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Supplements Atopic Dermatitis: Focusing on the Patient Care Strategy in the Managed Care Setting
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Overview of Atopic Dermatitis
Carmela Avena-Woods, BS Pharm, PharmD, BCGP
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Atopic Dermatitis: Focusing on the Patient Care Strategy in the Managed Care Setting

Overview of Atopic Dermatitis

Carmela Avena-Woods, BS Pharm, PharmD, BCGP
Burden of Atopic Dermatitis
Areas of disease burden most commonly impacted by AD include overall quality of life and the social, academic, and occupational realms.3 The burden of AD is not limited to just the patient, because AD is a chronic relapsing skin disease that can persist into adulthood and burden of disease is frequently experienced by the patient’s family. Several validated tools have been used to measure the adverse impact on quality of life during patient and family interviews, supporting a family-wide burden experience related to AD.15-18 Similarly, patients, their families, and society bear a significant weight related to the direct and indirect medical costs associated with AD.3,4,19,20 Direct costs include, but are not limited to, prescription and nonprescription costs, healthcare provider visits, hospital and emergency department visits, and hospitalizations. Indirect costs associated with AD include absenteeism from work, school, and physical activities; decreased productivity (presenteeism); and decreased quality of life (primarily due to sleep disturbance from itching, absenteeism, and time related to care).21-24

Quality of Life
Itching is the major symptom associated with impact on quality of life. For example, a US-based survey found 91% (n = 304) of patients with eczema experienced itching on a daily basis,25 and 36% of patients identified decreasing the amount of itch to be their primary treatment goal.26 Furthermore, itch has been associated with mental distress and increased risk for suicidal ideation in those with AD.27 Of note, emotional stress has also been shown to increase itching, implying a bidirectional relationship.28 Sleep disturbance is a frequent consequence of itching and is experienced by approximately two-thirds of patients with AD.8,29 Patients with sleep disturbance report difficulty initiating and maintaining sleep, which leads to daytime fatigue.30 Children with AD who experience sleep disturbances are associated with higher rates of developing attention-deficit/hyperactivity disorder, headaches, and short stature.30-32 Sleep disturbances experienced by adults with AD are associated with poor overall health perception.7 In addition to the physical symptoms, AD can lead to embarrassment from appearance, decreased self-esteem, and a negative impact on social life.33,34 While a patient’s quality of life is impacted tremendously, so, too, are the patient’s parents and caregivers. An international study conducted in 2006 found that 30% of patients and caregivers believed other individuals in the household were impacted by AD.34

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