Atopic dermatitis (AD) is a chronic inflammatory skin disease that appears in early childhood. It is characterized by intense pruritus, dry skin, and skin lesions that appear in flares and have a considerable impact on patients’ lives.1,2 In recent years, the prevalence of AD has increased to between 7% and 20% in children and between 2% and 7% in adults.2,3 The etiology of AD has been linked to genetic, biological, immunological, and environmental factors.4 As a consequence of certain pathophysiological features of AD, such as the persistence of subclinical inflammation and skin barrier dysfunction, there has been a paradigm shift in the approach to treating the disease. It is now possible, after the resolution of a flare, to recommend a proactive treatment strategy aimed at preventing new flares and achieving longer flare-free intervals.5,6

AD can cause various difficulties. Numerous studies have highlighted the physical, psychological, and social impact of the disease on patients’ lives, especially during acute episodes.1,7–9 AD flares can interfere with sleep and rest, disrupt personal performance in school, at work, and in social relationships, and lead to considerable emotional distress associated with symptom severity. We believed it would be interesting to assess how patients with AD on maintenance therapy perceive their health-related quality of life (HRQOL), as there is little evidence on this group of patients in Spain. Previous studies have examined patients’ attitudes toward medical recommendations and treatment for AD flares.10,11 Nevertheless, research on patient satisfaction with maintenance strategies and on adherence to maintenance therapy is needed because these factors have important clinical implications.12–14 The primary objective of this study was to evaluate HRQOL, patient satisfaction, and treatment adherence in patients receiving maintenance therapy to control AD. The secondary objective was to confirm the basic psychometric properties of the Atopic Dermatitis Impact Scale (ADIS).

A total of 156 dermatologists throughout Spain participated in this multicenter, cross-sectional, epidemiological study. The enrollment period lasted from November 2009 to June 2010. During this period, each dermatologist consecutively interviewed 2 patients—1 adult (aged > 16 years) and 1 child (aged 2-15 years)—who had been clinically diagnosed with moderate or severe AD in accordance with the diagnostic criteria described by Hanifin and Rajka.15 Patients enrolled in the study had a disease duration of at least 16 months and had been receiving topical pharmacologic maintenance therapy for at least 4 months as a proactive strategy to prevent flares and control the disease. Topical pharmacologic maintenance therapy was defined as the prescription of topical calcineurin inhibitors, topical corticosteroids, or alternatives, with or without emollients, once the dermatologist had determined that the AD flare for which the patient had previously been treated was under control (stable or inactive AD lesions in the dermatologist's judgment). This topical therapy was prescribed according to the dermatologist's criteria, following the routine clinical practice of each hospital. All patients (or their parents, in the case of children) gave their written informed consent to participate in the study, which was conducted in accordance with Good Clinical Practice guidelines and the Declaration of Helsinki.