Itching in Atopic Dermatitis: Patient- and Physician-reported Outcomes in the German Atopic Dermatitis Registry TREATgermany

Abstract

TREATgermany is an investigator-initiated prospective disease registry. It investigates physician- and patient-reported disease severity (Eczema Area and Severity Index (EASI), objective Scoring Atopic Dermatitis (oSCORAD), Investigator Global Assessment, Patient-Oriented Eczema Measure (POEM), Patient Global Assessment (PGA)), patient-reported symptoms (itch, sleep loss, depressive symptoms), therapy courses and dermatological quality of life (DLQI) in moderate-to-severe atopic dermatitis with SCORAD > 20. 1,134 atopic dermatitis patients (mean age 41.0 ± 14.7 years, 42.5% females) were enrolled by 40 German recruiting sites (dermatological clinics and practices) between June 2016 and April 2021. The current analysis focuses on itch scores obtained with a numerical rating scale (NRS)) documented for the previous 3 days prior to baseline visit. The results show that 97.2% (1,090 of 1,121) patients experienced itch. Itch severity correlated moderately with severity of atopic dermatitis oSCORAD (rho = 0.44 (0.39-0.48)) and EASI score (rho = 0.41 (0.36-0.46)). A strong correlation was found with self-reported disease severity as PGA (rho = 0.68 (0.65-0.71)), POEM sum score (rho = 0.66 (0.63-0.69)) and dermatological quality of life impairment DLQI (rho = 0.61 (0.57-0.65)). Itch as a subjective complaint is more closely correlated with patient-reported outcomes than with objective assessments by the physician.

Fig. 1

Boxplots of itch severity over severity by categories of Investigator Global Assessment (IGA) (n = 1,115), Eczema Area and Severity Index (EASI) (n = 1,111) and objective Scoring Atopic Dermatitis (oSCORAD) (n = 1,115). EASI and oSCORAD were categorized as follows: oSCORAD (scale: 0–83): 0–7.9 = clear, 8–23.9 = mild, 24–37.9 = moderate, 38–83 = severe; EASI (scale: 0–72): 0 = clear, 0.1–5.9 = mild, 6–22.9 = moderate, 23–72 = severe (25). Outliers are not shown.

Fig. 2

Boxplots of itch severity over severity by categories of Patient Global Assessment (PGA) (n = 1,119), Dermatological Life Quality Index (DLQI) (n = 1,120) and (Patient-Oriented Eczema Measure) POEM (n = 1,121). DLQI and POEM were categorized as follows: POEM (scale: 0–28): 0–2 = clear/almost clear, 3–7 = mild, 8–16 = moderate, 17–24 = severe, 25–28 = very severe (26). DLQI (scale: 0–30): 0–1 = no effect at all on patient’s life, 2–5 = small effect, 6–10 = moderate effect, 11–20 = very large effect, 21–30 = extremely large effect.