Atopic Dermatitis Severity, Patient Perception of the Disease, and Personality Characteristics: How Are They Related to Quality of Life?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Assessment of Disease Severity by SCORAD
2.2. Questionnaires on Quality of Life (Psychological Tests)
2.2.1. Dermatological Quality of Life Analyzed by the Dermatology Life Quality Index (DLQI)
2.2.2. Health-Related Quality of Life Analyzed by the World Health Organization Quality of Life Brief Version (WHOQLO-BREF)
2.3. Illness Perception Analyzed by the Brief Illness Perception Questionnaire (Brief IPQ)
2.4. Personality Traits Analyzed by the Crown–Crisp Experiential Index (CCEI)
2.5. Statistical Methods
3. Results
3.1. Results from SCORAD, DLQI, WHOQOL-BREF, Brief IPQ, and the CCEI Analyzed for Both Symptomatic and Asymptomatic AD Patients
3.2. Results for the Second Assessment of Parameters/Variables Analyzed at the Two-Month Follow-Up (Symptomatic Patients only) (SCORAD, DLQI, WHOQOL-BREF, and Brief IPQ)
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
- Huang, J.; Choo, Y.J.; Smith, H.E.; Apfelbacher, C. Quality of life in atopic dermatitis in Asian countries: A systematic review. Arch. Dermatol. Res. 2021. Epub ahead of print. [Google Scholar] [CrossRef] [PubMed]
- Weidinger, S.; Novak, N. Atopic dermatitis. Lancet 2016, 387, 1109–1122. [Google Scholar] [CrossRef]
- Peng, W.; Novak, N. Pathogenesis of AD. Clin. Exp. Allergy 2015, 45, 566–574. [Google Scholar] [CrossRef] [PubMed]
- Morelli, P.; Gaspari, M.; Gabriele, C.; Dastoli, S.; Bennardo, L.; Pavel, A.B.; Patruno, C.; Del Duca, E.; Nisticò, S.P. Proteomic Analysis from Skin Swabs Reveals a New Set of Proteins Identifying Skin Impairment in Atopic Dermatitis. Exp. Dermatol. 2021, 30, 811–819. [Google Scholar] [CrossRef] [PubMed]
- Nettis, E.; Ortoncelli, M.; Pellacani, G.; Foti, C.; Di Leo, E.; Patruno, C.; Rongioletti, F.; Argenziano, G.; Ferrucci, S.M.; Macchia, L.; et al. A Multicenter Study on the Prevalence of Clinical Patterns and Clinical Phenotypes in Adult Atopic Dermatitis. J. Investig. Allergol. Clin. Immunol. 2020, 30, 448–450. [Google Scholar] [CrossRef] [PubMed]
- Silverberg, J.I.; Gelfand, J.M.; Margolis, D.J.; Boguniewicz, M.; Fonacier, L.; Grayson, M.H.; Simpson, E.L.; Ong, P.Y.; Chiesa Fuxench, Z.C. Patient Burden and Quality of Life in Atopic Dermatitis in US Adults: A Population-Based Cross-Sectional Study. Ann. Allergy Asthma Immunol. 2018, 121, 340–347. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Koszorú, K.; Borza, J.; Gulácsi, L.; Sárdy, M. Quality of Life in Patients with Atopic Dermatitis. Cutis 2019, 104, 174–177. [Google Scholar] [PubMed]
- Schmitt, J.; Buske-Kirschbaum, A.; Roessner, V. Is Atopic Disease a Risk Factor for Attention-Defi Cit/Hyperactivity Disorder? A Systematic Review. Allergy 2010, 65, 1506–1524. [Google Scholar] [CrossRef]
