BACKGROUND:Atopic dermatitis (AD) has characteristics of a systemic disease due to underlying systemic inflammation, which is supported by reports of various comorbidities. OBJECTIVES:To examine the associations between AD and (nonatopic) multimorbidity in a population-based cohort from the northern Netherlands and to identify differences in multimorbidity patterns between participants with multimorbidity and no AD. METHODS:We assessed the lifetime prevalence of 52 diseases, from 15 domains, combining data from questionnaires, medication records and clinical assessments within the Lifelines Cohort. Lifetime AD was self-reported, physician-diagnosed and disease severity based on the Patient-Oriented Eczema Measure. Multimorbidity was defined as the lifetime presence of at least two diseases, while nonatopic multimorbidity excluded asthma, rhinitis and food allergy. A composite morbidity score (cMS) indicated the degree of multimorbidity. We analysed associations of AD and AD severity with multimorbidity and cMS using binary and multinomial logistic regression, adjusting for age and sex, and additionally adjusting for socioeconomic and lifestyle factors. Patterns of nonatopic multimorbidity based on disease domains were explored using latent class analysis, stratified by AD presence. RESULTS:Of 37 193 participants, 3242 (8.7%) had AD. The odds for nonatopic multimorbidity were 1.47-fold higher in participants with AD, particularly for those with moderate-to-severe disease (adjusted odds ratio 1.74 vs. 1.41 for mild disease). The association strengthened with higher degrees of nonatopic multimorbidity, reaching 2.09-fold for ≥ 5 diseases. When considering atopic diseases in the definition of multimorbidity and the cMS, the associations with AD were even stronger. Further adjustments for socioeconomic and lifestyle factors were corroborative. We identified five distinct multimorbidity classes among individuals with and without AD, with two differing across the groups. One class, characterized by the orofacial domain, was only present among those with AD, while another class - resembling the metabolic syndrome - had more of a respiratory contribution to AD with further differences regarding cardiometabolic involvement. CONCLUSIONS:Participants with AD, especially moderate-to-severe disease, are more likely to experience (nonatopic) multimorbidity and showed unique patterns of nonatopic multimorbidity with regard to orofacial and cardiometabolic diseases. Our findings highlight the importance of promoting awareness for interdisciplinary approaches to managing patients with AD. An author video to accompany this article is available online.

Despite growing awareness on hand eczema (HE) in Western countries, public attention to HE in China is limited. We aimed to investigate the clinical characteristics of HE and examine its association with atopic dermatitis in the Chinese population. A multicenter cross-sectional study was conducted across 23 tertiary hospitals in China between September 2018 and November 2019. Patients with HE completed a survey covering demographics, allergic diseases, and HE-specific characteristics and underwent patch testing. Clinical severity was assessed using the Hand Eczema Severity Index. Binary logistic and linear regression models were used. In total, 2072 patients with HE were included (mean age = 39.8 years, 60.6% female). The most common HE subtype was allergic contact dermatitis, followed by irritant contact dermatitis. One third had moderate-to-very-severe HE, and at least 64.3% had chronic HE. The positive patch test rate was 50.7%. Approximately one quarter had a physician-confirmed diagnosis of atopic dermatitis that was associated with greater HE severity, longer persistence of HE, higher disease burden, and altered contact sensitization patterns in patients with HE. This study indicates that addressing both HE and atopic dermatitis might improve prognosis and QOL for affected individuals, emphasizing the need for targeted preventions and management strategies for this patient population.

The Atopic Dermatitis Control Tool (ADCT) has not been validated in the Dutch population, and comparisons with the Recap of atopic eczema (RECAP) questionnaire are still lacking. This prospective study was conducted at a Dutch tertiary hospital between June 2021 and December 2022, to assess measurement properties of the Dutch ADCT in adults with atopic dermatitis (AD) and compare it with RECAP. Participants completed the ADCT, RECAP, and reference instruments including Patient’s Global Assessment (PtGA), Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), quality-of-life questionnaire of the EuroQol Group (EQ-5D-5L), Numeric Rating Scale (NRS) peak itch/sleep disturbance, Skindex-29, and Global Rating of Change (GRC), at baseline, 1–3 days, and 4–12 weeks. Construct validity was assessed through a priori hypotheses, whilst reliability was evaluated with standard error of measurement (SEMagreement) and intraclass correlation coefficient (ICCagreement). Interpretability was examined using anchor-based approaches. In total, 196 adults with AD were included. Among a priori hypotheses, 82% (single-score validity) and 59% (responsiveness) were confirmed. The SEMagreement was 1.15, and the ICCagreement was 0.983. The final bandings for the ADCT were established, with a binary cutoff of ≥ 6 indicating uncontrolled AD. The smallest detectable change (SDC) was 3.2, and the minimally important change (MIC) value from predictive modelling was 2.9. Furthermore, the ADCT exhibited high correlations with RECAP at all levels (most correlations being above 0.80). These results demonstrated the Dutch ADCT as a valid, reliable, and responsive tool, and have important clinical implications.

The lack of a validated Chinese version of the Recap of Atopic Eczema questionnaire (RECAP) questionnaire limits its applicability. This prospective study, conducted at a Chinese tertiary hospital between April and November 2024, aimed to evaluate measurement properties of the Chinese RECAP. Participants completed RECAP and reference instruments at baseline, 1–3 days, and 4–6 weeks. Construct validity was evaluated through hypothesis testing, while reliability was assessed using standard error of measurement (SEMagreement) and intraclass correlation coefficient (ICCagreement). Interpretability of both single and change scores was examined using anchor-based methods. In total, 153 adults with atopic dermatitis (AD) (mean age 28.4 years, 51.0% male) were included, with approximately half having moderate-to-severe disease. Of the predefined hypotheses, 57.1% (single score) and 71.4% (change score) were confirmed. The SEMagreement was 1.99, and the ICCagreement was 0.96. Final RECAP bandings were established, with a binary cutoff of ≥ 11 defining uncontrolled AD. The Smallest Detectable Change was 5.5. while the Minimally Important Change was 3.5 using the receiver operating characteristics (ROC) method and 0.6 after adjustment via predictive modelling. Our finding confirmed that the Chinese RECAP is a valid, reliable, and responsive tool for evaluating eczema control. An improvement of ≥ 6 represents a real and clinically meaningful change.

