Abstract
-
Purpose
Atopic dermatitis (AD) in adolescents has received less attention than AD in infants and children. However, AD can persist or worsen after school age and affect health-related quality of life (HRQoL) beyond adolescence. This study aimed to examine HRQoL and its associated factors among adolescents with AD, guided by Roy’s Adaptation Model.
-
Methods
This cross-sectional study was conducted between May and August 2023 and included adolescents aged 13–18 years with AD. Data on symptom experience, body image, peer relationships, self-management, HRQoL, and general and disease-related characteristics were collected using self-report questionnaires and electronic medical records. Data were analyzed using descriptive statistics, the independent t-test, analysis of variance, Pearson correlation analysis, and multiple regression analysis.
-
Results
A total of 97 adolescents with AD participated in the study, including 60 males (61.9%) and 37 females (38.1%). Participants were aged 13–18 years, with a mean age of 15.8±1.7 years. HRQoL was negatively correlated with symptom experience and positively correlated with body image, peer relationships, and self-management. Multiple regression analysis showed that allergen sensitization, symptom experience, and self-management were significantly associated with HRQoL, explaining approximately 40.0% of the variance.
-
Conclusion
Symptom experience and self-management were identified as key factors associated with HRQoL among adolescents with AD. