Flares Predict AD Severity and Quality of Life

Medscape

17-07-2025

TOPLINE:
In a Danish cohort study, the frequency, severity, and duration of flares predicted worse atopic dermatitis (AD) severity and quality of life a year later.
METHODOLOGY:
Researchers analyzed data from 878 adults with AD (median age in 2022, 49 years; 31.8% men) in the Danish Skin Cohort. Surveys were collected during January-February 2022 and January 2023.
Overall, 26.8% of patients had mild AD, 65.5% had moderate AD, and 32.2% had severe AD; 83.2% were actively treated for AD.
Researchers collected demographic information, number of flares within the past 12 months, and disease severity measures: Dermatology Life Quality Index (DLQI), Patient-Oriented Scoring of AD, and Patient-Oriented Eczema Measure (POEM).
They examined the association between flares reported in 2022 and patient-reported severity measures in 2023 using machine learning models.
TAKEAWAY:
In 2023, eczema severity as measured by POEM increased with the number of flares reported in 2022. The median score rose from 4.5 among those with no flares to 13 among those with more than 10 flares. The association was significant (quantile regression coefficient, 0.29; 95% CI, 0.20-0.38).
In 2023, patients who had more flares in 2022 reported a greater impact on quality of life, as measured by DLQI, although with regards to clinical significance, median DLQI scores indicated a small effect in patient's life (a score of 2-5). The correlation remained significant after adjusting for age, sex, and disease severity in 2022 (regression coefficient, 0.08; 95% CI, 0.04-0.12).
Predictive models identified flare severity, number of flares, flare duration, and patient weight as the most important predictors of AD severity 1 year later.
Baseline severity scores and prior-year flare counts were strong predictors of flare frequency in the following year.
IN PRACTICE:
'The self-reported number of flares in the previous year, in addition to disease severity, duration and severity of the flares, was found to be predictive of future disease severity and frequency of future flares,' the study authors wrote. 'Although a consensus on how many flares are too many remains to be established,' they added, 'the current findings suggest that flares might serve as an early indicator of disease progression or inadequate disease control, highlighting that flares could be relevant in clinical decision making to support optimal treatment strategies.'
SOURCE:
This study was led by Mia-Louise Nielsen, PhD, Department of Dermatology, Copenhagen University Hospital-Bispebjerg in Copenhagen, Denmark, and was published online on July 16 in JAMA Dermatology.
LIMITATIONS:
This study relied on self-reported data, with possible potential recall and misclassification biases.
DISCLOSURES:
Almirall provided funding for this study. Nielsen disclosed receiving personal fees from LEO Pharma. Two other authors reported receiving grants from AbbVie, Novartis, Sanofi, Janssen, UCB, Pfizer, Ebba Celinders Legat, and Else og Mogens Wedell-Wedellsborgs Fond outside the submitted work.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.