Hand Eczema Is Independently Associated with Significant Quality of Life Impact in Patients with Atopic Dermatitis

Background: Little is known about the patient burden of hand eczema (HE) in atopic dermatitis (AD).Objective: To assess the patient burden of HE and explore how HE severity influences quality of life (QoL).Methods: A prospective, dermatology practice-based study was performed in adult and pediatric patients with AD. HE severity was assessed by Physician's Global Assessment (none, mild, moderate, severe). QoL was assessed using the Dermatology Life Quality Index (DLQI), Patient Health Questionnaire-9 (PHQ-9), PROMIS Itch Questionnaire (PIQ), and Sleep Disturbance.Results: Overall, 542 patients were studied, including 362 (66.8%) of White race and 320 (59.9%) of female sex (mean ± SD age: 46.2 ± 17.1 years). In multivariable ordinal logistic regression models adjusting for demographics and total Eczema Area and Severity Index scores, mild HE compared to no HE was associated with more severe numeric rating scale (NRS) average itch (adjusted odds ratio [95% confidence interval]: 2.58 [1.26-5.31], P = 0.0101), interference of itch on QoL (PROMIS PIQ-Interference; 2.92 [1.15-7.39], P = 0.0242), impact of itch on mood and sleep (PROMIS PIQ-Mood; 2.56 [1.12-5.88], P = 0.0266). However, mild HE was not associated with significantly worse DLQI total scores overall (1.59 [0.84-3.00], P = 0.1559) or individual items from DLQI. Moreover, moderate-severe HE compared to no HE was associated with significantly worse NRS average itch (3.84 [1.54-9.59], P = 0.0042), interference of itch on QoL (PROMIS PIQ-Interference; 4.19 [1.44-12.22], P = 0.0091), and impact of itch on physical activities (PROMIS PIQ-Physical; 2.85 [1.04-7.76], P = 0.0410). In addition, moderate-severe HE was associated with significantly worse QoL (DLQI; 2.82 [1.25-6.35], P = 0.0129), particularly itch/soreness (4.99 [2.24-11.10], P = 0.0001), embarrassment/self-consciousness (2.42 [1.13-5.21], P = 0.0239), impact on social and leisure activities (2.88 [1.34-6.16], P = 0.0068), and problems with partner/family relationships (2.75 [1.27-5.97], P = 0.0109).Conclusions: Even mild HE was associated with substantial impacts on patient QoL in patients with AD, even after controlling for overall AD severity. However, moderate-severe HE had even worse disease impacts across all domains.