P079 Analysis of cumulative life course impairment in tertiary atopic dermatitis care: insights from the first use of the DermCLCI-r questionnaire in an English cohort

Abstract

Atopic dermatitis (AD) is a chronic condition regularly affecting patients from an early age. Both limited and widespread disease involvement can create overwhelming physical and emotional turmoil, conveying a significant burden on patients’ lives. This results in compounding negative life impact, known as cumulative life course impairment (CLCI). The DermCLCI-r questionnaire is a novel tool for measuring the impact of CLCI over a patient’s lifetime. This study reveals detailed insights from using the DermCLCI-r questionnaire in patients with tertiary AD in England and correlates it with clinical and quality-of-life data. In total, 102 patients with tertiary AD were assessed using Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI) and DermCLCI-r. Of the included patients, 59.8% were male. The mean age was 32.5 years, the mean age at diagnosis 9.2 years, the mean EASI was 6.6; the mean DLQI was 6.9, and 89.2% (91 of 102) were on systemic therapy. Overall, 94.1% of patients (96 of 102) reported experiencing at least one high-burden item (defined as ‘quite’ or ‘very’ burdensome) due to their disease, with a mean number of 10.3 high-burden items per patient. The majority of patients experienced high burden from ‘effort to treat the disease’ (75.2%), ‘impairments in the choice of clothing’ (75%), ‘stress due to the disease’ (73%), ‘nervousness, anxiety or tension’ (68.7%), ‘limitations in physical performance’ (63.4%), ‘impairments in quality of life’ (62.5%), ‘sleep disorder’ (56.4%), ‘not being able to stop or control worries’ (55%) and ‘dejection, melancholy or hopelessness’ (50%). The overall DermCLCI-r score correlated significantly with the total DLQI score (r = 0.30, P = 0.005). CLCI plays a multifaceted life-changing role in patients with tertiary AD, with issues contributing to physical and mental comorbidity, emotional burden and social disadvantages. The DermCLCI-r questionnaire is able to detect these issues, allowing clinicians to identify more specific and personalized treatment goals to effectively target disease burden. Future work will involve completing validation of the English-language DermCLCI-r questionnaire by assessing longitudinal responsiveness over 1 year.