Worse Health-Related QOL, Mental Health in Patients With AD During the Pandemic

Polish patients with atopic dermatitis reported lower overall health and impaired quality of life related to mental health in the first year of the COVID-19 pandemic.

Nearly half of surveyed patients with atopic dermatitis (AD) were discontented with telemedicine during the COVID-19 pandemic, with lower overall health ratings and life satisfaction also reported by these populations. Findings were published in the International Journal of Environmental Research and Public Health.

As patients with AD are more prone to adverse behavioral health conditions such as anxiety and depression, preventive measures precipitated by the pandemic and the threat of COVID-19 infection may further exacerbate mental health and disease severity in patients, researchers hypothesized.

“Although SARS-CoV-2 is mainly responsible for respiratory disfunctions, not skin disorders, it has an immense impact on dermatology and dermatological patients,” they added. “A number of chronic skin diseases may be exacerbated by stress, toxic substances and allergens found in disinfectants and cleansers.”

Researchers sought to determine the impact of the COVID-19 pandemic on the mental state and exacerbation of skin lesions in patients with AD.

Adult patients with AD were recruited from the Department of Dermatology, Pediatric Dermatology and Dermatological Oncology, at the Medical University of Lodz in Poland, and the Dermoklinika Centrum Medyczne. Participants completed surveys betwee May and August 2020 on their cognitive and preventive behaviors regarding COVID-19 and the accessibility of medical support, including online consultations.

Patients also responded to the self-reported Dermatology Life Quality Index (DLQI) and Hospital Anxiety and Depression Scale for anxiety (HADS-A) and depression (HADS-D).

A total of 138 patients completed the survey questionnaire (mean [SD] age, 32.04 [7.45] years; 54% male), of whom more than half (53.6%) were living in a large city (over 500,000 inhabitants). Five patients (3.6%) had relatives or friends diagnosed with COVID-19, and none were asked to quarantine due to suspicion of infection nor had they been infected.

According to survey findings, 69% of patients were worried about being infected with COVID-19, and 63% believed that people suffering from skin disease were more prone to be infected with the virus than the general population.

Reduced quality of life and greater severity of anxiety and depression was exhibited by patients with mild and moderate AD during the pandemic compared with before, but these trends were not statistically significant in those with severe disease:

  • DLQI values during normal conditions vs during the COVID-19 pandemic for patients with mild disease (5.3 [1.5] vs 7.2 [1.3])
  • DLQI values during normal conditions vs during the COVID-19 pandemic for patients with moderate disease (8.59 [1.8] vs 9.9 [1.8])
  • HADS-A values among adults with AD during non-epidemic conditions vs during the pandemic (7.7 [1.8] vs 8.6 [2.1]; P < .05)
  • HADS-D values among adults with AD during non-epidemic conditions vs during the pandemic (6.0 [1.5] vs 7.9 [1.9]; P < .05)

Furthermore, 66.1% of the patients reported using telemedicine, of whom nearly 50% were discontented with its use. One-third of patients reported no issues with its use. Most patients (60%) who received immunosuppressive and immunomodulating treatments considered changing their treatment, and a total of 12% of patients temporarily interrupted their use of drugs during the pandemic.

“These results provide original information that can be applied in dermatologic patient screenings, as it is important to evaluate the state of depression and anxiety during the epidemic period,” concluded the study authors. “The identification of patients who are depressed and would benefit from further support is necessary in order to make individual interventions in time.”

Reference

Sieniawska J, Lesiak A, Ciążyński K, Narbutt J, and Ciążyńska M. Impact of the COVID-19 pandemic on atopic dermatitis patients. Int J Environ Res Public Health. 2022 Feb 2;19(3):1734. doi:10.3390/ijerph19031734