Patients ages 65 years and older with atopic dermatitis (AD) have similar disease severity when compared with younger adult patients, but they have more profound sleep disturbances, especially trouble staying asleep.
Those are key findings from a cross-sectional study that Jaya Manjunath, BS, and Jonathan I. Silverberg, MD, PhD, MPH, presented during a poster session at the Revolutionizing Atopic Dermatitis virtual symposium.
“Atopic dermatitis is a chronic, pruritic skin disease associated with sleep disturbance and fatigue affecting adults of all ages,” they wrote. “When caring for geriatric patients, several factors such as sleep disturbance, polypharmacy, cognition, social support, and mobility should be considered. However, little is known about the characteristics of atopic dermatitis in the geriatric population.”
Manjunath, a student at George Washington University School of Medicine and Health Sciences, Washington, DC, and Silverberg, director of clinical research in the department of dermatology at GWU, recruited patients with AD ages 18 and older diagnosed by Hanifin-Rajka criteria who were evaluated at an academic medical center between 2014 and 2019. They underwent full body skin exams and completed electronic questionnaires. AD severity was assessed with the Eczema Area and Severity Index (EASI), Scoring Atopic Dermatitis (SCORAD) total and itch subscores, Investigator’s Global Assessment (IGA), Patient-reported Global Assessment of atopic dermatitis severity, and the Patient-Oriented Eczema Measure (POEM).
The researchers also assessed the frequency of sleep disturbances, including difficulty falling asleep and staying asleep, and used multivariable logistic regression models to evaluate associations of age (65 and older vs 18-64 years) with AD severity, sleep disturbance or fatigue, controlling for total POEM score, sex, and race.
Using adjusted odds ratios, Manjunath and Silverberg found that being age 65 or older was not associated with AD severity on the EASI (adjusted odds ratio [AOR], 1.47); total Scoring Atopic Dermatitis (aOR, 1.10), and itch subscore (aOR, 1.00); IGA (aOR, 1.87); patient-reported Global Assessment of AD severity (aOR 0.80), or the patient-oriented eczema measure (aOR, 0.55), associations that were not statistically significant.
However, the researchers found that older adult age was associated with an increased number of nights of sleep disturbance from AD in the past week (aOR, 2.14; P = .0142), as well as increased fatigue in the past 7 days (aOR, 1.81; P = .0313), trouble sleeping in the past 7 days (aOR, 1.98; P = .0118), and trouble staying asleep in the past 7 days (aOR, 2.26; P = .0030), but not with difficulty falling asleep in the last 7 days (aOR, 1.16; P = .5996).
“Future studies are needed to determine why geriatric AD patients have increased sleep disturbance and optimal interventions to address their sleep disturbance,” the researchers concluded.
The study was supported by the Agency for Healthcare Research and Quality, the Dermatology Foundation, and by an unrestricted grant from Galderma. Manjunath has disclosed no relevant financial relationships. Silverberg reported that he is a consultant to and/or an advisory board member for several pharmaceutical companies. He is also a speaker for Regeneron and Sanofi and has received a grant from Galderma.
Doug Brunk is a San Diego-based award-winning reporter for MDedge and Medscape who began covering healthcare in 1991. He is the author of two books related to the University of Kentucky Wildcats men’s basketball program.