Clinical and Laboratory Investigations
Dermatology 2007;215:123–129 Received: November 2, 2006
DOI: 10.1159/000104263
Atopic Dermatitis: Impact on the Quality
of Life of Patients and Their Partners
L. Misery a A.Y. Finlay d N. Martin b S. Boussetta b C. Nguyen c E. Myon b
C. Taieb b
a
Department of Dermatology, University Hospital, Brest, b Department of Public Health, Pierre Fabre Laboratories,
Boulogne, and c Laboratoires Pierre Fabre Santé, Castres, France; d Department of Dermatology, Wales College of
Medicine, Cardiff University, Cardiff, UK
Key Words
Atopic dermatitis patients, partners  Quality of life  Sexual
partner
Abstract
Background: The impact of atopic dermatitis (AD) on the
patient’s quality of life is relatively well known. However, the
influence on the patient’s spouse has never been studied.
Objective: To evaluate the impact of AD on the quality of life,
sleeping and sexual life of patients and their partners. Meth-
ods: In this cross-sectional study, patients and their partners
completed a number of questionnaires asking about their
general health and their quality of life [Short Form 12, Ep-
worth, Dermatology Life Quality Index (DLQI)] and complet-
ed an idiosyncratic measure asking about their sexual func-
tioning. AD severity was clinician rated using Scoring atopic
dermatitis (SCORAD). Results: A total of 266 patients were
included. The mean DLQI score was 8.8. The physical and
mental composite 12 scores were 50.7 and 39.5, respectively.
These 3 scores were significantly related to SCORAD. A de-
crease in sexual desire due to AD was noted in 57.5% of pa-
tients. The quality of life of partners did not appear to be
particularly impaired, but 36.5% reported that the appear-
ance of eczema had an impact on their sex life. Conclusion:
The influence of AD on sex life is significant both for the pa-
tients and their partners. Copyright © 2007 S. Karger AG, Basel
© 2007 S. Karger AG, Basel
1018–8665/07/2152–0123$23.50/0
Fax +41 61 306 12 34
E-Mail karger@karger.ch Accessible online at:
www.karger.com www.karger.com/drm
Accepted: February 27, 2007
Introduction
Atopic dermatitis is defined as an inflammatory skin
manifestation associated with atopy [1]. Although the di-
agnostic criteria are currently the subject of debate [2],
the UK Working Party diagnostic criteria (which have
been applied by the authors) have been validated in dif-
ferent settings and geographical regions. The prevalence
of atopic dermatitis is obviously increasing [3].
Atopic dermatitis decreases in terms of incidence and
severity with the advancing age of the patient [4]. How-
ever, 40% of adolescents [5] may still suffer from their
childhood atopic dermatitis and 50% of adults who had
atopic dermatitis may continue to experience recurrences
[6], even though the symptoms may remain very moder-
ate [6].
Although atopic dermatitis is not life-threatening, it is
an uncomfortable and highly visible disorder. Daily care
and factors which trigger acute episodes, which overall
are unpredictable, require constant vigilance. Pruritus is
a cause of discomfort, as is pain in other disorders, and
results in sleep disorders. Atopic dermatitis is often as-
sociated with atopic manifestations: asthma, spasmodic
rhinitis and conjunctivitis, which can also impair the
health quality of life of the patients (children and/or
adults) [1, 3, 7].
Given that the impact of atopic dermatitis on the qual-
ity of life of infants or young children and of their fam-
ilies has been reported in many previously published ar-
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Prof. Laurent Misery
Service de Dermatologie, CHU Morvan
University of Exeter
FR–29609 Brest Cedex (France)
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Tel. +33 298 22 33 15, Fax +33 298 22 33 82
E-Mail laurent.misery@chu-brest.fr
ticles, the adverse consequences of this disorder on chil-
dren’s quality of life no longer need to be demonstrated.
Conversely, the influence on the quality of life of family
members [8] is relatively unknown.
The management of a chronic illness should also take
into account the role of the disorder in the patients’ im-
mediate family. Thus, proximology studies the daily im-
pact on the parents of a sick child or on the partner of an
adult patient. The impact of atopic dermatitis on the qual-
ity of life of an adult patient is (partially) known, but, to
our knowledge, its effect on the partner has never been
evaluated.
Some studies were previously performed on the sexu-
al impact of skin diseases, but there are very few about
atopic dermatitis [9–11].
The present study is a cross-sectional analysis whose
objective was to evaluate the impact of atopic dermatitis
on the quality of life, and also more precisely qualities of
sleeping and sexual life, of adult patients with this condi-
tion and on that of their partners (where applicable).
Patients and Methods
This study was entitled ESCAPADE (in French: Evaluation si-
multanée conjoint et adultes patients atteints de dermatite
atopique; in English: simultaneous evaluation on adult patients
suffering atopic dermatitis and their partners).
The study was observational and did not modify the relation
between the dermatologist and his patient. Therefore, it was not
concerned by a specific law in France and thus did not require a
submission to an ethics committee. Moreover, anonymity of the
patients and partner did not allow to identify them.
Between May and September 2004, 90 French dermatologists
included patients over 16 years of age with atopic dermatitis (ac-
cording to the UK Working Party criteria) [12]. The dermatolo-
gists registered the clinical profile of the patient’s atopic dermati-
tis and calculated the SCORAD (Scoring atopic dermatitis) in-
dex.
Patients and their partners (if applicable) completed a range of
questionnaires: two health quality of life rating scales [Short
Form 12 (SF-12) and Epworth] and a questionnaire on the impact
on sex life. Concerning the patient, the Dermatology Life Quality
Index (DLQI) supplemented the effect of atopic dermatitis on the
health quality of life. Lastly, the patients and their partners were
asked to reply to the following question: ‘Currently, do you con-
sider your eczema (atopic dermatitis) as: mild, moderate, severe
or very severe?’ For all of the questions, the patients and partners
had to reply separately and anonymously.
Measures
The SCORAD [13] is an index intended to evaluate the sever-
ity of atopic dermatitis. The SCORAD makes it possible to stan-
dardize the measure of severity by an overall approach which
takes into account signs and symptoms. Three parameters are
124 Dermatology 2007;215:123–129
considered: severity of clinical signs, extension of the dermatosis
and severity of symptoms (pruritus and sleep disorders) accord-
ing to visual analog scales. Currently, it is the most widely used
score for assessment of the disease severity.
The SF-12 scale [14, 15], the short version of the SF-36, is a ge-
neric instrument used as a population health measure. The high-
er the score, the better the quality of life. The replies to the ques-
tions are dichotomic (yes/no), ordinal (excellent to poor) or ex-
press a frequency rate (constantly to never). Two scores can be
calculated based on 12 questions: a physical composite score
(PCS-12) and a mental composite score (MCS-12). There is no
global score. In case of a non-reply to a question comprising one
of the subscales, the score cannot be calculated. The PCS-12 and
MCS-12 scores are obtained by addition, using regression coeffi-
cients for each question. Lastly, they are converted [mean score of
50 and standard deviation (SD) of 10] to be compared to US ‘stan-
dards’, i.e. a representative sample of the US population (transla-
tion note for more clarity). This conversion allows the scores to be
directly compared to those of the general US population. There-
fore, the scores above and below 50 are above and below the mean
scores of the general US population, i.e. a representative sample
of the US population. We used the French version of SF-12, which
has been previously evaluated [16].
The Epworth scale [13] is a self-questionnaire comprised of 8
items which evaluate daytime sleepiness. Thus, it is an indirect
measurement of sleep disorders. Each of the items takes into ac-
count relatively common situations, in which subjects are asked
to state their opinion on the likelihood of falling asleep. A total
score is calculated. The higher the score, the higher the likelihood
for a subject to fall asleep. The maximum score is 24 and the mean
score of subjects with no sleep disorders is about 5 [17].
The DLQI is a health quality of life scale specific to dermato-
logic disorders [18]. It is comprised of 10 items which focus on 6
dimensions: ‘symptoms’, ‘daily activities’, ‘leisure’, ‘work’, ‘per-
sonal relationships’ and ‘treatment’. A total score (between 0 and
30) is calculated and can be expressed as a percentage. The high-
er the score, the more quality of life is impaired. The health qual-
ity of life is considered impaired with a score of 6, very impaired
with a score of 11 and extremely impaired with a score of 21 or
greater [19].
The questionnaire about sexuality was not yet validated but
was used in the study CHOQ (Cohorte HBP Observatoire et
Qualité de Vie) [20]. In this study, the objective was to evaluate
the impact of benign prostate hypertrophy on patient’s quality of
life and on their partners’. This study demonstrated, thanks to
this sexual questionnaire, that the more important the severity of
benign prostate hypertrophy is, the more the quality of life is fad-
ed. This questionnaire included 7 items for the patients and 6 for
their partners. The replies to each item were ordinal (never to al-
ways). The analysis of this questionnaire was realized by item and
no global score was calculated.
Statistical Analysis
Quantitative variables were compared between groups using
the Student t test (if there were 2 groups) or using ANOVA (if there
were more than 2 groups). Qualitative variables were compared
using the 2 test or Fisher’s exact test if the conditions for applica-
tion were not fulfilled. Statistical analyses were preformed using
the SAS software version 8.2 (SAS Institute). Simple regressions
were made to explore associations between certain variables.
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 Results Table 1. Quality of life in patients (DLQI)

Characteristics of the Patient Population DLQI patient Subjects Mean 8 SD

The population consisted of 266 patients, 34.2% males DLQI by population 247 8.785.32
and 65.8% females. The mean age was 32.7 years (SD = DLQI mean by gender
12.7) and the duration of atopic dermatitis was 19.3 years Male 84 8.785.3
on average (SD = 13.4). The mean SCORAD score was Female 155 8.885.4
44.6 (SD = 17.1): 1.6% of our population presented with p = 0.8171
DLQI mean by severity of AD
mild atopic dermatitis (SCORAD scores between 0 and evaluated by dermatologist
14), 42.9% with moderate atopic dermatitis (SCORAD Moderate 104 6.884.4
scores between 15 and 40) and 55.6% with severe atopic Severe 135 10.285.6
dermatitis (SCORAD scores strictly greater than 40). As p < 0.0011
the number of patients with mild severity was too small
AD = Atopic dermatitis.
(less than 10 patients), we decided to not include them in 1 The statistical test used was the t test.
the group analysis because we needed at least 30 patients
per group to perform this kind of analysis. Of the pa-
tients, 35.3% lived alone, 27.6% lived with a partner and
had no children, 36.4% lived with a partner with a child,
and 0.8% lived in a community. The occupation catego- Table 2. Quality of life in patients (SF-12)
ries which were most commonly represented were sala-
ried workers (16%), students (13%) and teachers (10%). Score Subjects Mean 8 SD

