Understanding the Burden of Moderate-to-Severe Atopic Dermatitis

The impacts of atopic dermatitis (AD) go beyond the physical symptoms observable on the skin. It has a severe ‘hidden burden’ on patients’ lives, particularly because of its chronic nature, which leads to a cycle of recurrent inflammation.^2,3,15

Over 50% of patients report lifestyle limitations associated with AD.^5,7 Several other aspects of their lives are also negatively affected by the disease including finances, relationships and mental health, with the risk of depression being approximately doubled in adults with AD compared with adults who do not have atopic dermatitis.^7,10

The high heterogeneity seen in AD and wide range of phenotypes across patient groups require each patient to be thoroughly assessed for symptoms to establish severity, using assessments such as EASI (Eczema Area and Severity Index) and IGA (Investigator Global Assessment), as well as self-reported outcomes tools POEM (Patient-Oriented Eczema Measure) and DLQI (Dermatology Life Quality Index).^11,21,22

Available treatments focus on short-term relief.¹⁹ This patient burden leaves a remaining unmet need, with 75% of patients considering that their treatment failed to meet expectations.¹³

The wide variation in disease expression and patient needs require a shift to detailed assessment of symptoms and impact of AD on quality of life (QoL). A range of tools are available to clinicians to determine the severity of the disease and the requirements of individual patients’ lifestyles to choose the most appropriate management options.²¹

Atopic Dermatitis Burden: the Widespread Disruption Across Patients’ Lives

Persistent inflammation in AD contributes to a cycle of recurring flares that disrupt daily life, both via the classical symptoms of AD, including intense itch, but also numerous aspects of QoL.^2,3,15

Learn more about the initiating phase of immune dysregulation, known as the inflammatory prequel.

The continuous demands and care required for AD extend far beyond the skin, affecting patients’ routines and holistic wellbeing across numerous areas of their lives.^1-10 In fact, AD is the primary cause of global disease burden resulting from a skin disease.¹⁶

The burden of atopic dermatitis is pervasive, impacting not only the lifestyle of patients themselves, but also their families – with limitations on daily activities, mental health, and economic stability.⁷

• Lifestyle Limitations: More than half of adults with AD report that the condition limits their lifestyle. Some patients avoid social interaction entirely, and the disease negatively impacts fundamental daily activities, including bathing.^5,7
• Economic Strain: AD imposes a tremendous financial burden on patients and their families through direct medical costs and loss of productivity.⁷ Patients face high out-of-pocket costs for non-prescription management, including moisturizers and hygiene products.¹⁷
• Relationships: Approximately one in three adults with atopic dermatitis (36.5%) have reported that AD interfered with their romantic relationships.⁸
• Mental Health: The risk of depression is approximately doubled in adults with AD compared with adults who do not have atopic dermatitis (odds ratio, 1.89), with particularly high risk seen with moderate (odds ratio, 2.24) and severe (odds ratio, 5.64) AD – with severe AD showing nearly sixfold increase in depression risk compared with healthy adults.¹⁰

Severity of Atopic Dermatitis and Impact on Patient Burden

When assessing the atopic dermatitis burden of disease, it is critical to recognize that AD is highly heterogeneous, with the phenotype of the disease varying widely between patients.¹¹ AD can manifest differently across racial groups, with variations in clinical features, genetics, and immune activity reflecting the disease’s heterogeneity across populations.¹¹

While patients with more severe AD report a greater impact on health status, health-related quality of life, and productivity compared to those with milder AD, it is important to note that even patients with milder disease report substantial daily impact from symptoms.⁵ This means that AD can negatively impact patients’ QoL and expectations from treatment regardless of the clinical severity of the AD.⁵

However, research reveals significantly great impacts of more severe versus milder AD across numerous measures, including mean self-reported global atopic dermatitis severity, which shows a sixfold increase in patient-reported severity with severe vs mild AD:⁵

