Pain Severity and Use of Analgesic Medication in Adults With Atopic Dermatitis

A Cross-sectional Study

J.P. Thyssen; A.-S. Halling-Sønderby; J.J. Wu; A. Egeberg


The British Journal of Dermatology. 2020;182(6):1430-1436. 

In This Article

Abstract and Introduction


Background: Adult patients with atopic dermatitis (AD ) report skin pain, but the relationship with disease severity, anatomical location and use of pain medication is unclear.

Objectives: To examine pain in adults with AD .

Methods: We performed a cross-sectional study of nationwide healthcare data and survey data from the Danish Skin Cohort. In total, 3208 randomly selected adults from the general population and 3834 adults with a dermatologist-verified diagnosis of AD present in adulthood were included. Patient-Oriented SCOR ing Atopic Dermatitis determined AD severity, and numerical rating scales estimated the severity of pruritus and skin pain. Complete information on the use of analgesic medication was obtained from the Danish nationwide prescription registry.

Results: Respectively, 6·8%, 55·5%, 34·0% and 3·7% of the AD cohort reported that they were asymptomatic, or had mild, moderate or severe disease at the time of assessment. Skin pain was positively associated with AD severity and itch. Higher skin pain scores were observed in plantar, chest and palmar areas. Use of pain medication was not increased in patients with AD .

Conclusions: Patients with AD did not display increased use of pain medication, but few had severe disease. The close relationship observed between itch and pain highlights the potential benefits of established AD treatments to also reduce skin pain in AD .


Atopic dermatitis (AD) is a common chronic inflammatory skin condition. Nearly all affected patients suffer from chronic and relentless itch, which may be located at both lesional and nonlesional skin. The partly neglected association between AD and skin pain has been highlighted in recent epidemiological studies, and the association is increasingly acknowledged.[1–3] Several explanations for the associated skin pain may be put forward, including a burning skin sensation from AD and topical medication, as well as painful fissured skin. To our knowledge, there is no mention of skin pain assessment or treatment in any current guidelines or consensus reports.

Previous studies on skin pain in AD have been relatively small, and it has therefore not been firmly established whether disease severity and itch are associated with skin pain, and whether certain anatomical areas are particularly prone to skin pain. Importantly, it is currently unknown whether the increased occurrence of skin pain translates into increased consumption of pain medication.

In the present cross-sectional study, we examined the characteristics of skin pain in adult patients with AD and whether pain was associated with an increased number of dispensed prescriptions of pain medication.