PCS-12 patient
Patient Results
The mean DLQI score was 8.8 (SD = 5.5), with no sig- PCS-12 mean by population 222 50.787.2
nificant gender differences [8.6 for males (SD = 5.3) vs. PCS-12 mean by gender
8.8 for females (SD = 5.6)] (table 1). An analysis according Male 80 51.787.3
Female 142 50.687.2
to severity (assessed using the SCORAD scores) demon- p = 0.7141
strated DLQI scores of 6.8 (SD = 4.4) and 10.2 (SD = 5.6), PCS-12 mean by severity of AD
respectively, for the groups with moderate and severe evaluated by dermatologist
atopic dermatitis (p ! 0.0001). Localization of the skin Moderate 93 52.685.9
lesions had a significant impact: the mean DLQI was 10 Severe 117 49.287.9
p = 0.00061
(SD = 5.4) for the group of patients presenting with dis-
ease involvement of the hands or face versus 8.1 (SD = 5.2) MCS-12 patient
for the group of patients with no visible lesions (p =
MCS-12 mean by population 222 39.6810.5
0.0074). The duration of the atopic dermatitis did not MCS-12 mean by gender
have a significant influence on the DLQI score. Male 80 40.989.9
Although the physical dimensions (PCS-12) of the SF- Female 142 38.9810.7
12 did not seem to be impaired [score = 50.7 (SD = 7.3)], p = 0.1591
conversely the mental dimension (MCS-12) was consid- MCS-12 mean by severity of AD
evaluated by dermatologist
erably impaired [score = 39.5 (SD = 10.6)]. In an analysis Moderate 93 43.089.7
performed by severity group (based on the SCORAD Severe 117 36.5810.2
scores), the MCS-12 scores were 42.8 (SD = 9.8) and 36.5 p < 0.0011
(SD = 10.1), respectively, for the moderate and severe
groups (p ! 0.0001). Similarly, the physical dimensions AD = Atopic dermatitis.
1 The statistical test used was the t test.
(PCS-12) were significantly (p ! 0.001) impaired depend-
ing on severity: 52.6 (SD = 5.9) and 49.2 (SD = 7.9), re-
spectively, for the moderate and severe groups (table 2).
Daytime sleepiness (Epworth scale) showed a mean
score of 6.7 (SD = 4.7). Analysis by severity of atopic der-
matitis (SCORAD) did not demonstrate any significant
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Table 3. Epworth scores of patients and partners Partner Results
Of the 266 patients questioned, 167 lived with a part-
Epworth score Subjects Mean 8 SD ner, and 156 of the partners responded to the question-
Patient naire, i.e. an effective response rate of 93.4%. The mean
age of the partners was 37.7 years (SD = 12.2), with 67.1%
Epworth mean score 232 6.784.7 males and 32.9% females.
Epworth mean score by gender Approximately 1 partner out of 6 (14.7%) stated that
Male 81 6.584.5 the atopic dermatitis could ‘sometimes’ be contagious. In
Female 146 6.884.8
p = 0.6591 addition, 60.4% of spouses feared the transmission of
Epworth mean score by severity atopic dermatitis to their child. When asked about the
of AD evaluated by dermatologist impact of their partner’s atopic dermatitis on their sex
Moderate 95 6.284.8 life, 32% stated that atopic dermatitis at least ‘sometimes’
Severe 124 7.284.6 resulted in a decrease in their sexual desire. This impact
p = 0.1481
on sexual desire was related to atopic dermatitis severity:
Partner 16.3% in the moderate atopic dermatitis group versus
Epworth mean score 134 6.184.8 39.5% in the severe atopic dermatitis group (p = 0.005;
Epworth mean score by gender table 5). Concerning the question ‘Does your spouse’s ec-
Male 90 6.184.6 zema produce a decrease in your spouse’s sexual desire?’,
Female 43 6.385.3
48.3% of spouses replied at least ‘sometimes’. Neverthe-
p = 0.8621
Epworth mean score by severity less, 63.5% of spouses stated that the appearance of their
of AD evaluated by dermatologist partner’s eczema had ‘never’ had an impact on their sex
Moderate 49 6.485.7 life (table 4).
Severe 80 6.184.2 The partners’ quality of life, as measured by SF-12, did
p = 0.7431
not appear related to the severity of the patients’ atopic
AD = Atopic dermatitis. dermatitis, as rated by SCORAD. This was verified both
1 The statistical test used was the t test. for the physical and mental dimensions. The partners’
SF-12 scores were 54 (SD = 6.1) and 49.3 (SD = 8.2), re-
spectively, for the physical and mental dimensions (ta-
ble 6). However, the mental dimension was more severely
impaired when the partner was a female (MCS-12 = 46.8
difference: the mean Epworth score was 6.2 (SD = 4.8) for and SD = 10 vs. MCS-12 = 50.6 and SD = 6.8 for males,
the moderate atopic dermatitis versus 7.1 (SD = 4.6) for p ! 0.002).
the severe atopic dermatitis group (table 3). The sleep quality of the partner was also measured,
When the patients were asked about the impact of with the Epworth scale. Overall, it was not impaired. Nei-
atopic dermatitis on their sex life, only 10.5% stated that ther did the scores obtained demonstrate any relationship
their atopic dermatitis had no effects on their physical with the patient’s atopic dermatitis (table 3).
appearance, and 18.3% expressed that their spouses
feared the illness may be contagious. The direct effects of Comparison between Patient and Partner Responses
atopic dermatitis on the patients’ sex life were significant: While 81.4% of patients and 84.7% of partners knew
a decrease, at least occasionally, in sexual desire for 57.5% that atopic dermatitis was not contagious, 18.6 and 15.3%,
of patients, effects on sex life due to the appearance of respectively, thought that it could ‘sometimes’ be conta-
atopic dermatitis (redness, dry skin) for 55.4% of patients gious. Furthermore, 70% of patients and 60.4% of part-
and impact of treatment on sex life for 46.8% (table 4). ners feared transmission of atopic dermatitis to their
Moreover, we evaluated differences between patients child (66.7% of females vs. 57.3% of males).
with or without partners in their answers to the sexual Of the partners, 63.5% responded that eczema (and its
questionnaire. There were no differences, except for the treatment 68.2%) had never had an impact on their sex
question ‘Is your partner afraid that your disease is con- life, while this was not the case in 44.6% of patients (and
tagious?’ Indeed more patients who were celibates thought 53.2% for its treatment) (table 7).
that their partners would be afraid that the disease could
be contagious (27.4 vs. 11.9%).
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Table 4. Impact of atopic dermatitis on sex life according to the patients and the partners

Patients Spouses
never some- often always total never some- often always total
times times

Is your spouse afraid that your illness is contagious? 192 39 2 2 235 127 22 0 1 150
Do you believe that your spouse’s disease is contagious? (81.70) (16.60) (0.85) (0.85) (100) (84.67) (14.67) (0) (0.67) (100)
Are you afraid of transmitting your eczema to your child? 24 14 18 24 80 57 54 23 10 144
Are you afraid of transmitting your spouse’s eczema to your (30.00) (17.50) (22.50) (30.00) (100) (39.58) (37.50) (15.97) (6.94) (100)
child?
Does your eczema decrease your sexual desire? 105 99 36 7 247 100 40 6 1 147
Does your spouse’s eczema decrease your sexual desire? (42.51) (40.08) (14.57) (2.83) (100) (68.03) (27.21) (4.08) (0.68) (100)
Does your eczema decrease your spouse’s sexual desire? 144 69 13 1 227 76 53 16 2 147
Does your spouse’s eczema decrease your sexual desire? (63.44) (30.40) (5.73) (0.44) (100) (51.70) (36.05) (10.88) (1.36) (100)
Does the appearance of your eczema (redness, dryness) have an 111 97 33 8 249 94 45 8 1 148
impact on your sex life? (44.58) (38.96) (13.25) (3.21) (100) (63.51) (30.41) (5.41) (0.68) (100)
Does the appearance of your spouse’s eczema (redness, dryness)
have an impact on your sex life?
Does the treatment of your eczema have an impact on your 132 82 25 9 248 101 36 8 3 148
sexuality? (53.23) (33.06) (10.08) (3.63) (100) (68.24) (24.32) (5.41) (2.03) (100)
Does the treatment of your spouse’s eczema have an impact on
your sexuality?

Figures in parentheses are percentages.

Table 5. Correlation between severity

and impact of atopic dermatitis on the Impact on Total Moderate Severe p value
spouses’s sexual desire sexual desire at (2)
least sometimes n % n % n %

