Severity of atopic dermatitis symptoms differs between males, females

Male patients experienced more severe objective symptoms with atopic dermatitis than female patients, according to a study presented at European Academy of Allergy and Clinical Immunology Hybrid Congress 2022.

But female patients perceive their subjective symptoms as more severe, with equal impairments in quality of life, Katharina Zeiser, MPH, a doctoral student at the Institute of Environmental Medicine in Augsburg, Germany, said during the presentation.

“In general, it is known that more females than male patients are affected by atopic dermatitis. However, there are only a few studies that have looked at sex and gender differences in symptom severity and quality-of-life impairment,” Zeiser said. “Sex-associated differences in atopic dermatitis remain insufficiently understood.”

The ProRaD multicenter, longitudinal observational study enrolled 1,011 adolescent and adult patients aged 12 to 88 years (57% female) at four study centers in Bonn and Augsburg in Germany and Davos and Zurich in Switzerland between February 2016 and November 2021.

The researchers used the Wilcoxon test to compare the severity of symptoms between the male and female patients. Based on the SCORing Atopic Dermatitis (SCORAD) test, Eczema Area and Severity Index (EASI) and affected body surface area, male patients had more objective severe symptoms than female patients.

“We found that the more objective measures of atopic dermatitis severity such as the SCORAD or EASI scores or the effective body surface area correlated quite well with each other,” Zeiser said.

Yet the researchers found no significant differences between the male and female patients in subjective measures such as those pertaining to dermatology quality of life (DLQI), itch, sleeplessness or days missed from work or school due to AD.

“Looking at the correlation of objective severity measures with DLQI,” Zeiser said, “it appears that female patients have more severe quality-of-life impairment than male patients, especially when having moderate to severe symptoms.”

Further, the researchers found that differences in symptom severity between male and female patients were independent of age, education and most treatments. There also were no differences in symptom severity between male and female patients who had received ultraviolet therapy in the previous year or who had fewer years of education.

Greater symptom severity was, however, associated with use of therapy and lower education levels among male and female patients. The researchers additionally reported that higher education had a stronger positive impact on females with AD than on males.

Also, the researchers found associations between treatment use, lower educational levels and greater symptom severity in both males and females, implying that patients with greater symptom severity are more likely to be treated. This correlation between low educational levels and high symptom severity followed a well-known phenomenon called the social gradient in health, the researchers reported.

“Although male patients had more severe objective symptoms, female patients perceived their subjective symptoms as severe, and their quality of life was equally impaired,” Zeiser said.

“Of course, further multivariate analysis of our data is necessary to better understand and validate our findings and to explain the underlying biological or psychosocial mechanisms to explain our results,” Zeiser said.

Researchers at the Bonn ProRaD Study Center are now working on a sex-specific biomarker analysis to better understand these findings.

Reference:

• Atopic dermatitis – new study describes sex differences in disease severity and perception. https://eaaci-cdn-annual2022-media.azureedge.net/media-library-uploads/8_Atopic_dermatitis_New_study_describes_sex_differences_in_disease_severity_and_perception_fafcc83422.pdf. Published July 1, 2022. Accessed July 1, 2022.