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Disease insight reports

Costed Integrated Patient Scenario: Atopic Dermatitis

This report was funded by Sanofi. Wilmington Healthcare was commissioned by Sanofi to develop this report, which has been informed by input from experts working in dermatology care, including leading clinicians and patient charities. Sanofi has had no editorial input on this report or its recommendations.

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Atopic dermatitis (AD) is a chronic relapsing skin condition characterised by intense itching, dry skin, redness, inflammation and exudation. It affects mainly the flexor surfaces of the elbows and knees, as well as the face and neck.

It is thought that the condition may affect as many as 15–20% of school-age children and 2–10% of adults. Most people with AD (more than 80%) experience mild disease; only around 2–4% of people with AD have a severe form of the disease. This can be debilitating where much of the body is covered by excoriated, bleeding and infected lesions. Despite the lower prevalence, the presentation of disease in adults is often more severe and chronic in nature.

The impact of AD on quality of life can be considerable and varies. Sometimes this may be according to disease severity; however, any level of AD can impact quality of life negatively and the psychosocial impact of the condition should not be underestimated. In addition to the burden imposed by daily treatment, studies have shown not only that the condition affects everyday activities such as work or school and social relationships, but also that people with AD may experience anxiety, depression and other psychological problems.

The All-Party Parliamentary Group (APPG) on Skin highlighted concerns in its 2020 mental health report that access to specialist mental health support dedicated to dermatology patents is limited throughout the UK, despite a growing need for such services. Suffice to say that psychological interventions can be helpful in coping with many skin conditions. Yet many individuals with skin disease are desperate and frustrated at being unable to receive the psychological support.

Management of AD takes place predominantly in primary care and aims to relieve symptoms and prevent secondary complications. This management involves skin care, anti-inflammatory treatment, and the identification and avoidance of exacerbating factors. Providing people with good-quality information about these issues is essential to successfully managing and treating AD. For patients with severe AD that have not responded to appropriate therapy, early referral to secondary care is advised. It is essential that primary care professionals identify when patients need to be referred, or recognise quickly when signs of deterioration occur, in order that patients can access stepped-up treatment as soon as possible and be provided with the right support and information to self-manage.

This resource provides clarity on the issues faced in managing AD by bringing the scenarios to life in a realistic way. The resource also provides practical guidance on how to improve care and quality of life for patients in the context of the service ‘recovery and reset’ phase following Covid-19.