- Yaghmaie, P.; Koudelka, C.W.; Simpson, E.L. Mental Health Comorbidity in Patients with Atopic Dermatitis. J. Allergy Clin. Immunol. 2013, 131, 428–433. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Dalgard, F.J.; Gieler, U.; Tomas-Aragones, L.; Lien, L.; Poot, F.; Jemec, G.; Misery, L.; Szabo, C.; Linder, D.; Sampogna, F.; et al. The Psychological Burden of Skin Diseases: A Cross-Sectional Multicenter Study Among Dermatological Out-Patients in 13 European Countries. J. Investig. Dermatol. 2015, 135, 984–991. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ali, F.; Vyas, J.; Finlay, A.Y. Counting the Burden: Atopic Dermatitis and Health-related Quality of Life. Acta Derm. Venereol. 2020, 100, adv00161. [Google Scholar] [CrossRef] [PubMed]
- Schmitt, J.; Spuls, P.I.; Thomas, K.S.; Simpson, E.; Furue, M.; Deckert, S.; Dohil, M.; Apfelbacher, C.; Singh, J.A.; Chalmers, J.; et al. The Harmonising Outcome Measures for Eczema (HOME) Statement to Assess Clinical Signs Of Atopic Eczema in Trials. J. Allergy Clin. Immunol. 2014, 134, 800–807. [Google Scholar] [CrossRef] [PubMed]
- Hanifin, J.M.; Rajka, G. Diagnositic features of atopic dermatitis. Acta Derm. Venereol. 1980, 92, 44–47. [Google Scholar]
- Kunz, B.; Oranje, A.P.; Labrèze, L.; Stalder, J.F.; Ring, J.; Taïeb, A. Clinical Validation and Guidelines for the SCORAD Index: Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1997, 195, 10–19. [Google Scholar] [CrossRef]
- Finlay, A.Y.; Khan, G.K. Dermatology Life Quality Index (DLQI)—A Simple Practical Measure for Routine Clinical Use. Clin. Exp. Dermatol. 1994, 19, 210–216. [Google Scholar] [CrossRef] [PubMed]
- Skevington, S.M.; Lotfy, M.; O’Connell, K.A.; WHOQOL Group. The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual. Life Res. 2004, 13, 299–310. [Google Scholar] [CrossRef] [PubMed]
- Broadbent, E.; Petrie, K.J.; Main, J.; Weinman, J. The Brief Illness Perception Questionnaire. J. Psychosom. Res. 2006, 60, 631–637. [Google Scholar] [CrossRef] [PubMed]
- Crown, S.; Duncan, K.P.; Howell, R.W. Further evaluation of the Middlesex Hospital Questionnaire (M.H.Q.). Br. J. Psychiatry 1970, 116, 33–37. [Google Scholar] [CrossRef] [PubMed]
- Rooney, J.F.F.; Beaumont, G.; Murphy, J.E.; Donald, J.F. Patient Self-Rating Scales in the Assessment of Psychotropic Drugs; In The Middlesex Hospital Questionnaire Prod. In Proceedings of the 5th World Congress of Psychiatry, Mexico City, Mexico, 28 November–4 December 1971. [Google Scholar]
- Cohen, J. A Power Primer. Psychol. Bull. 1992, 112, 155–159. [Google Scholar] [CrossRef] [PubMed]
- Meštrović-Štefekov, J.; Lugović-Mihić, L.; Hanžek, M.; Bešlić, I.; Japundžić, I.; Karlović, D. Salivary cortisol values and personality features of atopic dermatitis patients: A prospective study. Dermatitis 2021, in press. [Google Scholar]
- Senra, M.S.; Wollenberg, A. Psychodermatological Aspects of Atopic Dermatitis. Br. J. Dermatol. 2014, 170, 38–43. [Google Scholar] [CrossRef]
- Ginsburg, I.H.; Prystowsky, J.H.; Kornfeld, D.S.; Wolland, H. Role of Emotional Factors in Adults with Atopic Dermatitis. Int. J. Dermatol. 1993, 32, 656–660. [Google Scholar] [CrossRef] [PubMed]
- Wittkowski, A.; Richards, H.L.; Griffiths, C.E.; Main, C.J. The Impact of Psychological and Clinical Factors on Quality of Life in Individuals with Atopic Dermatitis. J. Psychosom. Res. 2004, 57, 195–200. [Google Scholar] [CrossRef]
