LAUSR

Abstract Objective Itch is a common symptom of atopic dermatitis (AD), however, there is limited evidence of the frequency and association of skin pain alongside itch. This study assessed the incremental dual burden and impact of itch and skin pain on satisfaction, quality of life and work productivity in patients with AD in Japan. Methods Data were drawn from the 2020 Adelphi AD Disease Specific Programme, a point-in-time survey of dermatologists (n = 56) and their patients with history of moderate/severe AD (n = 265). Patients were grouped accordingly: no itch/skin pain (No I/SP, reference group, n = 89), itch/no skin pain (I-only, n = 71), and itch and skin pain (I + SP, n = 26). Descriptive analyses were performed alongside a range of regression models, dependent on outcome variables. Results I + SP patients had a 4.97-point worse POEM score (p = .005) and 14.5% more overall work impairment (p = .034) versus the reference group. I-only and I + SP patients were 8.92 and 23.5 times more likely, respectively, to experience sleep disruption on a day-to-day basis (both p < .001). I + SP patients were 4.6 times more likely to be bothered by their symptoms (p = .034), had a mean EASI score 6.7 points higher (p = .008) and had 1.39 more areas affected (p = .001). I + SP patients were 7.26 times more likely to express dissatisfaction with lack of improvement in their condition and 8 times more likely to be dissatisfied with convenience of treatment (both p < .05). Conclusion This dissatisfaction, alongside variations in reported symptomatic burdens, suggests that physicians could consider alternative and/or novel therapeutic approaches for the management of both itch and skin pain. PLAIN LANGUAGE SUMMARY Patients with atopic dermatitis experience a broad range of symptoms, including both itch and skin pain, however it is not clear how these symptoms combine to impact patients in everyday life. This survey of 56 dermatologists and 265 patients with a history of moderate or severe atopic dermatitis investigated the impact of both itch and skin pain on quality of life and treatment satisfaction in Japan. Patients were categorised into three groups depending on the presence of these symptoms; patients with either no itch or skin pain, patients with itch but no skin pain, or patients with both itch and skin pain. These three groups were then compared. Patients with both itch and skin pain reported this combination of symptoms together impacted on their daily lives more than patients with itch but no skin pain, or no itch or skin pain. In particular, patients with both itch and skin pain had more areas of their body affected and reported being more bothered by their symptoms compared to those who did not experience these symptoms, with daily work impairment, sleep disruption and quality of life all worse. Importantly, patients with both itch and skin pain were more likely to be dissatisfied with the lack of improvement in their condition and with the convenience of their treatment. These results suggest that physicians should take into consideration the presence of both itch and skin pain when making treatment decisions in atopic dermatitis, and the need to consider treatments to target both symptoms.