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Investigating Lifestyle Behaviors Associated With Moderate to Severe Atopic Dermatitis


Several modifiable lifestyle factors were associated with moderate to severe atopic dermatitis in a patient cohort from the Netherlands, including smoking, alcohol consumption, and stress.

Certain modifiable lifestyle factors may increase disease severity risk in patients with atopic dermatitis (AD), according to study findings published in Clinical and Experimental Dermatology.

AD, which has an estimated prevalence of 7.1% among adults in the European general population and 9.3% in the Netherlands, has considerable impact on health-related quality of life, particularly among patients with severe disease.

Several lifestyle factors have been considered to potentially correlate with AD severity, such as smoking, obesity, and alcohol consumption, but researchers noted that existing literature on this topic is limited.

“Understanding how the association with modifiable lifestyle factors varies by AD severity may help to monitor patients with moderate to severe AD in daily practice and develop strategies for treatment and prevention,” wrote the study authors. “Hitherto, studies on the association between moderate to severe AD and lifestyle factors among adults have not been conducted in the Netherlands.”

Seeking to further explore the association between moderate to severe AD and lifestyle factors, they conducted a cross-sectional study of adults in the Dutch general population who were registered in the Lifelines Cohort Study in 2020.

A total of 135,950 adults were sent a digital AD questionnaire, of which 56,896 subjects (mean age, 55.8 years; 39.7% males) were included in the analysis. Participants provided data on lifestyle factors from baseline, collected between 2006 and 2013, including smoking, alcohol use, stress, obesity, physical activity, diet, and sleep duration.

“Based on self-reported physician-diagnosed AD in lifetime, subjects were categorized into AD and non-AD. The point prevalence was determined as the proportion of the subjects with physician-diagnosed AD who had current eczema in the past week,” the authors explained. “Regarding disease severity, subjects with current eczema completed the Patient-Oriented Eczema Measure.”

Of the study cohort, lifetime prevalence of self-reported physician-diagnosed AD was 9.1%, point prevalence of AD was 3.3%, and the point prevalence of moderate to severe AD was 2.3%.

After adjusting for age and sex, moderate to severe AD was positively associated with a smoking pack years of greater than 15, an alcohol consumption of more than 2 drinks/day, class I obesity (body mass index, 30-34.9 kg/m2), and a shorter sleep duration of less than or equal to 7 hours/day.

Moreover, dose-response associations with increased smoking pack years and level of chronic stress was identified among those with moderate to severe AD. No associations with abdominal obesity, physical activity, diet quality, and a vegetarian/vegan diet were observed.

“Our findings indicate that more screening and counselling for lifestyle factors particularly smoking, alcohol use, stress, obesity, and sleep disturbances, appears warranted in patients with moderate to severe AD,” concluded the study authors.

“Further longitudinal studies are required to better characterize the direction of these associations, and develop strategies for prevention.”


Zhang J, Loman L, Oldhoff JM, Schuttelaar MLA. Moderate-to-severe atopic dermatitisand lifestyle factors in the Dutch general population. Clin Exp Dermatol. Published online April 5, 2022. doi:10.1111/ced.15212

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