Page 36 - JCBP-1-1

Journal of Clinical and
Basic Psychosomatics Quality of life in patients with atopic dermatitis

and 10% of adults in high-income countries . Adults with were identified as important factors in predicting suicidal
[2]
AD have a younger mean age and age of onset, yet a longer tendencies in AD . Furthermore, a study in the same year
[12]
mean duration of illness and a significantly higher rate of showed that depression, anxiety, and suicidal tendencies
involvement at the site and with other allergic diseases than were more common in AD individuals than those without
adults with other types of dermatitis , all of which may AD. However, they did not lead to psychiatric consultation,
[3]
[13]
seriously affect the quality of life (QOL) and the physical hospitalization, or suicide .
and mental health of patients. The existing research is observational or may fail to
The pathogenesis of AD is complex, and it is reveal causal relationships . Therefore, our study is
[14]
supported that a strong genetic predisposition, epidermal conducted to confirm the relationship between QOL,
dysfunction, skin microbiome abnormalities, and anxiety, and depression in AD patients.
dysregulation in immune and neuroimmune systems are
critical in AD development . In recent years, more studies 2. Materials and methods
[4]
have emphasized the regulatory role of aryl hydrocarbon 2.1. Patients and questionnaire design
receptor (AhR) in chronic inflammatory skin diseases.
It has been reported that AhR is involved in several The inclusion criteria of AD patients for the study were AD
[15]
physiological processes, such as cell physiology, host diagnosed according to the Hanifin and Rajka criteria ;
defense, proliferation and differentiation of immune cells, voluntary participation; age 18 or older; and can read
and detoxification. Although the pathogenic role of AhR and understand correctly and voluntarily complete the
in AD is not clear, recent clinical trials have reported the questionnaire. Exclusion criteria were patients with serious
efficacy of topical AhR agonist tapinarof in AD [5,6] . The physical and mental illnesses; patients with alcohol or drug
first-line therapy of AD is local anti-inflammatory therapy. addiction; incomplete questionnaires; and casual answers.
Such topical therapies include topical corticosteroids, Most of the patients came from outpatient clinics, and
the topical calcineurin inhibitors tacrolimus and most were with the disease severity of mild to moderate.
pimecrolimus, and more recently, the phosphodiesterase 4 This research was in line with the Declaration of Helsinki.
inhibitor - crisaborole. Signing the informed consent form was not required as the
For the more severe AD, the current therapeutic study did not involve the collection of human biological
guidelines suggest using ciclosporin A, methotrexate, specimens and personal information. However, oral
azathioprine, and mycophenolate mofetil in addition consent was obtained from all the patients.
to ultraviolet light . Dupilumab and tralokinumab are In the questionnaire, the following general information
[7]
examples of targeted biotherapy targeting different immune was collected: General demographic data, lifestyle, and
pathways and their cytokines or receptors [8,9] . Baricitinib consultation behavior, such as whether they received
exemplifies a more wide-ranging approach using small treatment and have atopic comorbidities. Questionnaire
molecules that interact with multiple signal transduction filling followed the voluntary rule, and all personal
pathways linked to several cytokine receptors and immune information and questionnaire responses were treated
[7]
pathways . Although imm unomodulant therapies have strictly confidential.
achieved good outcomes recently, most patients still The questionnaire included two parts: (i) Dermatology
choose traditional clinic treatment schemes due to the cost. Life Quality Index (DLQI) was used to assess the
Despite these advances, disease management still follows a disease-specific dermatological QOL of patients with
“one-size-fits-all” paradigm. dermatological diseases. It consisted of six subscales
Given the poor effect of routine treatment for moderate (10 dimensions in total) that assessed the limiting effect of
and severe AD, intervention on mental factors may dermatology on the patient’s daily life in the past week in
provide new promising AD treatment. It has long been various domains (symptoms and sensations, daily activities,
documented that dermatological disorders are strongly leisure, work/school, interpersonal relationships, and
associated with psychiatric disorders and significantly therapy). Each question had several answers (none, some,
affect QOL, anxiety, and depression . According to severe, and very severe). The total score was the sum of
[10]
a study in the United States (US), about one-third of the scores for each question, with higher scores indicating
American adult AD patients reported having depressive a greater impact of skin disease on QOL. The total score
symptoms, and one-third of adult AD patients met the ranged from 0 (no disease impact) to 30 (maximum
[11]
diagnostic criteria of major depressive disorder . In 2017, impact), where 0 – 1 indicated no impact, 2 – 5 indicated a
a German study proved that depressive symptoms, the small impact, 6 – 10 indicated a moderate impact, 11 – 20
severity of AD, young age, and little contact in the family indicated a large impact, and 21 – 30 indicated a great

Volume 1 Issue 1 (2023) 2 https://doi.org/10.36922/jcbp.0956