Background/Aims: Numerous therapies are recommended to treat atopic dermatitis. The German national health care study ‘Atopic Health' generated nationwide data on the care situation from the patients' perspective. Methods: Data for 1,678 adult patients were collected within a retrospective cohort study throughout the year 2010. Six scores to capture satisfaction with care, quality of life (Dermatology Life Quality Index, EQ-5D-VAS), therapeutic success and benefits (Patient Benefit Index) were analyzed using descriptive methods and analysis of variance. Results: 82.1% of patients were highly satisfied with their treatment. Topical corticosteroids and climate therapies were associated with the best success ratings. Quality of life was moderately impaired (mean Dermatology Life Quality Index 8.5 ± 6.5). 88.4% of the patients indicated a relevant therapeutic benefit (Patient Benefit Index ≥1) with significantly better scores for topical immunomodulating therapies and climate therapies. Conclusion: The most frequently applied therapies presented pleasant success and benefit ratings, even if quality of life could be improved for more than one third of patients.

1.
Carroll CL, Balkrishnan R, Feldman SR, Fleischer AB, Manuel JC: The burden of atopic dermatitis: impact on the patient, family, and society. Pediatr Dermatol 2005;22:192-199.
2.
Schaefer I, Rustenbach SJ, Zimmer L, Augustin M: Prevalence of skin diseases in a cohort of 48,665 employees in Germany. Dermatology 2008;217:169-172.
3.
Bieber T: Atopic dermatitis. N Engl J Med 2008;358:1483-1494.
4.
Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schäfer T, Schwennesen T, Seidenari S, Simon D, Ständer S, Stingl G, Szalai S, Szepietowski JC, Taïeb A, Werfel T, Wollenberg A, Darsow U; European Dermatology Forum (EDF); European Academy of Dermatology and Venereology (EADV); European Federation of Allergy (EFA); European Task Force on Atopic Dermatitis (ETFAD); European Society of Pediatric Dermatology (ESPD); Global Allergy and Asthma European Network (GA2LEN): Guidelines for treatment of atopic eczema (atopic dermatitis) part I. J Eur Acad Dermatol Venereol 2012;26:1045-1060.
5.
Ring J, Alomar A, Bieber T, Deleuran M, Fink-Wagner A, Gelmetti C, Gieler U, Lipozencic J, Luger T, Oranje AP, Schäfer T, Schwennesen T, Seidenari S, Simon D, Ständer S, Stingl G, Szalai S, Szepietowski JC, Taïeb A, Werfel T, Wollenberg A, Darsow U; European Dermatology Forum; European Academy of Dermatology and Venereology; European Task Force on Atopic Dermatitis; European Federation of Allergy; European Society of Pediatric Dermatology; Global Allergy and Asthma European Network: Guidelines for treatment of atopic eczema (atopic dermatitis) part II. J Eur Acad Dermatol Venereol 2012;26:1176-1193.
6.
Torrelo A, Ortiz J, Alomar A, Ros S, Prieto M, Cuervo J: Atopic dermatitis: impact on quality of life and patients' attitudes toward its management. Eur J Dermatol 2012;22:97-105.
7.
Lewis V, Finlay AY: 10 years experience of the Dermatology Life Quality Index (DLQI). J Investig Dermatol Symp Proc 2004;9:169-180.
8.
Holm EA, Wulf HC, Stegmann H, Jemec GBE: Life quality assessment among patients with atopic eczema. Br J Dermatol 2006;154:719-725.
9.
Augustin M, Radtke MA, Zschocke I, Blome C, Behechtnejad J, Schäfer I, Reusch M, Mielke V, Rustenbach SJ: The patient benefit index: a novel approach in patient-defined outcomes measurement for skin diseases. Arch Dermatol Res 2009;301:561-571.
10.
Kemp AS: Cost of illness of atopic dermatitis in children: a societal perspective. Pharmacoeconomics 2003;21:105-113.
11.
Ehlken B, Möhrenschlager M, Kugland B, Berger K, Quednau K, Ring J: Krankheitskostenstudie bei Patienten mit atopischem Ekzem in Deutschland. Hautarzt 2005;56:1144-1151.
12.
Poole CD, Chambers C, Allsopp R, Currie CJ: Quality of life and health-related utility analysis of adults with moderate and severe atopic dermatitis treated with tacrolimus ointment versus topical corticosteroids. J Eur Acad Dermatol Venereol 2010;24:674-678.
13.
Garside R, Stein K, Castelnuovo E, Pitt M, Ashcroft D, Dimmock P, Payne L: The effectiveness and cost-effectiveness of pimecrolimus and tacrolimus for atopic eczema: a systematic review and economic evaluation. Health Technol Assess 2005;9:iii, xi-xiii, 1-230.
