Immunochemical Markers and Quality of Life in Severe Atopic Dermatitis: A Real-World Analysis

Severe atopic dermatitis (AD) impacts quality of life substantially, however the major clinical and immunologic contributors to this burden remain unclear. This study aimed to compare clinical and immunochemical profiles between patients with non-severe and severe AD and to identify key factors associated with QoL impairment in those with severe disease.

A retrospective analysis was conducted on 371 patients diagnosed with AD from 2020 to 2023 at Kosin University Gospel Hospital. Patients were categorized according to Eczema Area and Severity Index (EASI) scores, with severe AD defined as EASI > 21. Clinical characteristics, immunologic markers, and Dermatology Life Quality Index (DLQI) scores were assessed. Multivariate regression was used to identify factors independently associated with DLQI.

Among all patients, 140 (37.7%) had severe AD. This group exhibited significantly higher EASI and DLQI scores, more widespread skin involvement, and increased skin infections. Laboratory findings showed elevated total IgE, eosinophil counts, and specific IgE to Pityrosporum orbiculare. In the severe AD group, higher DLQI scores, indicating poorer QoL, were positively associated with eosinophil percentage, specific IgE to P. orbiculare, EASI score, and pruritus score, whereas total IgE and white blood cell (WBC) count showed an inverse relationship with DLQI.

Clinical severity and immunologic activity were associated with QoL in patients with severe AD. Total IgE, specific IgE to P. orbiculare, WBC and eosinophil counts, pruritus, and EASI scores were identified as factors influencing QoL. These findings highlight the importance of heterogeneous immunologic profiles in assessing QoL in severe AD. Future large-scale cohort studies are needed to elucidate the dynamic interactions among immunologic profiles, treatment response, and QoL in severe AD.