Journal Article Corrected proof How can we better address patients' needs in topical psoriasis treatment? Get access Junfen Zhang, Junfen Zhang Conceptualization, Writing - original draft, Writing - review & editing Dermatology Hospital, Southern Medical University, Guangzhou, ChinaDepartment of Dermatology, University Medical Center Groningen, Groningen, the Netherlands Correspondence: Junfen Zhang. Email: jzhang01@smu.edu.cn https://orcid.org/0000-0001-7816-0328 Search for other works by this author on: Oxford Academic Google Scholar Marie L A Schuttelaar Marie L A Schuttelaar Writing - review & editing Department of Dermatology, University Medical Center Groningen, Groningen, the Netherlands https://orcid.org/0000-0002-0766-4382 Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, ljae046, https://doi.org/10.1093/bjd/ljae046 Published: 05 February 2024 Article history Received: 23 January 2024 Accepted: 24 January 2024 Published: 05 February 2024 Corrected and typeset: 16 March 2024

Journal Article Accepted manuscript Bridging the gap: Validating the Patient-Reported Impact of Dermatological diseases (PRIDD) measure Get access Junfen Zhang, Junfen Zhang Dermatology Hospital, Southern Medical University, Guangzhou, China Correspondence: Junfen Zhang, Email:jzhang01@smu.edu.cn https://orcid.org/0000-0001-7816-0328 Search for other works by this author on: Oxford Academic Google Scholar Bin Yang Bin Yang Dermatology Hospital, Southern Medical University, Guangzhou, China Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, ljae315, https://doi.org/10.1093/bjd/ljae315 Published: 05 August 2024 Article history Received: 19 July 2024 Revision received: 25 July 2024 Accepted: 01 August 2024 Published: 05 August 2024

Background The Recap of atopic eczema questionnaire (RECAP) was developed to measure eczema control in patients with atopic dermatitis (AD). The measurement properties of RECAP have not yet been validated in caregivers of children with AD. Objectives To assess the construct validity, responsiveness, reliability and interpretability of the Dutch proxy version of RECAP. Methods A prospective validation study was conducted in children (aged < 12 years) with AD and their caregivers (in a Dutch tertiary hospital). At three timepoints (T-0 = baseline; T-1 = after 1-7 days; T-2 = after 4-8 weeks) RECAP and multiple reference instruments were completed by caregivers of child patients. Single- and change-score validity (responsiveness) were tested with a priori hypotheses on correlations with reference instruments. Intraclass correlation coefficients (ICCagreement) and standard error of agreement (SEMagreement) were reported. Bands for perceived eczema control were proposed. The smallest detectable change (SDC) and minimally important change (MIC) were determined. Two anchor-based methods based on receiver operating characteristic curve (ROC) and predictive modelling were used to determine the MIC. Results A total of 231 children with AD and their caregivers participated. Of our a priori hypotheses for single-score and change-score validity, 77% and 80% were confirmed, respectively. A stronger correlation than hypothesized was found for all rejected hypotheses. Excellent reliability was found (ICCagreement = 0.94, 95% confidence interval 0.90-0.96). The SEMagreement was 1.9 points. The final banding was 0-1 (completely controlled), 2-7 (mostly controlled), 8-12 (moderately controlled), 13-18 (a little controlled) and 19-28 (not at all controlled). A cutoff point of >= 8 was selected to identify children whose AD is not under control. The SDC was 5.3 and the MIC values were 1.5 and 3.6 for the ROC and predictive modelling approaches, respectively. No floor or ceiling effects were observed. Results A total of 231 children with AD and their caregivers participated. Of our a priori hypotheses for single-score and change-score validity, 77% and 80% were confirmed, respectively. A stronger correlation than hypothesized was found for all rejected hypotheses. Excellent reliability was found (ICCagreement = 0.94, 95% confidence interval 0.90-0.96). The SEMagreement was 1.9 points. The final banding was 0-1 (completely controlled), 2-7 (mostly controlled), 8-12 (moderately controlled), 13-18 (a little controlled) and 19-28 (not at all controlled). A cutoff point of >= 8 was selected to identify children whose AD is not under control. The SDC was 5.3 and the MIC values were 1.5 and 3.6 for the ROC and predictive modelling approaches, respectively. No floor or ceiling effects were observed. Conclusions The proxy version of RECAP is a valid, reliable and responsive measurement instrument for measuring eczema control in children with AD. An improvement of >= 6 points can be regarded as a real and important change in children with AD.

BackgroundLong-term daily practice data on patient-reported benefits of dupilumab for atopic dermatitis (AD) remains limited.ObjectiveTo evaluate patient-reported outcome measures (PROMs) and the safety of dupilumab in patients with moderate-to-severe AD over a follow-up period of up to 5 years.MethodsData were extracted from the prospective, multicenter BioDay registry (October 2017 - 2022) of patients with moderate-to-severe AD treated with dupilumab in daily practice.ResultsIn total 1223 patients, 1108 adults and 115 pediatric patients, were included. After ≥1 year of treatment, mean Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI), Numeric rating scale (NRS)-pruritus ranged between 7.8-8.7, 3.5-4.2, and 2.9-3.1 in adults, respectively, whilst these PROMs ranged between 8.9-10.9, 4.4-6.4, and 3.0-3.7 in pediatric patients, respectively. At follow-up, overall work impairment decreased from 40.1% to 13.3-16.3% in adults. Furthermore, class I obesity and itch-dominant patients generally had less favorable treatment response. Of all patients, 66.8% reported ≥1 adverse event, with conjunctivitis being the most common(33.7%).LimitationsThe overall percentage of missing values for selected PROMs was 26% in adults and 46% in pediatric patients.ConclusionIn addition to favorable safety, dupilumab has demonstrated sustained effectiveness across various PROMs, underscoring the treatment benefits from patients’ perspectives.

