based study was performed using questionnaires and physical examination (n=592). AD subsets were defined using verbal rating scale for average itch combined with either eczema area and severity index, objective—scoring atopic dermatitis (SCORAD), or validated investigator's global assessment as follows: mild-moderate itch and lesions (MI-ML), mild-moderate itch and severe lesions (MI-SL), severe itch and mild-moderate lesions (SI-ML), and severe itch and lesions (SI-SL). Results: At baseline, there were only weak-moderate correlations of numerical rating scales for worst itch or average itch or SCORAD itch with eczema area and severity index, objective-SCORAD, body surface area, and validated investigator's global assessment (Spearman's rho = 0.32-0.62). Most patients had MI-ML (59.4%-62.3%), followed by SI-ML (21.3%-29.1%), SI-SL (6.0%-12.9%), and MI-SL (3.8%-6.4%). Patients with SI-SL, followed by SI-ML and MI-SL, described their AD as being more severe overall and had worse impairment in sleep, mental health, and quality of life. However, those with MI-SL or SI-SL were far more likely to be classified as severe by a physician (multivariable logistic and linear regression, P <.005 for all). Baseline MI-SL, SI-ML, and SI-SL were associated with similar longitudinal courses over time and more AD flares and itch triggers than MI-ML. Conclusion: Combined itch and lesional severity seem to describe unique AD phenotypes. Further studies are needed to confirm these findings and understand the optimal treatments for these groups.
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U2 - 10.1016/j.anai.2021.03.019
DO - 10.1016/j.anai.2021.03.019
M3 - Article
C2 - 33819616
AN - SCOPUS:85109116285
SN - 1081-1206
VL - 127
SP - 83-90.e2
JO - Annals of Allergy, Asthma and Immunology
JF - Annals of Allergy, Asthma and Immunology
IS - 1
ER -
