Unseen Burdens: How Cumulative Life Course Impairment (CLCI) Affects Patients with Moderate-to-Severe Atopic Dermatitis (AD)

DUPIXENT® (dupilumab) Prescribing Information UK

Introduction

AD is a chronic inflammatory skin condition characterised by intense itching and periodic flares of inflamed, dry skin which may eventually impair patients' quality of life (QoL).^1,2 The underlying pathophysiology of AD typically involves type 2 inflammation (T2I), driven by cytokines such as IL-4 and IL-13, which exacerbate symptoms and contribute to the disease's complexity.³ However, the burden of uncontrolled moderate-to-severe AD can extend far beyond the visible symptoms, encompassing psychological and social impact that can contribute to CLCI.^2,4 

According to the Global Burden of Disease study, AD has the highest disability-adjusted life-year (DALY) burden among all skin diseases, with an age-standardised DALY rate significantly higher than psoriasis and urticaria.² 

This article focuses on understanding CLCI in AD, and the importance of recognising and addressing these hidden burdens.

Moderate-to-Severe Atopic Dermatitis–A Cumulative Burden

The multidimensional burdens of AD in patients with moderate-to-severe symptoms include more than just skin lesions and itching.^1,5,6 Patients frequently suffer from specific elements of CLCI such as stigma, psychological distress, limited social support, and coping challenges, all of which contribute to CLCI.⁴ 

The cumulative effect of these burdens over the years can lead to a potentially irreversible damage, affecting various life domains such as productivity at school and work, and the ability to maintain social relationships.^2,4,8

Listen to Dr Hywel Cooper discuss AD and the impact on patients QoL

CLCI–Potentially Irreversible Damage Due to Inadequate Treatment and Uncontrolled AD^2,4,7,9,10

Timely identification and treatment escalation of patients with uncontrolled AD may improve the signs, symptoms and quality of life burdens these patients are currently experiencing.⁸
 

Conclusion

The burdens of uncontrolled AD may become cumulative, impacting various aspects of a patient's life and contributing to CLCI.^1,4,6 By understanding and addressing these multifaceted challenges, healthcare professionals can improve patient outcomes and quality of life.^2,8

Early identification of at-risk patients, using appropriate tools, and timely escalation to appropriate treatments are crucial in providing best practice care for patients.^4,8,11

Discover tools that can help you identify AD patients that are uncontrolled.

DUPIXENT is approved for use in eligible patients as young as 6 months old in AD.¹²

DUPIXENT is indicated for use in patients aged 12 years and older with moderate-to-severe atopic dermatitis (AD), and in patients aged 6 months to 11 years of age with severe AD, who are candidates for systemic therapy.¹²

AD, atopic dermatitis; CLCI, Cumulative Life Course Impairment; DALY, disability-adjusted life-year; IL, interleukin; QoL, quality of life; T2I, type 2 inflammation.

References

1. Weidinger S et al. Lancet. 2016; 387(10023): 1109⁠—1122.
2. Fasseeh AN et al. Dermatol Ther (Heidelb). 2022; 12(12): 2653⁠—2668.
3. Moniaga CS et al. Diagnostics (Basel). 2021; 11(11): 2090.
4. Augustin M, et al. JEADV. 2022; 36(7): 3⁠—16.
5. Weidinger S et al. Br J Dermatol. 2024; 190(6): 846⁠—857.
6. Calzavara-Pinton P et al. Adv Ther. 2023; 40(12): 5366⁠—5382.
7. Thyssen JP et al. J Allergy Clin Immunol. 2023; 151(5): 1155⁠—1162.
8. von Stülpnagel CC et al. J Eur Acad Dermatol Venereol. 2021; 35(11): 2166⁠⁠—2184.
9. Davis DMR et al. J Am Acad Dermatol. 2022; 86(6): 1335⁠—1336.e18.
10. Bacci ED et al. J Dermatolog Treat. 2023; 34(1): 2202288.
11. Bieber T. Nat Rev Drug Discov. 2023; 22(8): 662⁠—680.
12. DUPIXENT Summary of Product Characteristics. 2025.