There is a lack of knowledge concerning loneliness and psychiatric disorders other than anxiety and depression in patients with atopic dermatitis. This cross-sectional study was conducted within the Lifelines Cohort Study, in the Netherlands, by sending an atopic dermatitis questionnaire to adult participants (n = 135,950) in 2020. Psychiatric disorders were measured with a self-reported question and validated instrument (Mini International Neuropsychiatric Interview; M.I.N.I.), and loneliness was assessed with the validated 6-item De Jong Gierveld Loneliness Scale. In total, 56,896 subjects (mean age 55.8 years, 39.7% males) were included. Atopic dermatitis showed positive associations with self-reported chronic fatigue syndrome, burnout, depression, social phobia, panic disorder, attention deficit hyperactivity disorder, and eating disorder in the participants’ lifetimes. Based on the M.I.N.I., atopic dermatitis was positively associated with panic disorder and at least 1 anxiety disorder. In addition, subjects with atopic dermatitis were more likely to experience loneliness compared with those without atopic dermatitis. These associations were observed only in the moderate-to-severe, but not mild, atopic dermatitis group. This study raises awareness that a significant proportion of adults with atopic dermatitis feel lonely and are affected by several psychiatric disorders, especially those severely affected by atopic dermatitis. Further studies are required to evaluate if interdisciplinary care, such as the collaboration between dermatologists and psychiatrists, could optimize medical care for this vulnerable patient group.

Background: Anxiety and depression have been widely discussed in patients with atopic dermatitis (AD), but not other mental disorders. Meanwhile, loneliness has not been addressed in AD.

BACKGROUND: Health literacy (HL) is essential for patients with multiple atopic diseases to improve their health, given the complexity of their disease and treatment regimens. OBJECTIVE: To estimate the proportion of adults with multiple atopic diseases (at least 2 of atopic dermatitis, asthma, allergic rhinitis, and food allergy) in the Dutch general population and to evaluate the prevalence of limited HL, and its association with socioeconomic status (SES), lifestyle factors, and health-related quality of life (HR-QoL) in this patient population. METHODS: This cross-sectional study was conducted within the Lifelines Cohort Study via sending an add-on digital questionnaire, including (among others) questions on atopic dermatitis, to all adult participants (n [ 135,950) between February and May 2020. Data on asthma, allergic rhinitis, lifestyle factors, HR-QoL, and SES were extracted from baseline assessment between 2006 and 2013. Functional, communicative, and critical HL were measured by validated items from Chew and the Dutch Functional Communicative and Critical Health Literacy questionnaires between 2012 and 2016. Food allergy was measured by the Food Allergy Questionnaire between 2014 and 2016. RESULTS: In total, 11.8% of the overall study population reported ever having multiple atopic diseases; of those, 23.6% reported having limited functional HL, with a higher prevalence among those with a low SES. Limited functional HL showed positive associations with smoking, obesity, chronic stress, a low diet quality, and decreased HR-QoL among subjects with multiple atopic diseases. CONCLUSIONS: We identified an HL deficit, and its association with a low SES and poor health outcomes among patients with multiple atopic diseases. Further research is warranted to utilize a more extensive assessment to measure HL and include more health outcomes, such as treatment adherence and disease control. (c) 2023 Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology (J Allergy Clin Immunol Pract 2023;11:1429-38)

Background Limited research has been conducted on the measurement properties of the Recap of atopic eczema (RECAP) questionnaire, particularly in relation to interpretability. Objectives To investigate the validity, reliability, responsiveness and interpretability of the Dutch RECAP in adults with atopic dermatitis (AD). Methods We conducted a prospective study in a Dutch tertiary hospital, recruiting adults with AD between June 2021 and December 2022. Patients completed the RECAP questionnaire, reference instruments and anchor questions at the following three timepoints: baseline, after 1-3 days and after 4-12 weeks. Hypotheses testing was used to investigate single-score validity and change-score validity (responsiveness). To assess reliability, both standard error of measurement (SEMagreement) and intraclass correlation coefficient (ICCagreement) were reported. To assess the interpretability of single scores, bands for eczema control were proposed. To investigate the interpretability of change scores, both smallest detectable change (SDC) and minimally important change (MIC) scores were determined. To estimate the MIC scores, four different anchor- based methods were employed: the mean change method, 95% limit cut-off point, receiver operating characteristic curve and predictive modelling. Results In total, 200 participants were included (57.5% male sex, mean age 38.5 years). Of the a priori hypotheses, 82% (single-score validity) and 59% (responsiveness) were confirmed. Known-group analyses showed differences in the RECAP scores between patient groups based on disease severity and impairment of the quality of life. The SEMagreement was 1.17 points and the ICCagreement was 0.988. The final banding was as follows: 0-1 (completely controlled); 2-5 (mostly controlled); 6-11 (moderately controlled); 12-19 (a little controlled); 20- 28 (not at all controlled). Moreover, a single cut-off point of >= 6 was determined to identify patients whose AD is not under control. The SDC was 3.2 points, and the MIC value from the predictive modelling was 3.9 points. Neither floor nor ceiling effects were observed. Conclusions The RECAP has good single-score validity, moderate responsiveness and excellent reliability. This study fills a gap in the interpretability of the RECAP. Our results indicate a threshold of >= 6 points to identify patients whose AD is 'not under control', while an improvement of >= 4 points represents a clinically important change. Given its endorsement by the Harmonising Outcome Measures for Eczema initiatives, the results of this study support the integration of RECAP into both routine clinical practice and research settings.

This is an invited commentary letter for the publication entitled "The association between domestic hard water and eczema in adults from the UK Biobank cohort study" in the recent issue of BJD.