14.
Taneja C, Antaya RJ, Berger A, Marshall TS, Seifeldin R, Oster G: Cost-effectiveness of tacrolimus ointment versus pimecrolimus cream in adults with atopic dermatitis. J Drugs Dermatol 2010;9:372-376.
15.
Green C, Colquitt JL, Kirby J, Davidson P, Payne E: Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation. Health Technol Assess 2004;8:iii, iv, 1-120.
16.
Deleuran MS, Vestergaard C: Therapy of severe atopic dermatitis in adults. J Dtsch Dermatol Ges 2012;10:399-406.
17.
Denby KS, Beck LA: Update on systemic therapies for atopic dermatitis. Curr Opin Allergy Clin Immunol 2012;12:421-426.
18.
Langenbruch A, Radtke M, Franzke N, Ring J, Foelster-Holst R, Augustin M: Quality of health care of atopic eczema in Germany: results of the national health care study AtopicHealth. J Eur Acad Dermatol Venereol 2013, Epub ahead of print.
19.
Oranje AP, Glazenburg A, Wolkerstorfer A, de Waard-van der Spek FB: Practical issues on interpretation of scoring atopic dermatitis: the SCORAD index, objective SCORAD and the three-item severity score. Br J Dermatol 2007;157:645-648.
20.
Twiss J, Meads DM, Preston EP, Crawford SR, McKenna SP: Can we rely on the Dermatology Life Quality Index as a measure of the impact of psoriasis or atopic dermatitis? J Invest Dermatol 2012;132:76-84.
21.
Finlay AY, Khan GK: Dermatology Life Quality Index (DLQI) - a simple practical measure for routine clinical use. Clin Exp Dermatol 1994;19:210-216.
22.
Hongbo Y, Thomas CL, Harrison MA, Salek MS, Finlay AY: Translating the science of quality of life into practice: What do dermatology life quality index scores mean? J Invest Dermatol 2005;125:659-664.
23.
Hurst NP, Kind P, Ruta D, Hunter M, Stubbings A: Measuring health-related quality of life in rheumatoid arthritis: validity, responsiveness and reliability of EuroQol (EQ-5D). Br J Rheumatol 1997;36:551-559.
24.
Rabin R, de Charro F: EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001;33:337-343.
25.
Blome C, Augustin M, Behechtnejad J, Rustenbach SJ: Dimensions of patient needs in dermatology: subscales of the patient benefit index. Arch Dermatol Res 2011;303:11-17.
26.
Blome C, Augustin M, Siepmann D, Phan NQ, Rustenbach SJ, Ständer S: Measuring patient-relevant benefits in pruritus treatment: development and validation of a specific outcomes tool. Br J Dermatol 2009;161:1143-1148.
27.
Barbeau M, Bpharm HL: Burden of atopic dermatitis in Canada. Int J Dermatol 2006;45:31-36.
28.
Peters AS, Kellberger J, Vogelberg C, Dressel H, Windstetter D, Weinmayr G, Genuneit J, Nowak D, von Mutius E, Radon K: Prediction of the incidence, recurrence, and persistence of atopic dermatitis in adolescence: a prospective cohort study. J Allergy Clin Immunol 2010;126:590-595.e1-3.
29.
Verboom P, Hakkaart-Van L, Sturkenboom M, De Zeeuw R, Menke H, Rutten F: The cost of atopic dermatitis in the Netherlands: an international comparison. Br J Dermatol 2002;147:716-724.
30.
Sánchez-Pérez J, Daudén-Tello E, Mora AM, Lara Surinyac N: Impacto de la calidad de vida relacionada con la salud en población pediátrica y adulta española con dermatitis atópica: estudio PSEDA. Actas Dermosifiliogr 2013;104:44-52.
31.
Hoare C, Li Wan Po A, Williams H: Systematic review of treatments for atopic eczema. Health Technol Assess 2000;4:1-191.
32.
Reitamo S, Ortonne JP, Sand C, Cambazard F, Bieber T, Fölster-Holst R, Vena G, Bos JD, Fabbri P, Groenhoej Larsen C: A multicentre, randomized, double-blind, controlled study of long-term treatment with 0.1% tacrolimus ointment in adults with moderate to severe atopic dermatitis. Br J Dermatol 2005;152:1282-1289.
33.
Imaizumi A, Kawakami T, Murakami F, Soma Y, Mizoguchi M: Effective treatment of pruritus in atopic dermatitis using H1 antihistamines (second-generation antihistamines): changes in blood histamine and tryptase levels. J Dermatol Sci 2003;33:23-29.
34.
Herman SM, Vender RB: Antihistamines in the treatment of dermatitis. J Cutan Med Surg 2003;7:467-473.
