QWhat is Atopic Dermatitis Spectrum Disorder?

The concept that certain diseases may manifest as a “spectrum” has never been introduced to the specialty of dermatology but is well established in the field of psychiatry with “autism spectrum disorder” as a prime example. Atopic dermatitis (AD) is remarkable in its heterogenous clinical manifestations. AD not only presents differently according to the patient’s age, ethnic background/skin phototype, etc, but it is also associated with many different clinical features which have been considered critical for making the diagnosis of AD. With more than 40 different clinical manifestations of atopic dermatitis, it is not surprising that the field of dermatology has created more than 10 different diagnostic criteria for the diagnosis of AD.

The concept that AD is a spectrum disorder was introduced years ago by John Koo, MD, who is board certified in both psychiatry and dermatology. Subsequently, a consensus meeting was held involving 10 key opinion leaders in atopic dermatitis. The group concluded that AD is, in fact, a spectrum disorder. Adapting this terminology of “atopic dermatitis spectrum disorder” may eliminate the confusion that results from the presence of the more than 10 different diagnostic criteria published in the medical literature. The practical implication of adopting this concept and the terminology of “atopic dermatitis spectrum disorder” is numerous and ultimately benefits the patient.

The concept of atopic dermatitis spectrum disorder allows patients to access effective treatments much more readily. For example, many patients with pruritus and lichen simplex chronicus may, in fact, have underlying atopic dermatitis, but it might not be obvious on any given clinic visit. If the clinician writes the diagnosis as “lichen simplex chronicus,” most insurance companies will deny medications such as dupilumab because it is considered off label. This approach will not unfairly deny access to all the AD medications we have available for the patients who often present with partial and different manifestations of AD at each visit.

References:

1. Vakharia PP, Chopra R, Silverberg JI. Systematic Review of Diagnostic Criteria Used in Atopic Dermatitis Randomized Controlled Trials. Am J Clin Dermatol. 2018;19(1):15-22. doi:10.1007/s40257-017-0299-4
2. Butler DC, Simpson E, Guttman-Yassky E, et al. The atopic dermatitis spectrum disorder. Recognizing the clinical heterogeneity in patients with atopic related skin conditions in order to improve therapeutic decision-making and outcomes: an expert panel consensus statement. J Dermatol Treat. 2022;33(4):2397-2399. doi:10.1080/09546634.2021.1966356
3. Butler DC, Koo J. Atopic dermatitis spectrum disorder: new conceptualization for the coming new therapeutic era. J Dermatol Treat. 2018;29(8):743-744. doi:10.1080/09546634.2018.1527433