To the Editor: The COVID-19 pandemic might disproportionately impact patients with atopic dermatitis (AD), a chronic inflammatory disorder with immune dysregulation. We conducted a large cross-sectional study to investigate the associations between COVID-19-related impact and AD severity among adults in the Dutch general population. This study was conducted within the Lifelines Cohort Study,1Scholtens S. Smidt N. Swertz M.A. et al.Cohort Profile: LifeLines, a three-generation cohort study and biobank.Int J Epidemiol. 2015; 44: 1172-1180https://doi.org/10.1093/ije/dyu229Google Scholar a multidisciplinary prospective population-based cohort study examining the health and health-related behaviors of 169,729 persons living in the north of the Netherlands in a unique three-generation design. All procedures were approved by the medical ethics committee, and all participants provided written informed consent. AD-related data were collected by sending out a digital questionnaire to all adult participants of the Lifelines Cohort Study (N = 135,950) between February and May 2020 (response rate, 42.4%).2Zhang J. Loman L. Voorberg A.N. Schuttelaar M.L.A. Prevalence of adult atopic dermatitis in the general population, with a focus on moderate-to-severe disease: results from the Lifelines Cohort Study.J Eur Acad Dermatol Venereol. 2021; 35: e787-e790Google Scholar Definitions of AD have been described previously.2Zhang J. Loman L. Voorberg A.N. Schuttelaar M.L.A. Prevalence of adult atopic dermatitis in the general population, with a focus on moderate-to-severe disease: results from the Lifelines Cohort Study.J Eur Acad Dermatol Venereol. 2021; 35: e787-e790Google Scholar COVID-19-related variables were collected by sending out a series of COVID-19 questionnaires (weekly between March and May 2020, biweekly until July 2020, and then at monthly intervals until July 2021) to the adult participant of the Lifelines Cohort Study (N = 139,735),3Mc Intyre K. Lanting P. Deelen P. et al.Lifelines COVID-19 cohort: investigating COVID-19 infection and its health and societal impacts in a Dutch population-based cohort.BMJ Open. 2021; 11: e044474https://doi.org/10.1136/bmjopen-2020-044474Google Scholar of those 76,377 (54.7%) responded to at least one questionnaire. The selection of COVID-19 questionnaires varied across outcome measures of COVID-19-related variables. The COVID-19 infection rate, COVID-19 vaccination coverage, and side effects were based on combined answers from all available questionnaires; lung disease, body mass index, smoking habits, and information regarding precautions taken, were collected from the first COVID-19 questionnaire, which was sent out at the same period of AD questionnaire. Quality of health care was collected from the 15th questionnaire, while COVID-19-related psychological impact was collected from the 2nd questionnaire, because only these 2 questionnaires included all the variables related to health care and psychological impact, respectively. Associations between AD severity and COVID-19-related impact were analyzed using binary logistic regression models. A total of 53,545 participants, who responded to at least 1 COVID-19 questionnaire and responded to the AD questionnaire, were included (Table I). Nonresponders were younger and more often men (data not shown). In the multivariate analysis (Table II), both mild and moderate-to-severe AD showed a positive association with a higher prevalence of lung disease (mild AD: adjusted odds ratio [aOR], 2.50, 95% CI, 1.89-3.30; moderate-to-severe AD: aOR, 3.19, 95% CI, 2.68-3.80). All groups had similar COVID-19 infection rates. Participants with AD, regardless of disease severity, compared with non-AD participants, were more concerned about the COVID-19 crisis (mild AD: aOR, 1.06, 95% CI, 1.00-1.12; moderate-to-severe AD: aOR, 1.08, 95% CI, 1.04-1.12) and more often chose not to contact a doctor when having health problems (mild AD: aOR, 2.52, 95% CI, 1.35-4.67; moderate-to-severe AD: aOR, 2.43, 95% CI, 1.59-3.71). Participants with mild AD, but not moderate-to-severe AD, compared with non-AD participants, had a higher COVID-19 vaccination rate (aOR, 1.44; 95% CI, 1.01-2.05) and more frequently covered their mouth and nose in public (aOR, 1.93; 95% CI, 1.25-3.00). Moreover, only participants with moderate-to-severe AD compared with non-AD estimated a higher chance of becoming infected (aOR, 1.53, 95% CI, 1.00-2.35) and expected a more serious disease course (aOR, 1.51, 95% CI, 1.19-1.91). Those with moderate-to-severe AD compared with non-AD were more worried about getting sick (aOR, 1.41, 95% CI, 1.09-1.83) and a shortage of medications (aOR, 1.34, 95% CI, 1.09-1.65), and they also tended to take other precautions to prevent the spread of the COVID-19 virus (aOR, 1.23, 95% CI, 1.02-1.48). Participants with moderate-to-severe AD compared with non-AD participants, also more often expected side effects (aOR, 1.50, 95% CI, 1.11-2.01) and were more afraid of side effects of COVID-19 vaccines in the short-term (aOR, 1.42, 95% CI, 1.08-1.86) and long-term (aOR, 1.49, 95% CI, 1.19-1.86), and they reported suffering from side effects more frequently (aOR, 1.39, 95% CI, 1.10-1.75).Table ICharacteristics of the participants from the Lifelines cohort, who answered the questions related to AD and COVID-19, stratified for sex∗All characteristics are self-reported. Significant P values are in bold.Total, n (%)N = 53,545Male, n (%)N = 21,021Female, n (%)N = 32,524P valueAge, y, mean ± SD55.7 ± 12.557.5 ± 12.454.6 ± 12.5<.001Missing, n000Male21,021 (39.3)21,021 (100)0 (0)-Missing, n000AD prevalence, n (% [95% CI]) Physician-diagnosed AD in lifetime4838 (9.1 [8.8-9.3])1345 (6.4 [6.1-6.7])3493 (10.9 [10.4-11.1])<.001 Missing, n489135354 Point prevalence†Determined as the proportion of the participants with self-reported physician-diagnosed AD in a lifetime who had current eczema.1704 (3.2 [3.0-3.3])534 (2.6 [2.3-2.8])1170 (3.6 [3.4-3.8])<.001 Missing, n455119336Severity prevalence of AD‡According to the patient-oriented eczema measure, among the participants with self-reported physician-diagnosed AD in lifetime., n (% [95% CI]) Clear or mild505 (1.0 [0.9-1.0])191 (0.9 [0.8-1.1])314 (1.0 [0.9-1.1]).473 Moderate-to-severe1188 (2.2 [2.1-2.4])340 (1.6 [1.5-1.8])848 (2.6 [2.4-2.8])<.001Missing, n458119339Lung disease (ie, asthma, COPD, chronic bronchitis)3512 (9.0)1181 (7.7)2331 (9.8)<.001Missing, n14,43857308708BMI, kg/m2, mean ± SD26.1 ± 4.326.3 ± 3.626.0 ± 4.6<.001Missing, n12,39849927406Current smoking3346 (8.1)1374 (8.5)1972 (7.8).006 Missing, n12,01548937122COVID-19 infection and expected disease course COVID-19 infection§Defined as receiving either a positive SARS-CoV-2 polymerase chain reaction test or a positive clinician's diagnosis.2690 (5.1)948 (4.6)1742 (5.4)<.001 Missing, n455205250 Imagine that you get corona, you expect the course of the disease would be (serious complaints/very serious complaints/deadly)6540 (25.9)2606 (26.7)3934 (25.5).030 Missing, n28,32911,25617,073COVID-19 vaccination rateAt least one vaccine dose against COVID-19‖The vaccination rate was calculated based on all COVID-19 questionnaires sent out before the end of July 2021. According to the weekly report from the National Institute for Public Health and the Environment, 70% of people of all ages received at least one vaccine dose until July 27, 2021, in the Netherlands.27,131 (77.0)10,516 (77.4)16,615 (76.7).328Missing, n18,303743210,871Side effects of COVID-19 vaccines To what extent the corona vaccine will have serious side effects (often/very often)2434 (8.5)795 (7.2)1639 (9.4)<.001 Missing, n24,979995215,027 Afraid of short-term side effects (agree/completely agree)3163 (11.0)786 (7.1)2377 (13.5)<.001 Missing, n24,918993714,981 Afraid of long-term side effects (agree/completely agree)5627 (19.7)1397 (12.6)4230 (24.1)<.001 Missing, n24,918993714,981 Ever suffered side effects after COVID-19 vaccinations9845 (40.9)2707 (29.0)7138 (48.5)<.001 Missing, n307811721906Precaution taken Frequent hand washing or use of disinfectant38,866 (95.7)14,717 (93.2)24,149 (97.3)<.001 Social distancing40,115 (98.7)15,578 (98.6)24,537 (98.8).048 Covering mouth and nose in public1450 (3.6)543 (3.4)907 (3.7).252 Avoiding the use of public transport28,223 (69.5)10,433 (66.0)17,790 (71.7)<.001 Other precautions6072 (14.9)1763 (11.2)4309 (17.4)<.001Missing, n12,92052237697Attitudes toward the quality of health care It is justified that the capacity for regular health care is reduced in favor of the treatment of corona patients (agree/completely agree)7525 (26.1)3406 (30.4)4119 (23.3)<.001 I am worried that there will be a shortage of medications (agree/completely agree)7443 (25.8)2637 (23.5)4806 (27.2)<.001 The quality of health care is suffering due to the reduced capacity for regular health care (agree/completely agree)22,022 (76.3)8678 (77.4)13,344 (75.5)<.001 More people die as a result of the corona crisis (eg, postponing regular medical treatments, stress, depression) than as a result of the corona itself (agree/completely agree)15,408 (53.4)6037 (53.9)9371 (53.0).155Missing, n24,668981514,853 You had health problems that you would normally see the doctor for, but chose not to contact your doctor753 (2.6)241 (2.1)512 (2.9)<.001Missing, n24,618979314,825 Chose not to contact the doctor due to fear of corona67 (9.1)24 (10.2)43 (8.6).469Missing, n24,634979914,835Psychological impact Level of concerns about the corona crisis (1-10, mean ± SD)5.0 ± 2.24.6 ± 2.25.2 ± 2.1<.001Missing, n17,143691610,227 Quality of life (1-10, mean ± SD)7.3 ± 1.37.4 ± 1.37.3 ± 1.3<.001Missing, n13,63855568082 General health (good/very good/excellent)37,977 (93.7)14,869 (94.4)23,108 (93.2)<.001Missing, n13,01452787736 Worry about getting sick (often/always or almost always)2911 (7.2)890 (5.7)2021 (8.2)<.001Missing, n13,04152877754 Estimated chances of becoming infected (high/very high)865 (3.0)235 (2.2)630 (3.6)<.001Missing, n25,13010,13314,997AD, Atopic dermatitis; COPD, chronic obstructive pulmonary disease; BMI, body mass index.∗ All characteristics are self-reported. Significant P values are in bold.† Determined as the proportion of the participants with self-reported physician-diagnosed AD in a lifetime who had current eczema.‡ According to the patient-oriented eczema measure, among the participants with self-reported physician-diagnosed AD in lifetime.§ Defined as receiving either a positive SARS-CoV-2 polymerase chain reaction test or a positive clinician's diagnosis.‖ The vaccination rate was calculated based on all COVID-19 questionnaires sent out before the end of July 2021. According to the weekly report from the National Institute for Public Health and the Environment, 70% of people of all ages received at least one vaccine dose until July 27, 2021, in the Netherlands. Open table in a new tab Table IIImpact of the COVID-19 pandemic on adults with AD, stratified for current disease severity∗All characteristics are self-reported. Statistical significance is in bold. If a group size was below 10, we took the following three performances to prevent traceability to particpants: 1) n <10 rather than exact number, was displayed; 2) n <10 was treated as n = 10 when calculating the percentage; and 3) the corresponding number of missing was rounded.Non-AD in lifetime†Based on self-reported physician-diagnosed AD in a lifetime., n (%)N = 48,218Mild AD, n (%)N = 505Moderate-to-severe AD, n (%)N = 1188Mild AD vs non-ADModerate-to-severe AD vs non-ADCrude OR (95% CI)Adjusted OR (95% CI)‡Adjusted for age, sex, lung disease, smoking, and BMI.Crude OR (95% CI)Adjusted OR (95% CI)‡Adjusted for age, sex, lung disease, smoking, and BMI.Age, y, mean ± SD56.1 ± 12.553.4 ± 12.350.8 ± 13.00.98 (0.98-0.99)0.98 (0.97-0.99)0.97 (0.96-0.97)0.97 (0.96-0.97)Missing, n000Sex Male19,541 (40.5)191 (37.8)340 (28.6)1111 Female28,677 (59.5)314 (62.2)848 (71.4)1.12 (0.94-1.34)0.98 (0.79-1.21)1.70 (1.50-1.93)1.56 (1.34-1.83)Missing, n000Lung disease (ie, asthma, COPD, chronic bronchitis) No32,470 (92.0)301 (82.0)650 (78.3)1111 Yes2812 (8.0)66 (18.0)180 (21.7)2.53 (1.93-3.31)2.50 (1.89-3.30)3.20 (2.70-3.79)3.19 (2.68-3.80)Missing, n12,936138358BMI, kg/m2, mean ± SD26.1 ± 4.226.5 ± 4.826.5 ± 4.81.02 (1.00-1.05)1.02 (0.99-1.04)1.02 (1.01-1.04)1.02 (1.01-1.04)Missing, n11,086128339Current smoking No34,478 (92.0)350 (91.1)781 (90.0)1111 Yes2979 (8.0)34 (8.9)87 (10.0)1.12 (0.79-1.60)1.03 (0.70-1.50)1.29 (1.03-1.61)1.13 (0.89-1.44)Missing, n10,761121320COVID-19 infection and expected disease course COVID-19 infection§Defined as receiving either a positive SARS-CoV-2 polymerase chain reaction test or a positive clinician's diagnosis.No45,433 (95.0)473 (94.6)1103 (94.2)1111Yes2390 (5.0)27 (5.4)68 (5.8)1.09 (0.74-1.60)1.11 (0.71-1.73)1.17 (0.91-1.50)1.00 (0.74-1.36) Missing, n395517 Imagine that you get corona, you expect the course of the disease would beNo or mild complaints17,046 (74.6)152 (69.7)317 (65.0)1111Serious complaints or very serious complaints or deadly5795 (25.4)66 (30.3)171 (35.0)1.28 (0.96-1.71)1.12 (0.79-1.61)1.59 (1.31-1.92)1.51 (1.19-1.91) Missing, n25,377287700COVID-19 vaccination rate At least 1 vaccine dose against COVID-19No7156 (22.4)65 (21.1)188 (~27.4)1111Yes24,645 (77.2)243 (78.9)489 (~71.2)1.09 (0.83-1.43)1.44 (1.01-2.05)0.76 (0.64-0.90)0.98 (0.79-1.22)I prefer not to say111 (0.3)0 (0)<10 (~1.5)---- Missing, n16,306197500Side effects of COVID-19 vaccines To what extent the corona vaccine will have serious side effectsVery rarely or rarely or sometimes23,762 (91.7)225 (88.2)468 (86.7)1111Often or very often2137 (8.3)30 (11.8)72 (13.3)1.48 (1.01-2.18)1.24 (0.78-1.95)1.71 (1.33-2.20)1.50 (1.11-2.01) Missing, n22,319250648 Afraid of short-term side effectsCompletely disagree or disagree or neutral22,631 (87.2)211 (~81.2)438 (~80.5)1111Agree or completely agree2768 (10.7)39 (~15.0)96 (~17.6)1.51 (1.07-2.13)1.17 (0.77-1.78)1.79 (1.43-2.24)1.42 (1.08-1.86)Not applicable549 (2.1)<10 (~3.8)<10 (~1.8)---- Missing, n22,270240640 Afraid of long-term side effectsCompletely disagree or disagree or neutral20,471 (78.9)194 (~74.6)369 (~67.5)1111Agree or completely agree4938 (19.0)56 (~21.5)168 (~30.7)1.20 (0.89-1.61)1.01 (0.71-1.44)1.89 (1.57-2.27)1.49 (1.19-1.86)Not applicable541 (2.1)<10 (~3.8)<10 (~1.8)---- Missing, n22,270240640 Ever suffered side effects after COVID-19 vaccinationsNo12,794 (58.5)113 (~51.1)196 (~44.9)1111Yes8713 (39.8)98 (~44.3)231 (~52.9)1.27 (0.97-1.67)1.17 (0.85-1.61)1.73 (1.43-2.10)1.39 (1.10-1.75)I don't know or don't remember360 (1.6)<10 (~4.5)<10 (~2.3)---- Missing, n27782050Precaution taken Frequent hand washing or use of disinfectantNo1576 (4.3)21 (5.6)36 (4.2)1111Yes35,057 (95.7)357 (94.4)813 (95.8)0.76 (0.49-1.19)0.79 (0.50-1.27)1.02 (0.72-1.42)0.98 (0.68-1.39) Social distancingNo460 (1.3)<10 (~2.6)<10 (~1.2)1111Yes36,173 (98.7)373 (~97.4)842 (~98.8)0.95 (0.39-2.30)4.04 (0.57-28.88)1.53 (0.72-3.24)2.29 (0.85-6.16) Covering mouth and nose in publicNo35,334 (96.5)355 (93.9)822 (96.8)1111Yes1299 (3.5)23 (6.1)27 (3.2)1.76 (1.15-2.70)1.93 (1.25-3.00)0.89 (0.61-1.32)0.92 (0.61-1.40) Avoiding use of public transportNo11,232 (30.7)113 (29.9)246 (29.0)1111Yes25,401 (69.3)265 (70.1)603 (71.0)1.10 (0.83-1.45)1.06 (0.84-1.34)1.08 (0.93-1.26)1.14 (0.97-1.33) Other precautionsNo31,273 (85.4)318 (84.1)693 (81.6)1111Yes5360 (14.6)60 (15.9)156 (18.4)1.10 (0.83-1.45)1.10 (0.83-1.47)1.31 (1.10-1.57)1.23 (1.02-1.48)Missing, n11,585120330Attitudes toward quality of health care It is justified that the capacity for regular health care is reduced in favor of the treatment of corona patientsCompletely disagree or disagree or neutral19,338 (73.9)173 (69.8)408 (72.7)1111Agree or completely agree6826 (26.1)75 (30.2)153 (27.3)1.23 (0.94-1.61)1.15 (0.84-1.57)1.06 (0.88-1.28)0.97 (0.78-1.21) I am worried that there will be a shortage of medicationsCompletely disagree or disagree or neutral19,513 (74.6)176 (71.0)383 (68.4)1111Agree or completely agree6650 (25.4)72 (29.0)177 (31.6)1.20 (0.91-1.58)1.13 (0.83-1.56)1.36 (1.13-1.62)1.34 (1.09-1.65) The quality of health care is suffering due to the reduced capacity for regular health careCompletely disagree or disagree or neutral6287 (24.0)58 (23.4)120 (21.4)1111Agree or completely agree19,877 (76.0)190 (76.6)441 (78.6)1.04 (0.77-1.39)0.98 (0.70-1.37)1.16 (0.95-1.43)1.13 (0.89-1.44) More people die as a result of the corona crisis (eg, postponing regular medical treatments, stress, depression) than as a result of corona itselfCompletely disagree or disagree or neutral12,250 (46.8)118 (47.8)265 (47.2)1111Agree or completely agree13,910 (53.2)129 (52.2)297 (52.8)0.96 (0.75-1.24)0.87 (0.65-1.16)0.99 (0.84-1.17)0.87 (0.72-1.06)Missing, n22,054257627 You had health problems that you would normally see the doctor for, but chose not to contact your doctorNo25,581 (97.6)236 (95.2)531 (94.5)1111Yes631 (2.4)12 (4.8)31 (5.5)2.06 (1.15-3.70)2.52 (1.35-4.67)2.37 (1.63-3.43)2.43 (1.59-3.71) Missing, n22,006257626Chose not to contact the doctor due to fear of coronaNo568 (91.8)11 (~52.4)27 (~73.0)1111Yes51 (8.2)<10 (~47.6)<10 (~27.0)1.01 (0.13-8.00)1.16 (0.13-10.69)1.65 (0.56-4.90)1.59 (0.49-5.22) Missing, n22,018250620Psychological impact Level of concerns about the corona crisis (1-10, mean ± SD)4.9 ± 2.25.1 ± 2.15.2 ± 2.21.03 (0.98-1.08)1.06 (1.00-1.12)1.06 (1.02-1.09)1.08 (1.04-1.12) Missing, n15,482171388 Quality of life (1-10, mean ± SD)7.3 ± 1.37.2 ± 1.37.1 ± 1.40.93 (0.86-1.00)0.95 (0.87-1.04)0.88 (0.84-0.92)0.91 (0.86-0.96) Missing, n12,285132332 General healthPoor or mediocre2184 (6.0)34 (9.1)112 (13.1)1111Good or very good or excellent34,364 (94.0)339 (90.9)742 (86.9)0.63 (0.44-0.90)0.82 (0.53-1.27)0.42 (0.34-0.52)0.50 (0.39-0.64) Missing, n11,670132334 Worry about getting sickNever or rarely or sometimes33,963 (93.1)343 (91.2)765 (88.3)1111Often or always or almost always2534 (6.9)33 (8.8)101 (11.7)1.29 (0.90-1.85)1.06 (0.68-1.63)1.77 (1.43-2.19)1.41 (1.09-1.83) Missing, n11,721129322 Estimated chances of becoming infectedVery low or low or neutral24,971 (97.0)242 (~96.0)521 (94.0)1111High or very high764 (3.0)<10 (~4.0)33 (6.0)0.54 (0.20-1.46)0.46 (0.15-1.46)2.07 (1.45-2.97)1.53 (1.00-2.35) Missing, n22,483250634AD, Atopic dermatitis; OR, odds ratio; COPD, chronic obstructive pulmonary disease; BMI, body mass index.∗ All characteristics are self-reported. Statistical significance is in bold. If a group size was below 10, we took the following three performances to prevent traceability to particpants: 1) n <10 rather than exact number, was displayed; 2) n <10 was treated as n = 10 when calculating the percentage; and 3) the corresponding number of missing was rounded.† Based on self-reported physician-diagnosed AD in a lifetime.‡ Adjusted for age, sex, lung disease, smoking, and BMI.§ Defined as receiving either a positive SARS-CoV-2 polymerase chain reaction test or a positive clinician's diagnosis. Open table in a new tab AD, Atopic dermatitis; COPD, chronic obstructive pulmonary disease; BMI, body mass index. AD, Atopic dermatitis; OR, odds ratio; COPD, chronic obstructive pulmonary disease; BMI, body mass index. Our finding of no association between COVID-19 infection rate and the presence of AD in adults is consistent with a recent US study where patients with AD, even those treated with immunomodulatory medications, did not have a significantly elevated risk for COVID-19 infection.4Nguyen C. Yale K. Casale F. et al.SARS-CoV-2 infection in patients with atopic dermatitis: a cross-sectional study.Br J Dermatol. 2021; 185: 640-641https://doi.org/10.1111/bjd.20435Google Scholar However, COVID-19-related worries were more often seen in patients with moderate-to-severe AD, which might lead patients to practice more precautions in addition to basic rules (eg, hand hygiene, social distance). Furthermore, patients with moderate-to-severe AD tend to encounter dilemmas when comparing the benefit and the potential side effects of COVID-19 vaccines, which may explain why they had comparable vaccination rates to healthy controls. Notably, patients with AD were less likely to search for medical help, reflecting that they did not want to further burden the health care system. Nonetheless, this might also lead to situations where patients miss safety assessments and/or discontinue their treatment, resulting in disease exacerbation, which has been reported in a Danish surveyed-based study.5Loft N.D. Halling A.S. Iversen L. et al.Concerns related to the coronavirus disease 2019 pandemic in adult patients with atopic dermatitis and psoriasis treated with systemic immunomodulatory therapy: a Danish questionnaire survey.J Eur Acad Dermatol Venereol. 2020; 34: e773-e776https://doi.org/10.1111/jdv.16863Google Scholar To summarize, the COVID-19 pandemic has a considerable impact on patients with moderate-to-severe AD, highlighting the need for more attention for their overall wellbeing in daily practice. Dr Schuttelaar received consultancy fees from Sanofi Genzyme and Regeneron Pharmaceuticals; and is advisory board member for Sanofi, Regeneron, Pfizer, LEO Pharma, Lilly. Authors Zhang, Loman, and Kamphuis have no conflicts of interest to declare.

