Quality of life and family history (Table 3)
Sixty of 100 patients reported a history of AD in one or more of their family members. Patients with a family history of AD showed a slightly better QOL than those with a negative family history, a difference that was statistically insignificant.
Quality of life and the socioeconomic status (Table 4)
The better the socioeconomic standard the lesser was the impact of the disease on the patient's life. However, this was statistically nonsignificant.
Quality of life and disease severity (Table 5)
Assessment of SCORAD index in the studied group showed that 12 of them had a mild, 59 had a moderate, and 29 had a severe form of AD. QOL showed strongly significant deterioration with increase in disease severity. Patients with a mild form of AD had a higher QOL than those with severe disease, with a statistically high significant relationship.
Disease severity and symptoms and feelings (Table 6)
Symptoms and miserable mood changes of patients increased significantly with increase in disease severity compared with controls.
Disease severity and leisure time (Table 6)
The severity of AD influenced the leisure time of the affected children negatively compared with controls.
Disease severity and school attendance (Table 6)
School attendance of the affected children became irregular with increase in disease severity compared with controls.
Disease severity and interpersonal relationship (Table 6)
The interpersonal relationship between children with AD and their friends and colleagues was markedly affected by the increased severity of the disease compared with controls.
Disease severity and sleep rhythm (Table 6)
It was clear that the increase in disease severity in patients caused the sleep rhythm to be more disturbed and irregular compared with controls.
Disease severity and treatment difficulties (Table 6)
There was an increase in treatment difficulties with an increase in disease severity in patients compared with controls.
Studies on the relationship between disease severity of AD, and QOL are conflicting. Several studies have shown that there is not always a simple relationship between the extent of skin diseases and the resulting degree of handicap  whereas others have found that severity of AD affects the patients' QOL [4,5].
In this study, QOL was assessed in patients with AD with one dermatology-specific questionnaire: CDLQI. The severity of AD was measured for patients using the SCORAD, which is an objective index.
The QOL of the group of children that was studied was markedly affected by their skin condition. The study showed no statistical difference in the QOL of patients with AD with regard to their sex, unlike the study by Holm et al. , who found a greater impact of AD on the QOL of adult female patients than adult male patients. This may be attributed to the concern of adult female patients about their look and over the feeling of embarrassment and depression because of their skin condition. Patients with a positive family history showed better QOL than those with a negative family history, but the relationship was statistically insignificant. The better the socioeconomic standard, the lesser was the impact of the disease on the patient's life; however, the result was statistically insignificant.
The QOL showed a very strong and significant deterioration with an increase in disease severity; that is, the milder the disease the higher the QOL, and the more aggressive it gets the poorer the life quality. Similar results were reported by Ben-Gashir et al. . Mood changes increased with the increase in disease severity, which may manifest as high anxiety, depression, anger, and hostility. Severity of disease negatively influenced the leisure time of our patients. This is similar to the results of Chamlin et al.  who attributed it to the parents' worries about factors that may exacerbate the disease, and therefore parents usually restrict their children from swimming or playing outdoors. School attendance became irregular with increase in disease severity. Tiredness from loss of sleep affects schoolwork, causing impaired concentration, and children with severe eczema may lose time from school. In a US survey on AD, the parents of 429 children up to the age of 15 years, reported difficulties with school performance and daily social and leisure activities in 60% of the children, which related to perceived disease severity. All these factors have an inevitable negative effect on education and may lead to the child becoming withdrawn or exhibiting difficult behavior and even lead to the development of school avoidance/phobia . Interpersonal relationships were affected with the increase of disease severity. AD has one of the greatest effects on the child's QOL, disrupting family and/or social relationships and interfering with daily activities and normal development. Peer and teacher acceptance may be affected by the appearance of the child and concerns about infectivity. These problems can lead to environmental, social, and emotional deprivation . With the increase of disease severity, sleeping rhythm became more disturbed and irregular in our patients. Chamlin et al.  reported that children with sleep disturbances were more likely to have a higher SCORAD index than those without sleep disturbance, and similarly, their parents were more likely to report sleep disturbance as well. There was an increase in problems with regard to treatment with the increase in disease severity. Lewis-Jones and Finlay  reported that there is dissatisfaction with messy treatments or bandages, and having to wear particular cotton clothes rather than synthetics. Lawson et al.  found that the majority of parents did not rate personal financial costs as the most important aspect of life affected, but single-parent low-income families found this to be one of the most important negative aspects of caring for a child with AD.
We can conclude that AD has been shown to have the potential for profound and far-reaching effects on all aspects of the lives of children and their families, particularly in those cases of severe disease. Including QOL measures as a part of the assessment of AD is recommended. This will provide essential additional information and enable us to supply resources for future disease management.
There is no conflict of interest.
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Keywords:© 2011 Egyptian Women's Dermatologic Society
atopic dermatitis; quality of life; SCORAD