- Linnet, J.; Jemec, G.B. An Assessment of Anxiety and Dermatology Life Quality in Patients with Atopic Dermatitis. Br. J. Dermatol. 1999, 140, 268–272. [Google Scholar] [CrossRef] [PubMed]
- Drucker, A.M. Atopic dermatitis: Burden of Illness, Quality of Life, and Associated Complications. Allergy Asthma Proc. 2017, 38, 3–8. [Google Scholar] [CrossRef] [PubMed]
- Wittkowski, A.; Richards, H.L.; Griffiths, C.E.; Main, C.J. Illness Perception in Individuals with Atopic Dermatitis. Psychol. Health Med. 2007, 12, 433–444. [Google Scholar] [CrossRef] [PubMed]
- Oh, S.H.; Bae, B.G.; Park, C.O.; Noh, J.Y.; Park, I.H.; Wu, W.H.; Lee, K.H. Association of Stress with Symptoms of Atopic Dermatitis. Acta Derm. Venereol. 2010, 90, 582–588. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Arck, P.C.; Slominski, A.; Theoharides, T.C.; Peters, E.M.; Paus, R. Neuroimmunology of Stress: Skin Takes Center Stage. J. Investig. Dermatol. 2006, 126, 1697–1704. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Wahlgren, C.F. Pathophysiology of Itching in Urticaria and Atopic Dermatitis. Allergy 1992, 47, 65–75. [Google Scholar] [CrossRef] [PubMed]
- Suárez, A.L.; Feramisco, J.D.; Koo, J.; Steinhoff, M. Psychoneuroimmunology of Psychological Stress and Atopic Dermatitis: Pathophysiologic and Therapeutic Updates. Acta Derm. Venereol. 2012, 92, 7–15. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Tang, Y.Y.; Ma, Y.; Fan, Y.; Feng, H.; Wang, J.; Feng, S.; Lu, Q.; Hu, B.; Lin, Y.; Li, J.; et al. Central and Autonomic Nervous System Interaction is Altered by Short-Term Meditation. Proc. Natl. Acad. Sci. USA 2009, 106, 8865–8870. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Rønnstad, A.; Halling-Overgaard, A.S.; Hamann, C.R.; Skov, L.; Egeberg, A.; Thyssen, J.P. Association of Atopic Dermatitis with Depression, Anxiety, and Suicidal Ideation in Children and Cdults: A Systematic Review and Meta-analysis. J. Am. Acad. Dermatol. 2018, 79, 448–456. [Google Scholar] [CrossRef] [Green Version]
- Schmitt, J.; Langan, S.; Williams, H.C. What are the best outcome measurements for atopic eczema? A systematic review. J. Allergy Clin. Immunol. 2007, 120, 1389–1398. [Google Scholar] [CrossRef] [PubMed]
- Iannone, M.; Tonini, G.; Janowska, A.; Dini, V.; Romanelli, M. Definition of treatment goals in terms of clinician-reported disease severity and patient-reported outcomes in moderate-to-severe adult atopic dermatitis: A systematic review. Curr. Med. Res. Opin. 2021, 37, 1295–1301. [Google Scholar] [CrossRef]
- Lifschitz, C. The Impact of Atopic Dermatitis on Quality of Life. Ann. Nutr. Metab. 2015, 66, 34–40. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Silverberg, J.I.; Gelfand, J.M.; Margolis, D.J.; Boguniewicz, M.; Fonacier, L.; Grayson, M.H.; Ong, P.Y.; Chiesa Fuxench, Z.C.; Simpson, E.L. Symptoms and Diagnosis of Anxiety and Depression in Atopic Dermatitis in U.S. Adults. Br. J. Dermatol. 2019, 181, 554–565. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Thyssen, J.P.; Hamann, C.R.; Linneberg, A.; Dantoft, T.M.; Skov, L.; Gislason, G.H. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide. Allergy 2018, 73, 214–220. [Google Scholar] [CrossRef] [PubMed]
