Epidemiology of Adult Atopic Dermatitis in High-Burden Skin Areas: Results From a Cross-Sectional Patient Survey

Abstract: Background: Atopic dermatitis (AD) in high-burden skin areas such as the head-and-neck, the hands, and the genitals is associated with a high disease burden and impaired quality-of-life. Objective: We investigated the prevalence of AD in high-burden skin areas, clinical and demographic characteristics, and association with disease severity in adults with AD. Methods: A cross-sectional survey was sent to 16,718 adults seen with AD (ICD-10, L20.x) at a Danish hospital. Severity was assessed with the Patient-Oriented SCORing Atopic Dermatitis (PO-SCORAD). Results: 7049 completed the survey (42.2% response), and 6716 who reported anatomical site of AD were included. The point prevalence of hand eczema (HE), head-and-neck dermatitis (HND), and genital eczema (GE) increased with AD severity and was 68.7%, 60.0%, and 5.9% in moderate, and 81.7%, 75.6%, and 14.1% in severe AD ( P < 0.001). HND and HE patients were primarily women with childhood-onset and more severe AD. GE patients tended to be male, had severe AD, had more atopic comorbidities, and had higher corticosteroid and antibiotic use. Conclusions: AD in high-burden areas is common in adult Danes with AD and characterized by more severe AD and specific patient characteristics. This subgroup warrants recognition as difficult-to-treat, requiring close monitoring and earlier use of advanced systemic therapy.