<p>For years, objective measures dominated studies in atopic dermatitis (AD), but patient-reported outcomes (PROs) offer crucial insights into treatment success and patient well-being. Tools such as the Atopic Dermatitis Control Tool (ADCT) and the Recap of atopic eczema (RECAP) instrument can tell clinicians how their patients are feeling and whether they are benefiting from their treatment.</p>

When I was in training and for the first 10 or 15 years of my career, I did not put much faith in PROs because I thought that objective measures were much better. However, as I have gotten older (and ostensibly wiser), I have come to realize that PROs may actually be more important than objective measures because they really cut to the heart of what we are trying to achieve, which is for the patient to be happy.

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What is the optimal outcome of using a medicine for AD? Is it clear skin? While that may be true, clearing the skin may also come with additional costs that are difficult to measure. At the end of the day, I really want my patient to be happy. Even if their rash is perfectly cleared or their itch is much better, if they are not happy for some other reason, that is important. Dissatisfaction may be related to an adverse event or because it is onerous to use a treatment, but it is difficult to know that without really understanding the patient perspective. The most important metric is the patient’s response when we ask them if they like the treatment.

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The Harmonising Outcome Measures for Eczema (HOME) initiative now has 2 PROs that it recommends at the top of its list. The first is the ADCT, which I use for every patient with AD at my practice. It is an easy questionnaire consisting of 6 questions; it takes 1 minute for a patient to complete the questionnaire, and it captures so much. I would much rather see data from an ADCT than from a Scoring Atopic Dermatitis (SCORAD) index or actigraphy. I remember when, years ago, everyone was using those actigraphy bracelets that measure movement at night to capture how much people with AD were scratching. I would push back on that and say that you could just ask the patient how they are sleeping. In my opinion, the use of actigraphy was the triumph of technology over common sense.

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The other PRO that the HOME group endorses is the RECAP instrument, which is very similar to the ADCT. In addition, there are other tools used in other diseases, and one of the most important is the Dermatology Life Quality Index (DLQI). While very useful and important, I find that the DLQI is a bit cumbersome to use outside of research, so I rarely use it in routine clinical practice. Finally, of all the symptoms that patients presenting with AD and itch face, sleep is perhaps the single most important one because that really tells us how patients are doing in a very practical way. If they are not sleeping well, then—to some degree—everything else really does not matter.