Study: Frequent AD Flares Forecast Worse Outcomes in Following Year

Key Takeaways

• Frequent flares of atopic dermatitis (AD) were associated with more severe disease and poorer quality of life after a period of 1 year, new research suggests.

• Top predictors of disease burden included flare severity, duration, and number.

Frequent flares of atopic dermatitis (AD) are predictive of worse disease severity and reduced quality of life, according to findings from a large cohort study.

Researchers for the study examined data from the Danish Skin Cohort and included 878 adult patients with AD in the study, focusing on whether flare frequency in 2022 could predict disease burden in 2023. Median age was 49 years.

According to the study, the number of flares reported in 2022 was associated with multiple patient-reported severity measures after 1 year. Prior-year flares were predictive of higher scores on the Patient-Oriented Eczema Measure (POEM) and Dermatology Life Quality Index (DLQI), even after adjustment for baseline Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), 

“Flare severity, duration, and frequency emerged as among the strongest predictors of disease severity in 2023,” the researchers wrote. “Conversely, baseline AD severity also significantly predicted future flare frequency.”

The bidirectional relationship between disease severity and flare patterns was reinforced by boosted random forest models, emphasizing the prognostic relevance of capturing flare metrics in clinical settings. The authors said the study calls into question the limited emphasis flares are currently given in guiding treatment decisions.

“This study helps support the efficacy and safety of lebrikizumab in patients with skin of color and Fitzpatrick skin phototypes 4-6, a population for which data has been historically limited," Andrew Alexis, MD, a dermatologist at Weill Cornell Medicine, told Practical Dermatology. "The inclusion of novel endpoints such as improvement in AD-related post inflammatory pigment changes helps to improve our understanding of this important sequela of AD that contributes to the burden of disease in patients with skin of color.”

Source: Nielsen ML, et al. JAMA Dermatology. 2025. doi:10.1001/jamadermatol.2025.2073