Clinical Phenotyping of Atopic Dermatitis Using Combined Global Severity (POEM) and Facial Burden (BoFA)

Atopic dermatitis (AD) is characterized by substantial clinical heterogeneity. Global severity is typically assessed using scores such as the POEM; however, lesion localization -- particularly on the face -- may generate psychosocial consequences partly independent of overall disease severity. This cross-sectional observational study (VISEABLE) included 1,400 French adults with physician-confirmed AD. Severity was measured using the POEM (Clear/Almost Clear: 0-7 vs. Moderate-severe: ≥8) and facial involvement using the BoFA (0-109; threshold=36, population median). Six phenotypes were defined through a 2×3 combination. The POEM and BoFA correlation was moderate (r=0.365; ρ=0.389; p<0.001). Phenotype Ph3 (Clear/Almost Clear POEM / Severe facial involvement, n=58) exhibited stigmatization scores (PUSH-d=21.93) and life trajectory impact (DLLIM=14.76) not significantly different from Ph4 (Moderate-severe POEM / No facial involvement, n=527; p>0.25 for all comparisons). In multiple regression analysis restricted to patients with facial involvement, BoFA was the dominant independent predictor of stigmatization (β=11.44, p<0.001; partial R²=46.2 %; overall R²=0.532), superseding POEM (p=0.076, ns; partial R²=0.6%). Mild eczema with severe facial involvement generates a psychosocial burden comparable to that of moderate-to-severe eczema without facial involvement. Systematic BoFA assessment is essential in all patients with AD.

Abstract from PubMed