Atopic dermatitis hurts
Published online: June 19, 2019
Atopic Dermatitis (AD) is a disorder that comes with many symptoms. The most common symptom of AD is itch, which has been extensively studied. Yet, little is known about how commonly pain occurs in AD, what causes it, or how it impacts the health of people living with AD.
In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Jonathan Silverberg and colleagues analyzed data from a representative sample of adults in the US to understand pain occurring in AD. Respondents were asked questions about the nature of their pain from AD as well as the severity of their AD and quality of life.
Pain from AD was reported by 61% of US adults with AD. Among those with AD pain, 1 in 3 experienced pain at least once per week and 1 in 5 reported severe pain (worst pain intensity of at least 7 of 10). AD pain and severe pain occurred even in adults with mild AD and itch. However, AD pain was even more common and more severe with more severe AD and itch. AD pain characteristics varied greatly among respondents. Half of AD pain occurred only after scratching a lot, 42% reported pain that comes and goes and 11% reported pain constantly throughout the day. Further, pain was reported by 1 in 4 from open areas caused by scratching, 1 in 4 from small cracks in the skin, 1 in 4 from inflamed red skin and only 1 in 10 due to burning from creams or ointments. Mild AD was associated with pain occurring only after scratching a lot and open areas caused by scratching, whereas more severe AD was associated with pain that comes and goes or is constant throughout the day and from inflamed red skin. Patients with AD lesions on the face had lower proportions of pain only after scratching a lot, but higher proportions of pain caused by inflamed red skin, and similar rates of burning from creams or ointments. AD pain, and particularly more severe pain, negatively impacted numerous aspects of quality of life.
Overall, pain appears to be a common and often severe symptom in AD, which is distinct from itch. Pain in AD has many causes and is related in part to scratching, inflamed red skin, and-to a lesser extent - poor tolerance of topical medications. AD pain impacted all aspects of quality of life. Pain should be assessed along with itch in clinical practice and trials of AD. Future studies are needed to determine the mechanisms of pain in AD and how to best treat it.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.