35.
Kawashima M, Tango T, Noguchi T, Inagi M, Nakagawa H, Harada S: Addition of fexofenadine to a topical corticosteroid reduces the pruritus associated with atopic dermatitis in a 1-week randomized, multicentre, double-blind, placebo-controlled, parallel-group study. Br J Dermatol 2003;148:1212-1221.
36.
Kiebert G, Sorensen SV, Revicki D, Fagan SC, Doyle JJ, Cohen J, Fivenson D: Atopic dermatitis is associated with a decrement in health-related quality of life. Int J Dermatol 2002;41:151-158.
37.
Maksimović N, Janković S, Marinković J, Sekulović LK, Zivković Z, Spirić VT: Health-related quality of life in patients with atopic dermatitis. J Dermatol 2012;39:42-47.
38.
Gambichler T: Management of atopic dermatitis using photo(chemo)therapy. Arch Dermatol Res 2009;301:197-203.
39.
Meduri NB, Vandergriff T, Rasmussen H, Jacobe H: Phototherapy in the management of atopic dermatitis: a systematic review. Photodermatol Photoimmunol Photomed 2007;23:106-112.
40.
Grundmann SA, Beissert S: Modern aspects of phototherapy for atopic dermatitis. J Allergy (Cairo) 2012;2012:121797.
41.
Scheinfeld NS, Tutrone WD, Weinberg JM, DeLeo VA: Phototherapy of atopic dermatitis. Clin Dermatol 2003;21:241-248.
42.
Gambichler T, Othlinghaus N, Tomi NS, Holland-Letz T, Boms S, Skrygan M, Altmeyer P, Kreuter A: Medium-dose ultraviolet (UV) A1 vs. narrowband UVB phototherapy in atopic eczema: a randomized crossover study. Br J Dermatol 2009;160:652-658.
43.
Adler-Cohen C, Czarnowicki T, Dreiher J, Ruzicka T, Ingber A, Harari M: Climatotherapy at the Dead Sea: an effective treatment modality for atopic dermatitis with significant positive impact on quality of life. Dermatitis 2012;23:75-80.
44.
Autio P, Komulainen P, Larni HM: Heliotherapy in atopic dermatitis: a prospective study on climatotherapy using the SCORAD index. Acta Derm Venereol 2002;82:436-440.
45.
Harari M, Shani J, Seidl V, Hristakieva E: Climatotherapy of atopic dermatitis at the Dead Sea: demographic evaluation and cost-effectiveness. Int J Dermatol 2000;39:59-69.
46.
Mandelin JM, Remitz A, Virtanen HM, Malmberg LP, Haahtela T, Reitamo S: A 10-year open follow-up of eczema and respiratory symptoms in patients with atopic dermatitis treated with topical tacrolimus for the first 4 years. J Dermatolog Treat 2010;21:167-170.
47.
Yin ZQ, Zhang WM, Song GX, Luo D: Meta-analysis on the comparison between two topical calcineurin inhibitors in atopic dermatitis. J Dermatol 2012;39:520-526.
48.
Chen S, Yan J, Wang F: Two topical calcineurin inhibitors for the treatment of atopic dermatitis in pediatric patients: a meta-analysis of randomized clinical trials. J Dermatolog Treat 2010;21:144-156.
49.
Paller AS, Lebwohl M, Fleischer AB, Antaya R, Langley RG, Kirsner RS, Blum RR, Rico MJ, Jaracz E, Crowe A, Linowski GJ: Tacrolimus ointment is more effective than pimecrolimus cream with a similar safety profile in the treatment of atopic dermatitis: results from 3 randomized, comparative studies. J Am Acad Dermatol 2005;52:810-822.
50.
Simpson EL: Atopic dermatitis: a review of topical treatment options. Curr Med Res Opin 2010;26:633-640.
51.
Hanifin J, Gupta AK, Rajagopalan R: Intermittent dosing of fluticasone propionate cream for reducing the risk of relapse in atopic dermatitis patients. Br J Dermatol 2002;147:528-537.
52.
Schmitt J, Schäkel K, Fölster-Holst R, Bauer A, Oertel R, Augustin M, Aberer W, Luger T, Meurer M: Prednisolone vs. ciclosporin for severe adult eczema. An investigator-initiated double-blind placebo-controlled multicentre trial. Br J Dermatol 2010;162:661-668.
53.
Schmitt J: Versorgungsforschung am Beispiel Neurodermitis. Hautarzt 2011;62:178-188.
54.
Novak N, Werfel T: Spezifische Immuntherapie und atopische Dermatitis. Was gibt es Neues? Hautarzt 2011;62:650-656.
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