Pain is a common and burdensome symptom of atopic dermatitis in United States adults

Objective Characterize the frequency, intensity, characteristics and associations of pain from AD. Methods A cross-sectional, US population internet survey-based study of 602 adults with AD from the AD in America study was performed (modified UK Working Party Criteria). Results Overall, 365 (61%) reported pain from AD, with 199 (33%) experiencing pain at least once per week and 30 (5%) with pain daily. Among those with AD pain, 22% reported worst pain intensity ≥7. Frequency and intensity of AD pain were associated with PO-SCORAD, PO-SCORAD–itch and –sleep, and POEM (P≤0.004 for all). Among those experiencing AD pain, 179 (48%) reported pain occurring only after frequent scratching, 156 (42%) reported intermittent pain and 27 (11%) reported constant pain throughout the day. AD pain was most commonly associated with open areas caused by scratching (27%) and fissures in the skin (27%), followed by inflamed red skin (25%), with only a minority reporting pain mostly caused by burning from creams or ointments (10%). Mild AD was associated with more pain from scratching, whereas severe AD was associated with more constant pain and pain from inflamed skin. Conclusion Pain is a distinct symptom in AD, with heterogeneous frequency, characteristics, intensity and QOL impact. Pain was related to scratching, fissures, and/or inflamed red skin, and least from burning from topical medications. Skin pain should be assessed in AD patients and monitoring treatment response.