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.

中文翻译：

---

结合瘙痒和皮损严重程度对特应性皮炎进行临床表型分析

背景

特应性皮炎 (AD) 患者具有异质性临床表型，包括瘙痒和皮损严重程度的不同组合。对这些亚型的特征和病程知之甚少。

客观的

结合瘙痒和损伤严重程度来确定 AD 患者的特征、关联、负担和病程。

方法

使用问卷调查和体检 (n=592) 进行了一项基于实践的前瞻性研究。AD 子集使用针对平均瘙痒的口头评定量表结合湿疹面积和严重程度指数、客观评分特应性皮炎 (SCORAD) 或经过验证的研究者的总体评估定义如下：轻度-中度瘙痒和病变 (MI-ML)、轻度-中度瘙痒和严重损伤 (MI-SL)、严重瘙痒和轻度-中度损伤 (SI-ML) 以及严重瘙痒和损伤 (SI-SL)。

结果

在基线时，最严重瘙痒或平均瘙痒或 SCORAD 瘙痒的数字评分量表与湿疹面积和严重程度指数、客观 SCORAD、体表面积和经过验证的研究者的整体评估（斯皮尔曼的 rho = 0.32-0.62）之间只有弱-中等相关性). 大多数患者有 MI-ML (59.4%-62.3%)，其次是 SI-ML (21.3%-29.1%)、SI-SL (6.0%-12.9%) 和 MI-SL (3.8%-6.4%)。患有 SI-SL、其次是 SI-ML 和 MI-SL 的患者将他们的 AD 描述为总体上更严重，并且在睡眠、心理健康和生活质量方面有更严重的损害。然而，那些患有 MI-SL 或 SI-SL 的人更有可能被医生归类为严重（多变量逻辑和线性回归，P全部 < .005）。与 MI-ML 相比，基线 MI-SL、SI-ML 和 SI-SL 与类似的纵向过程相关，并且与 MI-ML 相比有更多的 AD 耀斑和瘙痒触发因素。

结论

结合瘙痒和损伤严重程度似乎描述了独特的 AD 表型。需要进一步的研究来证实这些发现并了解这些人群的最佳治疗方法。