Study: Visible AD Impacts Romantic Relationships, Occupation, Sexual Health of French Female Patients

Atopic dermatitis (AD) in visible areas has a higher impact on the romantic relationships, occupation, and sexual health of French female adult patients, according to a study published in Acta Dermato Venereologica.¹

Although AD often starts in early childhood, the researchers explained that it is increasingly persisting or beginning in adulthood. Despite the higher prevalence of AD among boys during infancy and childhood, it is becoming more prevalent in girls around puberty and into adulthood. A recent population-based European study found a higher adult AD prevalence among women than men (6.6% vs 4.4%, respectively).²

AD also impacts each patient’s quality of life, as it “was found to have the highest global disease burden in disability-adjusted life-years of any non-malignant skin disorder.”³ Therefore, it is associated with anxiety, depression, and decreased work productivity, which brings additional economic and health burdens onto patients.¹

The researchers noted that most studies on negative AD aspects have mainly focused on children, meaning the impacts on adult women have been poorly investigated. Consequently, they created an anonymous questionnaire to evaluate how AD affects the daily lives of adult French female patients, particularly its impact on the social, personal, and professional aspects of their lives.

To formulate their questionnaire, the researchers interviewed dermatologists and patients with AD to gather patient perceptions, concerns, and initial data. They used this information to create a semistructured questionnaire with closed-ended questions on the repercussions of AD across various phases of a woman’s life.

The researchers analyzed the objective clinical severity of AD using the Patient-Oriented Eczema Measure (POEM), “a self-assessment tool used to monitor disease activity in children and adults with AD.”⁴ The POEM asked patients how frequently 7 particular symptoms occurred during the preceding week, namely sleep, bleeding, weeping, skin cracking, itching, skin flaking off, and skin dryness. POEM scores ranged from 0 to 28, which the researchers used to create mild (0-7), moderate (8-16), and severe (17-28) AD severity groups. The questionnaire also asked patients to anonymously supply personal information, like their age, occupation, relationship status, atopic comorbidities, and AD presence in visible and/or sensual areas.

Between March and May 2022, the researchers enrolled survey participants from a representative sample of French adult women.¹ Eligible participants had an AD diagnosis, were older than 18 years, could understand French, and agreed to participate in surveys. Therefore, they enrolled 1009 French adult women with AD, with a mean (SD) age of 41.8 (14.2) years.

Of the study population, 67.7% reported having AD in a visible area, like their face, neck, and hands, while 19.6% had AD in a sensual area, like their breasts, buttocks, or genital area. According to the POEM, the study population consisted of 511 women (50.5%) with mild AD, 397 (39.3%) with moderate AD, and 101 (10.0%) with severe AD.

Additionally, 719 (71.4%) women in the study population had menstrual cycles, 58.7% (n = 422) of whom reported having AD exacerbations before (50.6%; n = 364) and during (48.3%; n = 347) menstruation. As for pregnancy, 7.3% (n = 74) reported being concerned about becoming pregnant due to their AD. Of this subgroup, 91% (n = 67/74) feared passing on AD to their child. Similarly, among the 92.7% (n = 935) not concerned about becoming pregnant, 26% (n = 243/935) also expressed the fear of passing down AD.

Also, 21.8% reported that their AD interfered with past romantic relationships; this was highest among those with AD in a visible area (31.4%; P = .0005). Similarly, AD negatively impacted the sexuality of 14.3% of sexually active women in the study population, with the AD location having a significant impact. Therefore, AD negatively impacted the sexuality of 16.8% of those with AD in a visible area (P < .0001) and 23.1% of those with AD in a sensual area (P = .0001).

Most of the study population reported being employed (n = 669; 66.3%). Of this subgroup, 20.9% (n = 140/669) encountered difficulties at work due to their AD. Consequently, 37.2% (n = 249) of women reported thinking about their AD at work, especially those with visible AD areas (42.6%; P < .0001). Additionally, 210 women (31.4%) reported taking a leave of absence from work at least once to consult a physician for their AD, and 19.6% (n = 131) reported taking sick leave due to their AD.

The researchers acknowledged their limitations, one being recollection bias due to the retrospective, self-reported nature of the study. Also, the questionnaire lacked questions regarding treatment options. Despite these limitations, the researchers made future treatment suggestions to providers based on their findings.

"Particular attention should be given to patients with localization of AD on the face, neck or hands, as they have a higher risk of social exclusion," the authors concluded. "Moreover, these results should encourage health professionals to ask patients with AD about the possible involvement of sensual areas."

Reference

1. Fougerousse AC, Alexandre M, Darrigade AS, et al. Impact of atopic dermatitis on adult women's lives: a survey of 1,009 French women. Acta Derm Venereol. 2024;104:adv10321. doi:10.2340/actadv.v104.10321
2. Richard MA, Paul C, Nijsten T, et al. Prevalence of most common skin diseases in Europe: a population-based study. J Eur Acad Dermatol Venereol. 2022;36(7):1088-1096. doi:10.1111/jdv.18050
3. Laughter MR, Maymone MBC, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990-2017. Br J Dermatol. 2021;184(2):304-309. doi:10.1111/bjd.19580
4. Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients’ perspective. Arch Dermatol. 2004;140(12):1513-1519. doi:10.1001/archderm.140.12.1513