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Substantial Disease Burden is Positively Correlated With a Greater Number of Atopic Dermatitis Lesion Locations


Patients with AD experienced significant impacts to disease severity, disease control, and quality of life regardless of lesion location count.

A higher number of atopic dermatitis (AD) lesion locations on the body is positively correlated with more substantial disease burden in patients, according to findings of a study published in the Journal of the European Academy of Dermatology and Venereology.1

The study found that regardless of the number of locations on the body affected by AD, patients experienced substantial disease burden. Increased disease severity, poor disease control, and decreased quality of life all worsened as the number of lesion locations increased.

Young woman with eczema covered hands
Image Credit: © oscity - stock.adobe.com

Background and Methods

Previous studies, for example, have explored the relationship between lesion distribution and patients' overall quality of life. A 2019 analysis by Silverberg et al identified 5 classes of lesional distribution, each associated with different quality of life impacts. Classes 2, 3, 4, and 5 showed significantly higher Dermatology Life Quality Index (DLQI) scores compared to class 1.2

Researchers utilized the CorEvitas AD Registry, a comprehensive database established to gather longitudinal data from patients diagnosed with AD and under the care of a dermatologist or qualified dermatology practitioner. From July 2020 to June 2021, the registry enlisted a total of 1,211 participants.

Researchers collected relevant data from within the registry, including patient demographics, disease characteristics, medical history, lifestyle factors such as smoking and alcohol use, disease activity, severity, and various clinician- and patient-reported outcomes. They also used the database to track comorbidities, adverse events, infections, hospitalizations, and other safety-related outcomes.

Patients enrolled in the study were adults aged 18 years and above who had been diagnosed with AD by a dermatologist or other clinician. All patients had either initiated systemic therapy within 12 months prior to enrollment or had presented with moderate to severe AD. Patients could have multiple affected areas, and the total number of areas with lesions was categorized accordingly.

Individuals were excluded from participation if they were actively involved in or planning to become involved in any double-blind randomized controlled trials for systemic AD medications.

Variables studied included demographic and disease characteristics, body surface area, Eczema Area Severity Index, SCORing AD, validated Investigators Global Assessment for AD, Patient-Reported Eczema Measure, Atopic Dermatitis Control Tool, Sleep Loss Numeric Rating Scale, peak pruritus, skin pain severity, DLQI, and Work Productivity and Activity Impairment questionnaire.


Researchers utilized heat maps and tables to present findings and data from the total 1,211 participants involved in the study.

The heat map illustrated the proportion of patients with involvement in secondary locations concerning the index location. In total, 70% of the overall cohort had arm involvement, and among those with arm involvement, 80% also had lower limb involvement.

The average age of patients at enrollment ranged from 45.6 years (face) to 52.7 years (plantar feet), with females predominating except for genital lesions and buttocks. Most patients were White (>62.0%).

Small-to-medium differences were observed in gender, race, and geographic region across lesion number groups. Females constituted a decreasing proportion with increasing lesion numbers.

Greater lesion numbers correlated with more severe disease activity, indicated by larger effect sizes for mean total body surface area involvement, Eczema Area and Severity Index, and SCORing Atopic Dermatitis. A higher proportion of patients with multiple lesions exhibited a validated Investigator Global Assessment for AD score ≥3.


Potential study limitations, as noted by the study's authors, include a sample of patients with AD that may not be representative of all adults with AD in the US and Canada, the attribution of characteristics to a single lesion location, and the lack of comparison of outcomes based on varying body surface area and intensity.

However, the study involved a large sample of real-world patient and clinician experiences and clinical data, confirming and expanding upon existing understandings of AD's burden of disease. These results are suggestive of a large unmet need for AD therapies in real-world settings, according to authors.

"In our cohort of real-world patients with AD, lesions were most often present on the arms and lower limbs, and more than half of the patients reported ≥4 areas with AD lesions," wrote study authors Simpson et al. "An increase in the number of lesion locations corresponded with severe disease burden and poor disease control. Greater number of lesion locations was associated with decreased patient-reported quality of life and overall work productivity. Substantial disease burden was reported by patients in all the lesion location categories, suggesting an unmet need still exists in patients with AD."


  1. Simpson E, Lio P, Pierce E, et al. Impact of atopic dermatitis lesion locations and extent on patient burden: A real-world study. J Eur Acad Dermatol Venereol. April 26, 2024. Accessed May 8, 2024. https://doi.org/10.1002/jvc2.413
  2. Silverberg JI, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, Ong PY, et al. Distribution of atopic dermatitis lesions in United States adults. J Eur Acad Dermatol Venereol. 2019; 33: 1341–1348. https://doi.org/10.1111/jdv.15574
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