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Clinical and Quality of Life Indicators of Disease Severity

In this video, Dawn M.R. Davis, MD, describes the different factors to consider when assessing the severity of disease in patients with atopic dermatitis. Dr Davis is a professor of pediatric and adolescent medicine and professor of dermatology as well as division chair of clinical dermatology at Mayo Clinic in Rochester, MN.

Dr Davis: Commonly, there are three severity gradations for atopic dermatitis: mild, moderate, and severe.

Mild atopic dermatitis is demonstrated on the patient's skin by having mild erythema, mild skin accentuation, dryness, and mild to minimal scale.

Moderate levels of atopic dermatitis are similar to mild levels but are more intense with increased erythema, increased lichenification and accentuation of skin lines, increased dryness demonstrated by further scale, plus the presence of erosions that are superficial and excoriation.

Severe atopic dermatitis demonstrates all of those findings. Plus oftentimes, we'll have a little bit of skin infiltration and exudate.

With regards to the distribution of atopic dermatitis, at times using a particular quality of life rating scale or body surface area measurement is insufficient or inadequate to truly express the impact of the dermatitis on the patient.

When someone has generalized disease, it's very obvious to the patient, the provider, and others that their quality of life is impacted because you can see that they're inflamed and have active skin disease everywhere.

However, if somebody were to have localized disease in only a sensitive area, they can cause enough symptomatology and concern on their own that, even if it is the only isolated body surface area involved, it can still have profound consequences for the patient with regards to quality of life, which is why going by body surface area alone is insufficient. The entire picture should be taken into consideration.

Quality‑of‑life factors are very important for patients and their caregivers when a member of their family or friend has atopic dermatitis.

Some quality‑of‑life factors are evident to the patient, their caregiver, and the provider. Other factors that may impact patients, which may not be evident to providers or caregivers typically, include psychosocial and mental health concerns, such as concerns of bullying, being embarrassed by their skin appearance, having other individuals comment on their skin appearance with fear of contagion or fear of social stigmata, meaning that it was their fault or caused by something that they did voluntarily.

Other concerns include downstream ramifications of work or school truancy, having to skip school or work in order to go to the physician's office or because you're not feeling well from your atopic dermatitis.

Other quality of life factors include other atopic comorbidities. It is not uncommon that atopic dermatitis patients have other medical conditions related to atopy, such as allergic rhinoconjunctivitis, reactive airway disease or asthma, and/or food allergies. If any of those atopic diseases tend to be flaring, under poor management or control, oftentimes the atopic dermatitis patients will have difficulty with their skin disease at the same time.

I like to educate my patients and their care providers that atopic dermatitis is a systemic disease that requires whole‑person views and whole‑person care, often with the conjunction of our friends in primary care, allergy, social work, psychology, and psychiatry.

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