Background: Atopic dermatitis (AD) and hand eczema (HE) lead to a considerable public health burden, especially among patients with moderate to severe disease. A large epidemiologic study has not been conducted in the Netherlands yet. Methods: A cross-sectional study was conducted within the Lifelines Cohort Study by sending a digital questionnaire to 135,950 adults in 2020. Lifestyle factors were extracted from baseline assessment, performed between 2006 and 2013. The association between AD, HE, and lifestyle factors, were analyzed using univariate and multivariate binary logistic regression and linear regression models. Results: 57,798 subjects (42.5%) were included. The lifetime prevalence of AD was 9.3%, and the point prevalence of moderate to severe AD was 2.4%. The lifetime prevalence of HE was 15.0%, and the 1-year prevalence was 7.3%, with a proportion of severe to very severe HE at worst ever of 1.9%. Moderate to severe AD was associated with increased smoking pack years, >2 alcoholic drinks per day, chronic stress, and obesity. In addition, smoking amount and pack years, chronic stress, and obesity showed a positive association with HE in the past year. Conclusion: Moderate to severe disease represents a considerable proportion of patients with AD and HE. The current study also indicates that particular lifestyle factors are associated with AD and HE. Advice regarding lifestyle factors might contribute to improving overall health, of which AD and HE might possibly benefit in conjunction. Further longitudinal studies are required to better characterize the direction of these associations, and develop strategies for prevention.

