Atopic dermatitis affects all areas of patients’ lives, including their work and productivity, said Lyn Guenther, professor of dermatology at Western University, during Benefits Canada’s 2021 Chronic Disease at Work conference in late February.
The chronic skin condition, characterized by dry and itchy skin, is growing in prevalence in Canada. About 3.5 per cent of adults currently suffer from atopic dermatitis, and up to 17 per cent of Canadians have had it at some point in their lives. About 45 per cent of cases are mild, another 45 per cent are moderate and 10 per cent are severe.
For patients living with moderate or severe forms of the condition, Guenther said, it can be “debilitating.” Two-thirds experience “severe or intractable, unbearable itching” for more than half of the day, 75 per cent have experienced pain and 75 per cent have had their sleep interrupted.
“I want you to just think about what it was like when you either had a drug eruption, poison ivy, or a horrible mosquito bite that drove you nuts,” she said. “But now you have the mosquito bite over your entire body.”
A 2016-2017 quality of life report by the Eczema Society of Canada found 47 per cent of people living with atopic dermatitis didn’t want to exercise due to their condition, almost half (48 per cent) avoided social activities and 40 per cent were concerned about and avoided intimacy with others. Almost a third (30 per cent) changed their vocations or made changes within the workplace to accommodate their atopic dermatitis.
Canadians with moderate to severe atopic dermatitis missed about two days per month of work, and people with mild cases also experienced some work loss, according to a 2016 study of adults with the condition in France, Germany, the U.K. and the U.S. Severe patients lose roughly 17.4 hours a week to presenteeism.
“It really has affected all aspects of our patients’ lives,” Guenther said, noting when patients’ sleep is interrupted, they often become irritable and their performance is also reduced, whether at school or at work. Even when patients’ skin is in remission, they could still suffer from poor sleep, she adds, as after all those years of having very poor sleep, when their skin is good, many still experience trouble sleeping.
People living with atopic dermatitis also experience poor self-esteem and many are constantly worried about their next flare-up. In fact, Guenther said it’s associated with higher levels of anxiety and depression: roughly a quarter of people with the condition are viewed as having a high probability of anxiety or depression. Notably, depression is thought to be associated with the severity of the condition and the itch. As well, suicidal ideation has also been associated with atopic dermatitis.
Guenther noted many people struggling with mental-health issues due to the effects of living with atopic dermatitis are reluctant to come forward about their challenges, making it difficult for employers to help them. She says employer who want to help plan members experiencing these mental-health challenges can let them know it’s okay to receive help and that they can remain anonymous when receiving that help. “I think so many of them are afraid to come forward,” she said. “If you can improve the mental component, then you can have an employee that is very highly functioning.”
Currently, the condition is largely treated with moisturizers at first, followed by topicals and Janus kinase inhibitors. Patients who don’t experience sufficient relief from those can be given phototherapy with ultraviolet light, though Guenther noted treatments have been complicated by the coronavirus pandemic, with many centres that offer the treatment temporarily closed or seeing fewer patients.
One biologic has been approved to treat the disease, which has “led to tremendous improvement in quality of life [for] many of our patients,” Guenther said, with a third of those taking it seeing positive results in having nearly clear skin. She said patients need access to more oral treatments, as well as additional biologics for patients not seeing full improvement — or experiencing some side effects — from the current biologic treatment.
“If we could improve itching, we could have an employee back that was high functioning and able to do their job at a much higher level,” she said.