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Pain and Itch Are Dual Burdens in Atopic Dermatitis

Maarouf, Melody, MHS*; Kromenacker, Bryan, RN, MA*; Capozza, Korey L., MPH; Kempton, Darren, PT, DPT*; Hendricks, Aleksi, BS*; Tran, Khiem, PhD*; Shi, Vivian Y., MD

doi: 10.1097/DER.0000000000000406

Background Despite being widely reported by patients with atopic dermatitis (AD), pain symptoms, unlike itch, have not been widely assessed.

Objective The aim of the study was to understand the distinct pain symptoms in patients with AD.

Methods Responses from an anonymous questionnaire were collected from our eczema clinic (in-person survey) and collaboration with Global Parents for Eczema Research Group and the National Eczema Association (online survey) to assess skin pain among patients with AD 5 years and older. Eczema Area and Severity Index was measured in the clinic cohort to correlate with pain symptoms.

Conclusions In our international cohort of 103 patients with AD, 78% reported concomitant pain and itch. The greatest pain burden occurred on the hands (odds ratio [OR], 0.77), perioral region (OR, 0.74), and toes (OR, 0.7), corresponding to regions with the greatest sensory nerve density. Pain was most commonly described as “burning” and “stinging,” particularly when lesions were red, cracked, and dry. Its presence significantly interfered with sleep, leisure activities, and activities of daily living. Among the clinic cohort, we observed a strong Spearman correlation between objective Eczema Area and Severity Index score and subjective skin pain. It is imperative that clinicians understand patients’ unique pain burden to best evaluate clinical severity and quality-of-life interference.

From the *College of Medicine, University of Arizona, Tucson;

Global Parents for Eczema Research Group, Los Angeles, CA; and

Division of Dermatology, Department of Medicine, University of Arizona, Tucson.

Address reprint requests to Vivian Y. Shi, MD, Dermatology Division, University of Arizona, 7165 N. Pima Canyon Dr, Tucson, AZ 85718. E-mail:

M.M. and B.K. are co-first authors.

V.Y.S is a stock shareholder of Dermveda, has served as a paid advisor for Sanofi Genzyme, Burt's Bees, Menlo Therapeutics, and the National Eczema Association, received educational honorarium from Sanofi Genzyme, Pfizer, Novartis and Learnskin, and has received research funding from the Foundation for Atopic Dermatitis. The other authors have no funding or conflicts of interest to declare.

© 2018 American Contact Dermatitis Society
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