BACKGROUND:Studies on the association between severity of atopic dermatitis (AD) and lifestyle factors in adults have not been conducted in the Netherlands to date.AIM:To explore the association between moderate to severe AD and lifestyle factors in adults in the Dutch general population.METHODS:We conducted this cross-sectional study within the Lifelines Cohort Study by sending a digital AD questionnaire to 135 950 adults in 2020. We extracted data on lifestyle factors from baseline, collected between 2006 and 2013. We analysed the association between lifestyle factors and presence of AD of any severity and of moderate to severe AD, using binary logistic regression and linear regression models.RESULTS:We enrolled 56 896 participants (mean age 55.8 years, 39.7% males). The lifetime prevalence of self-reported physician-diagnosed AD was 9.1%, and the point prevalence of any AD and of moderate to severe AD was 3.3% and 2.3%, respectively. We found that moderate to severe AD was associated with smoking habit of > 15 pack-years, alcohol consumption of > 2 drinks per day, chronic stress, Class I obesity, and both shorter and longer sleep duration. Moreover, we found dose-response associations with increases in smoking pack-years and level of chronic stress. We observed no associations with abdominal obesity, physical activity, diet quality or a vegetarian/vegan diet.CONCLUSION:We found associations between moderate to severe AD and some modifiable lifestyle factors. Our findings indicate that more screening and counselling for lifestyle factors, particularly smoking, alcohol use, stress, obesity and sleep disturbances, appears warranted in patients with moderate to severe AD. Further longitudinal studies are required to better characterize the direction of these associations and to develop strategies for prevention.