- Sandhu, J.K.; Wu, K.K.; Bui, T.L.; Armstrong, A.W. Association Between Atopic Dermatitis and Suicidality: A Systematic Review and Meta-analysis. JAMA Dermatol. 2018, 155, 178–187. [Google Scholar] [CrossRef] [PubMed]
- Choe, S.J.; Kim, D.; Kim, E.J.; Ahn, J.S.; Choi, E.J.; Son, E.D.; Lee, T.R.; Choi, E.H. Psychological Stress Deteriorates Skin Barrier Function by Activating 11β-Hydroxysteroid Dehydrogenase 1 and the HPA Axis. Sci. Rep. 2018, 8, 6334. [Google Scholar] [CrossRef] [PubMed]
- Hong, J.; Buddenkotte, J.; Berger, T.G.; Steinhoff, M. Management of Itch in Atopic Dermatitis. Seminars in Cutaneous Medicine and Surgery. Semin. Cutan. Med. Surg. 2011, 30, 71–86. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Pondeljak, N.; Lugović-Mihić, L. Stress-induced Interaction of Skin Immune Cells, Hormones, and Neurotransmitters. Clin. Ther. 2020, 42, 757–770. [Google Scholar] [CrossRef] [PubMed]
- Meštrović-Štefekov, J.; Novak-Bilić, G.; Kuna, M.; Pap, N.; Lugović-Mihić, L. Psychological Stress in Patients with Atopic Dermatitis. Acta Dermatovenerol. Croat. 2018, 26, 297–303. [Google Scholar] [PubMed]
N | Mean | SD | Median | IQR | Min | Max | |
---|---|---|---|---|---|---|---|
Dermatology Life Quality Index (DLQI) | 84 | 7.4 | 6.5 | 5 | 2.25–12 | 0 | 24 |
Health-Related Quality of Life (WHOQOL-BREF) | |||||||
Physical health | 84 | 72.62 | 14.29 | 71.43 | 64.23–82.14 | 39.29 | 100 |
Mental health | 84 | 69.68 | 16.28 | 70.83 | 59.38–83.33 | 33.33 | 95.83 |
Social relations | 84 | 76.54 | 17.22 | 75 | 66.67–91.67 | 33.33 | 100 |
Environment | 84 | 72.54 | 13.94 | 71.88 | 62.5–84.38 | 40.63 | 100 |
Group | Average | SD | Median | IQR | p | r | |
---|---|---|---|---|---|---|---|
Dermatology Life Quality Index | symptomatic | 10.8 | 6.4 | 10.5 | 5–16.25 | ||
(DLQI) | asymptomatic | 4.0 | 4.6 | 3.0 | 1–5 | <0.001 | 0.565 |
Physical health | symptomatic | 72.45 | 14.47 | 75.0 | 66.1–82.1 | ||
(WHOQOL) | asymptomatic | 72.79 | 14.28 | 71.4 | 63.4–82.1 | 0.907 | 0.013 |
Mental health | symptomatic | 70.63 | 16.20 | 75.0 | 61.5–80.2 | ||
(WHOQOL) | asymptomatic | 68.73 | 16.49 | 70.8 | 58.3–83.3 | 0.575 | 0.061 |
Social relations | symptomatic | 79.46 | 17.47 | 83.3 | 66.7–93.8 | ||
(WHOQOL) | asymptomatic | 73.61 | 16.66 | 75.0 | 58.3–85.4 | 0.108 | 0.176 |
Environment | symptomatic | 73.68 | 13.51 | 75.0 | 65.6–84.4 | ||
(WHOQOL) | asymptomatic | 71.40 | 14.43 | 68.8 | 61.7–85.2 | 0.473 | 0.078 |
Group | Average | SD | Median | IQR | p | r | |
---|---|---|---|---|---|---|---|
Illness impact on life | symptomatic | 6.4 | 2.7 | 7.0 | 5–8 | ||
(IPQ1) | asymptomatic | 4.7 | 2.8 | 4.5 | 3–7 | 0.004 | 0.316 |
Illness duration | symptomatic | 8.6 | 1.8 | 9.0 | 7.75–10 | ||
(IPQ2) | asymptomatic | 5.8 | 3.1 | 6.0 | 4–8 | <0.001 | 0.460 |
Illness control | symptomatic | 4.6 | 2.8 | 5.0 | 2–7 | ||
(IPQ3) | asymptomatic | 5.1 | 2.4 | 5.0 | 3–7 | 0.376 | 0.097 |
Illness treatment | symptomatic | 7.2 | 2.2 | 7.0 | 5–9 | ||
(IPQ4) | asymptomatic | 7.7 | 2.3 | 8.0 | 7–9 | 0.150 | 0.157 |
