General and Skin-Specific Health-Related Quality of Life in Patients With Atopic Dermatitis Before and During the COVID-19 Pandemic

Abstract

Background: Few studies have investigated health-related quality of life (HRQoL) in patients with atopic dermatitis (AD) during the COVID-19 pandemic.

Objectives: The objectives of this study were to compare HRQoL in adult AD patients before and during the pandemic and to assess measurement performance of 4 HRQoL measures.

Methods: Between 2018 and 2021, a multicenter, cross-sectional survey was conducted, involving 218 adult AD patients. Health-related quality of life outcomes included the EQ-5D-5L, Skindex-16, Dermatology Life Quality Index (DLQI), and DLQI-Relevant (DLQI-R). Severity was measured using objective SCORing Atopic Dermatitis, Eczema Area and Severity Index, and Investigator Global Assessment.

Results: The mean ± SD EQ-5D-5L utility, Skindex-16, DLQI, and DLQI-R scores were 0.82 ± 0.22, 56.84 ± 27.46, 13.44 ± 8.46, and 13.76 ± 8.60, respectively. The patients reported more problems during the pandemic ( P < 0.05) regarding pain/discomfort (odds ratio [OR], 1.78), worrying (OR, 1.89), concerns about persistence/reoccurrence of disease (OR, 1.88), and social relationships (OR, 1.69). The HRQoL outcomes showed strong correlations with each other (range of rs , |0.69| to |0.99|). The Skindex-16, DLQI, and DLQI-R were able to discriminate between severity groups with large (η 2 = 0.20-0.23), whereas the EQ-5D-5L with moderate effect sizes (η 2 = 0.08-0.11).

Conclusions: Atopic dermatitis patients experienced significantly more problems in some areas of HRQoL during the pandemic. The EQ-5D-5L, Skindex-16, DLQI, and DLQI-R demonstrated good convergent and known-group validity and can be suitable instruments for HRQoL assessment in clinical and research settings.

Figure 1

Distribution of responses on the EQ-5D-5L, DLQI, and Skindex-16 before and since COVID-19. A, The EQ-5D-5L before COVID-19. B, The EQ-5D-5L since COVID-19. C, The DLQI before COVID-19. There was one missing response in the item 6 (sport) and another in item 9 (sexual difficulties). D, The DLQI since COVID-19. There was one missing response in the item 7 (working/studying). E, The Skindex-16 before COVID-19. There was one missing response in item 8 (frustration), item 9 (embarrassment), item 10 (being annoyed), item 11 (feeling depressed), and item 15 (daily activities). There were 2 missing responses in item 5 (persistence/reoccurrence), item 12 (interactions with others), and item 14 (show affection). There were 3 missing responses in item 13 (desire to be with people). F, Skindex-16 since COVID-19. There was 1 missing response in item 2 (burning or stinging), item 4 (skin irritation), item 6 (worry), item 7 (appearance), item 11 (feeling depressed), and item 13 (desire to be with people). There were 2 missing responses in item 3 (hurting), item 5 (persistence/reoccurrence), and item 16 (work or do what you enjoy). Percentages may not total 100 because of rounding. “Since COVID-19” refers to after March 11, 2020.