Journal of the European Academy of Dermatology and VenereologyVolume 35, Issue 11 p. e787-e790 Letter To The Editor Prevalence of adult atopic dermatitis in the general population, with a focus on moderate-to-severe disease: results from the Lifelines Cohort Study J. Zhang, J. Zhang orcid.org/0000-0001-7816-0328 Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsSearch for more papers by this authorL. Loman, L. Loman orcid.org/0000-0003-2731-9284 Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsSearch for more papers by this authorA.N. Voorberg, A.N. Voorberg orcid.org/0000-0001-5061-894X Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsSearch for more papers by this authorM.L.A. Schuttelaar, Corresponding Author M.L.A. Schuttelaar m.l.a.schuttelaar@umcg.nl orcid.org/0000-0002-0766-4382 Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Correspondence: M.L.A. Schuttelaar. E-mail: m.l.a.schuttelaar@umcg.nlSearch for more papers by this author J. Zhang, J. Zhang orcid.org/0000-0001-7816-0328 Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsSearch for more papers by this authorL. Loman, L. Loman orcid.org/0000-0003-2731-9284 Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsSearch for more papers by this authorA.N. Voorberg, A.N. Voorberg orcid.org/0000-0001-5061-894X Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the NetherlandsSearch for more papers by this authorM.L.A. Schuttelaar, Corresponding Author M.L.A. Schuttelaar m.l.a.schuttelaar@umcg.nl orcid.org/0000-0002-0766-4382 Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands Correspondence: M.L.A. Schuttelaar. E-mail: m.l.a.schuttelaar@umcg.nlSearch for more papers by this author First published: 23 June 2021 https://doi.org/10.1111/jdv.17471Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume35, Issue11November 2021Pages e787-e790 RelatedInformation