Illness symptoms | symptomatic | 7.9 | 2.2 | 8.0 | 7–10 | ||
(IPQ5) | asymptomatic | 5.2 | 2.5 | 5.0 | 3–7 | <0.001 | 0.521 |
Worries about the illness | symptomatic | 7.5 | 2.8 | 8.0 | 6–10 | ||
(IPQ6) | asymptomatic | 5.1 | 2.9 | 5.0 | 3–7 | <0.001 | 0.403 |
Understanding of the illness | symptomatic | 7.2 | 2.7 | 8.0 | 5–10 | ||
(IPQ7) | asymptomatic | 6.0 | 2.9 | 6.0 | 4–8 | 0.041 | 0.223 |
Effect of the illness on emotional state | symptomatic | 6.6 | 2.8 | 7.0 | 5–9 | ||
(IPQ8) | asymptomatic | 5.0 | 2.9 | 5.5 | 2–7 | 0.009 | 0.287 |
Non-Standardized Coefficient | Standardized Coefficient | p | Correlations | ||||
---|---|---|---|---|---|---|---|
B | SE | Beta | Zero Order | Partial | Semipartial | ||
Constant | −4.147 | 2.2 | |||||
SCORAD | 0.2 | 0.0 | 0.7 | <0.001 | 0.555 | 0.721 | 0.646 |
FFA | 0.7 | 0.3 | 0.4 | 0.024 | 0.411 | 0.365 | 0.243 |
OBS | 0.5 | 0.3 | 0.3 | 0.046 | 0.351 | 0.326 | 0.214 |
SOM | 0.1 | 0.3 | 0.0 | 0.891 | 0.310 | 0.023 | 0.014 |
DEP | −0.1 | 0.4 | −0.0 | 0.855 | 0.366 | −0.031 | −0.019 |
Mean | SD | Median | IQR | p | r | |
---|---|---|---|---|---|---|
DLQI 1 | 10.8 | 6.4 | 10.5 | 5–16.3 | ||
DLQI 2 | 9.2 | 6.6 | 9 | 3–14.3 | 0.046 * | 0.306 |
SCORAD 1 | 33.66 | 17.07 | 34.20 | 18.85–45.94 | ||
SCORAD 2 | 20.20 | 22.39 | 16.78 | 0.00–37.59 | <0.001 | 0.398 |
Physical health 1 | 72.45 | 14.47 | 75.00 | 66.07–82.14 | ||
Physical health 2 | 73.27 | 15.07 | 76.79 | 60.71–83.04 | 0.536 | 0.068 |
Mental health 1 | 70.64 | 16.20 | 75.00 | 61.46–80.21 | ||
Mental health 2 | 72.32 | 16.01 | 70.83 | 61.46–84.38 | 0.217 | 0.135 |
Social relations 1 | 79.46 | 17.47 | 83.33 | 66.67–93.75 | ||
Social relations 2 | 82.14 | 15.79 | 83.33 | 75.00–93.75 | 0.081 | 0.190 |
Environment 1 | 73.68 | 13.51 | 75.00 | 65.63–84.38 | ||
Environment 2 | 74.03 | 11.80 | 71.88 | 65.63–81.25 | 0.802 * | 0.039 |
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Lugović-Mihić, L.; Meštrović-Štefekov, J.; Ferček, I.; Pondeljak, N.; Lazić-Mosler, E.; Gašić, A. Atopic Dermatitis Severity, Patient Perception of the Disease, and Personality Characteristics: How Are They Related to Quality of Life? Life 2021, 11, 1434. https://doi.org/10.3390/life11121434
Lugović-Mihić L, Meštrović-Štefekov J, Ferček I, Pondeljak N, Lazić-Mosler E, Gašić A. Atopic Dermatitis Severity, Patient Perception of the Disease, and Personality Characteristics: How Are They Related to Quality of Life? Life. 2021; 11(12):1434. https://doi.org/10.3390/life11121434
Chicago/Turabian StyleLugović-Mihić, Liborija, Jelena Meštrović-Štefekov, Iva Ferček, Nives Pondeljak, Elvira Lazić-Mosler, and Ana Gašić. 2021. "Atopic Dermatitis Severity, Patient Perception of the Disease, and Personality Characteristics: How Are They Related to Quality of Life?" Life 11, no. 12: 1434. https://doi.org/10.3390/life11121434
APA StyleLugović-Mihić, L., Meštrović-Štefekov, J., Ferček, I., Pondeljak, N., Lazić-Mosler, E., & Gašić, A. (2021). Atopic Dermatitis Severity, Patient Perception of the Disease, and Personality Characteristics: How Are They Related to Quality of Life? Life, 11(12), 1434. https://doi.org/10.3390/life11121434