No 93 68.89 41 83.67 52 60.47 0

Yes 42 31.11 8 16.33 34 39.53 0.005
Total 135 100.00 49 100.00 86 100.00 0.005

Discussion
The study results demonstrate an impairment of the
quality of life of adult patients suffering from atopic der-
matitis. This impairment was much more significant in
severe atopic dermatitis, in particular according to the
DLQI, especially when the patient index was greater than
8. For patients without dermatological disorder, it was
only 0.5 [15]. This confirms the results of other studies.
A British one [21] investigated the influence of psycho-
logical and clinical factors on the quality of life of adult
patients with atopic dermatitis. These results demon-
strated a correlation between psychological harm and
impairment of quality of life. The British study also re-
vealed a relationship between severity of the illness and
quality of life. In our study, the quality of life was primar-
ily impaired in its psychological dimension.
It is shown here that an impairment of the mental di-
mension and a specific impairment of the quality of life is
more pronounced in patients with lesions on visible areas
of the body, which confirms the need for specific manage-
ment of atopic dermatitis as a function of lesion localiza-
tion. A German study [22] investigated the impact, in par-
ticular the occupational one, of the presence of lesions on
the hands. Questionnaires such as the SF-36 or DLQI list
very few items on the visible lesions. Therefore, it seemed
relevant for Coenraads et al. [22] to propose a question-
naire which examined the impact of lesions on the pa-
tient’s occupational life (i.e. relationships with colleagues),
since it is important to take this parameter into account.
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Table 6. Quality of life of the partners
Score
PCS-12 partner
PCS-12 mean score by population
PCS-12 mean score according to AD
severity evaluated by a dermatologist
Moderate
Severe
MCS-12 partner
MCS-12 mean score by population
MCS-12 mean score according to AD
severity evaluated by a dermatologist
Moderate
Severe
AD = Atopic dermatitis.
Table 7. Concordance between statements concerning impact on
sex life
Statement
Is your spouse afraid that your illness
is contagious?/Do you believe that your
spouse’s disease is contagious?
Are you afraid of transmitting your
eczema to your child?/Are you afraid of
transmitting your spouse’s eczema to your
child?
Does your eczema decrease your sexual
desire?/Does your spouse’s eczema decrease
your sexual desire?
Does your eczema decrease your spouse’s
sexual desire?/Does your spouse’s eczema
decrease your spouse’s sexual desire?
Does the appearance of your eczema
(redness, dryness) have an impact on your
sex life?/Does the appearance of your
spouse’s eczema (redness, dryness) have
an impact on your sex life?
Does the treatment of your eczema have
an impact on your sexuality?/Does the
treatment of your spouse’s eczema have an
impact on your sexuality?
128 Dermatology 2007;215:123–129
Very little is known about the impact of atopic derma-
titis on patients’ sex life. A study in the Netherlands [11]
Subjects Mean 8 SD investigated the effect of chronic skin diseases on sex life.
This cross-sectional study enrolled 52 patients with pso-
142 5486.1 riasis and 25 with atopic dermatitis. A third of the pa-
tients, especially those with psoriasis, reported that they
had problems in having sexual relations or were embar-
47 54.786.5 rassed during such relationships. These figures support
85 53.586
p = 0.28 those of our study, i.e. that atopic dermatitis substantial-
ly affects sexual desire.
What makes our study different is that for the first
142 49.388.2 time a quality of life investigation examined the part-
ner’s viewpoint and we compared these results to those
47 49.489.6
85 4987.5 obtained from the patient. The impact of atopic dermati-
p = 0.84 tis on sex life is significant for both the patient and the
partner. The role of atopic dermatitis in sex life can war-
rant sexual counseling in some patients, even though the
best approach is probably treatment of the atopic derma-
titis itself [23]. Atopic dermatitis has an impact on the
opportunity for employment of adults and hinders career
options [24]. Negative effects are also observed in family
relations. They are much more significant in families
which have a low income [24]. Therefore, the social im-
p value RSpearman pact does not only involve the patient’s public life but also
his/her private life.
<0.001 0.63 Although atopic dermatitis is not life-threatening, it
can on the other hand threaten the quality of life of the
patient and that of the partner. The demonstrated severe-
<0.001 0.53 ly impaired mental dimension of the disorder and the sig-
nificant impact on important physiological functions,
such as sleep and sex life, confirm the need for global
management of atopic dermatitis. Our rating scale on
<0.001 0.55 daytime sleepiness did not demonstrate any abnormality
in patients or their partners. This is in contradiction with
the results of other studies that demonstrated sleep disor-
<0.001 0.62 ders (the other studies used a visual analog scale). It can
be concluded that these potential sleep disorders had little
impact on daytime vigilance.
<0.001 0.56
This disorder is not always very well understood in
couple relationships, with patient’s partners often seem-
ing to be less affected by the eczema in their sex life than
the patients are. It appears necessary to promote discus-
<0.001 0.52 sion of the disorder among couples. Generally, the knowl-
edge regarding the contagiousness of this disorder is
good, but it is poor among about 15% of couples. Such
data again raise the question of the usefulness of adult
patient education in terms of their disease and its treat-
ment.
This study underlines that atopic dermatitis concerns
the whole family, due to its repercussions on the atten-
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dants and especially on the partners. In clinical practice,
the practitioners have to keep this notion in mind. Be-
yond, there is a need for further studies to better assess
the sexual functioning of patients and their partners, to
better explain why some patients have partners, whereas
others are alone, and to better understand the ideas of
patients and partners about their perceptions of atopic
dermatitis. The use of quality of life scales which are not
related to health may be more helpful for partners.

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