• Mild AD: 2.3
• Moderate AD: 7.8
• Severe AD: 14.8

This pattern holds across mean patient-reported eczema and itch, as assessed by the POEM and PO-SCORAD tools, respectively – with a particularly dramatic increase of nearly eightfold in self-reported eczema severity with severe vs mild AD:⁵

• Mild AD: eczema, 2.2; itch, 2.2
• Moderate eczema, 7.3; itch, 4.1
• Severe AD: eczema, 17.0; itch, 9.5

Burden of Frequent Treatment in Atopic Dermatitis

Even when AD appears to be well controlled, it is important to remember that the patients remain dependent on frequent and indefinite treatments that can be time-consuming and lead to low patient satisfaction.^13,18

Furthermore, even when on treatment, most patients (75%) fail to reach their treatment expectations.¹³ This means that the atopic dermatitis burden is compounded by frequent and continuous treatment that can leave patients feeling frustrated with their situation.^12,13,18

Despite advances, these treatments are inherently limited to achieving near-term disease control, rather than supporting a long-term immune normalization.¹⁹

As part of the wide-ranging impacts on quality of life, the uncontrolled symptoms, sleep disturbance, healthcare burden of treatment and lack of long-term disease control options contribute to higher rates of depression in patients with AD compared with healthy adults.^10,20

Explore current systemic and long-term AD treatment paradigms and unmet needs.

Tools to Assess Quality of Life in Atopic Dermatitis

To effectively address the multifaceted challenges of AD, clinicians can use a suite of assessment tools, including physical assessments like the EASI and IGA and patient-reported outcomes such as the POEM and DLQI, to measure disease severity from both clinical and patient-reported perspectives.^21,22

Clinical Assessments:

• IGA (Investigator Global Assessment): A tool that assesses overall severity of AD lesions, scored from 0 (clear) to 4 (severe). It takes into account erythema, induration/papulation, lichenification and oozing/crusting.²²
• EASI (Eczema Area and Severity Index): This tool integrates body surface area and skin lesion intensity into a single score, which is a core recommended instrument for measuring signs in AD clinical trials.²³

Patient-Reported Outcomes (PROs):

• Patient-Oriented Eczema Measure (POEM): A simple, valid, easily interpreted, and reproducible tool for assessing atopic dermatitis that provides a more comprehensive assessment of patient symptoms than that obtained by measuring individual symptoms alone.²⁴
• Dermatology Life Quality Index (DLQI): A 10-question self-assessment tool to measure the life impacts of skin conditions on patients’ lives, covering mental health, daily activities, leisure, work, personal relationships, and treatment impacts.²⁵

By utilizing these tools, clinicians may be able to deliver increasingly personalised "treat-to-target" approaches in AD in the future, and could also help to determine next steps if treatment is not delivering the desired outcomes, allowing them to change approach.²¹

Abbreviations

AD, atopic dermatitis; QoL, quality of life; EASI, Eczema Area and Severity Index; IGA, Investigator’s Global Assessment; PROs, patient-reported outcomes; POEM, Patient-Oriented Eczema Measure; DLQI, Dermatology Life Quality Index