BACKGROUND:Eczema control is a new construct to be measured in atopic dermatitis (AD). OBJECTIVES:Measuring patient-perceived eczema control and treatment satisfaction in AD patients, treated with dupilumab between 16 and 52 weeks. METHODS:Cross-sectional questionnaire study. Patients from the Dutch BioDay registry completed the Atopic Dermatitis Control Test (ADCT), Recap of Atopic Eczema (RECAP) and Treatment Satisfaction Questionnaire for Medication, Version II (TSQM v. II), along with other Patient Reported Outcome Measures (PROMs). RESULTS:104/157 patients responded (response rate 66.2%). Median ADCT score was 4 (interquartile range [IQR] 5); median RECAP score was 5 (IQR 6); median TSQM v.II global satisfaction score was 83.3 (IQR 25.0). According to the ADCT, 38.5-66.3% perceived their AD was 'in control', depending on the interpretability method used. Minimally clinically important difference (MCID) of ≥4 points for the DLQI and POEM was achieved respectively in N = 66 (84.6%) and N = 63 (78.8%) patients. CONCLUSION:When considering the favorable scores on other PROMs and the TSQM v. II, and comparing these to the relatively low percentage of patients perceiving control according to the ADCT, interpretability of eczema control still appears difficult. Treatment satisfaction in the studied cohort was high.