title: Quality of life and psychosocial issues are important outcome measures in eczema treatment.
abstract: BACKGROUND
  Atopic eczema (AE) is a common relapsing inflammatory skin disease in children associated with chronicity and poor quality of life. Many children also display depressive, anxiety and stress symptoms.
  
  
  OBJECTIVE
  To investigate the prevalence of depressive, anxiety and stress symptoms, and if these symptoms are associated with disease severity, quality of life and skin biophysiology in childhood AE.
  
  
  METHODS
  Psychological symptoms, eczema severity, quality of life and biophysical skin condition of consecutive adolescents at the pediatric dermatology clinic of a teaching hospital were evaluated with the validated Chinese versions of Depressive, Anxiety, Stress Scales (DASS-42), Beck Depression Inventory (BDI-13), Nottingham Eczema Severity Score (NESS), Children's Dermatology Life Quality Index (CDLQI), transepidermal water loss (TEWL) and stratum corneum skin hydration (SH), respectively.
  
  
  RESULTS
  AE patients (n=120) had lower SH, higher TEWL, worse CDLQI and reported higher overall, depressive and stress symptom scores, personal history of atopy, current topical corticosteroid usage and food avoidance than non-AE patients (n=26). Depressive, anxiety and stress symptoms were reported in 21%, 33% and 23% of AE patients, respectively. Multivariate analyses showed that these symptoms were significantly correlated with a poor quality of life (partial correlations of 0.40-0.49; p<0.001). Male patients had more severe disease (higher NESS, p=0.036) and DASS-depressive symptoms (multivariate OR=3.2, p=0.034) than females. Patients who reported current topical steroid usage generally practiced food avoidance (p=0.047), had poor quality of life (p=0.043) but less DASS-depression (multivariate OR=0.354, p=0.043). Only 6% of the 120 AE patients reported prior psychology consultation.
  
  
  CONCLUSIONS
  Quality of life impairments correlate with disease severity, aberrant skin biophysiology, depression, anxiety and stress symptoms in adolescents with AE. Physicians caring for these patients must evaluate the different but inter-correlated medical, biophysiological and pertinent psychosocial domains. These significant correlations imply that a holistic approach should encompass psychotherapy, behavioral therapy and coping strategies in conjunction with dermatologic therapy.
authors.affiliation: Department of Paediatrics .
authors.forename: Kam Lun
authors.initials: KL
authors.lastname: Hon
authors.forename: N H
authors.initials: NH
authors.lastname: Pong
authors.forename: Terence C W
authors.initials: TC
authors.lastname: Poon
authors.forename: Dorothy F Y
authors.initials: DF
authors.lastname: Chan
authors.forename: T F
authors.initials: TF
authors.lastname: Leung
authors.forename: Kelly Y C
authors.initials: KY
authors.lastname: Lai
authors.forename: Y K
authors.initials: YK
authors.lastname: Wing
authors.forename: Nai Ming
authors.initials: NM
authors.lastname: Luk
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D003876:Dermatitis, Atopic / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care / Q000379:methods; D015995:Prevalence; D011788:Quality of Life; D012720:Severity of Illness Index
chemical_list: D005938:Glucocorticoids
keywords: Anxiety; depression; eczema; psychosocial symptoms; quality of life; skin hydration; stress; transepidermal water loss