References

1. Nutten, S. (2015). Atopic dermatitis: global epidemiology and risk factors. Annals of Nutrition and Metabolism, 66(Suppl. 1), 8-16.
2. Weidinger, S., et al. (2018). Atopic dermatitis. Nature Reviews Disease Primers, 4(1), 1-20.
3. Zuberbier, T., et al. (2006). Patient perspectives on the management of atopic dermatitis. Journal of Allergy and Clinical Immunology, 118(1), 226-232.
4. Simpson, E. L., et al. (2016). Patient burden of moderate to severe atopic dermatitis (AD): Insights from a phase 2b clinical trial of dupilumab in adults. Journal of the American Academy of Dermatology, 74(3), 491-498.
5. Silverberg, J. I., et al. (2018). Patient burden and quality of life in atopic dermatitis in US adults: A population-based cross-sectional study. Annals of Allergy, Asthma & Immunology, 121(3), 340-347.
6. Zhang N, Chi H, Jin Q, Sun M, Zhao Y, Song P. Prevalence of sleep disorders in atopic dermatitis: a systematic review and meta-analysis. Arch Dermatol Res. 2025;317(1):668.
7. Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association. J Invest Dermatol. 2017;137(1):26-30.
8. Misery L, Finlay AY, Martin N, et al. Atopic dermatitis: impact on the quality of life of patients and their partners. Dermatology. 2007;215(2):123-129.
9. Juśko N, Masajada M, Żabówka A, Ćmiel A, Brzewski P, Reich A. Sexual Health in Patients with Atopic Dermatitis: A Cross-Sectional Study. Medicina (Kaunas). 2025;61(10):1782.
10. Yu SH, Silverberg JI. Association between Atopic Dermatitis and Depression in US Adults. J Invest Dermatol. 2015;135(12):3183-3186.
11. Brunner PM, Guttman-Yassky E. Racial differences in atopic dermatitis. Ann Allergy Asthma Immunol. 2019;122(5):449-455.
12. Eichenfield LF, Tom WL, Berger TG, et al. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014;71(1):116-132.
13. Augustin M, Costanzo A, Pink A, et al. Real-World Treatment Patterns and Treatment Benefits among Adult Patients with Atopic Dermatitis: Results from the Atopic Dermatitis Patient Satisfaction and Unmet Need Survey. Acta Derm Venereol. 2022;102:adv00830.
14. Aubert-Wastiaux H, Moret L, Le Rhun A, et al. Topical corticosteroid phobia in atopic dermatitis: a study of its nature, origins and frequency. Br J Dermatol. 2011;165(4):808-814.
15. Ong PY. Atopic dermatitis: Is innate or adaptive immunity in control? A clinical perspective. Front Immunol. 2022;13:943640.
16. Langan SM, Irvine AD, Weidinger S. Atopic dermatitis. Lancet. 2020;396(10247):345-360.
17. Smith Begolka W, Chovatiya R, Thibau IJ, Silverberg JI. Financial Burden of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States. Dermatitis. 2021;32(1S):S62-S70.
18. Carroll CL, Balkrishnan R, Feldman SR, Fleischer AB Jr, Manuel JC. The burden of atopic dermatitis: impact on the patient, family, and society. Pediatr Dermatol. 2005;22(3):192-199.
19. Nahm DH. Regulatory T Cell-Targeted Immunomodulatory Therapy for Long-Term Clinical Improvement of Atopic Dermatitis: Hypotheses and Perspectives. Life (Basel). 2023;13(8):1674.
20. National Eczema Association. Mental health and eczema – seeing the unseen. National Eczema Association. Available at: https://nationaleczema.org/blog/mental-health-science/
21. Vestergaard C, Skovsgaard C, Johansen C, Deleuran M, Thyssen JP. Treat-to-Target in Atopic Dermatitis. Am J Clin Dermatol. 2024;25(1):91-98.
22. Simpson EL, Bissonnette R, Paller AS, et al. The Validated Investigator Global Assessment for Atopic Dermatitis (vIGA-AD™): a clinical outcome measure for the severity of atopic dermatitis. Br J Dermatol. 2022;187(4):531-538.
23. Hanifin JM, Baghoomian W, Grinich E, Leshem YA, Jacobson M, Simpson EL. The Eczema Area and Severity Index-A Practical Guide. Dermatitis. 2022;33(3):187-192.
24. Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients' perspective. Arch Dermatol. 2004;140(12):1513-1519.
25. NHS. DLQI Tool. Available at: https://www.imperial.nhs.uk/-/media/website/services/dermatology/patient-forms/dermatology-life-quality-iindex-dlqi.pdf (last accessed January 2026).