P119 Recognise 1: exploring the association between itch and therapeutic choice in atopic dermatitis

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritus and recurrent eczematous lesions. These features contribute to sleep disturbances and reduced quality of life. A single-centre retrospective chart review was carried out to assess potential differences in treatment response by disease phenotype. Patients with newly diagnosed AD (n = 109) were categorized into four subgroups: severe itch–severe lesion (SI-SL, itch > 6/EASI > 21), severe itch–mild/moderate lesion (SI-ML, itch > 6/EASI ≤ 21), moderate itch–severe lesion (MI-SL, itch ≤ 6/EASI > 21) and mild/moderate itch–mild/moderate lesion (MI-ML, itch ≤ 6/EASI ≤ 21). Itch severity was determined by Peak Pruritus Numerical Rating Scale for worst itch in the past 7 days, and lesion severity was determined by Eczema Area and Severity Index (EASI). The last recorded therapy, whether systemic (e.g. methotrexate, ciclosporin, mycophenolate) or advanced (e.g. biologics, Janus kinase inhibitor) was compared between subgroups. Patient proportions in each subgroup were MI-ML (42%), SI-ML (28%), SI-SL (17%) and MI-SL (13%). Patients with severe lesions (SI-SL/MI-SL) tend to be classified as having more severe disease overall by physicians, which is supported by these two subgroups having the highest frequency of progression to advanced therapy: 37% in SI-SL, 36% in MI-SL, 30% in SI-ML and 0% in MI-ML. Nevertheless, despite lesion severity (EASI) being statistically similar between the SI-ML and MI-ML groups, none of those in the MI-ML group went on to have advanced therapies, even though it was the largest group. The itch-dominant phenotype (SI-ML) is the largest cohort of patients with severe AD in this study, and these patients may need to progress to advanced therapy earlier to achieve better disease control. Itch assessment is not routinely conducted in UK clinics and is not included in the NICE guidelines. Future research is needed to expand and consolidate these findings.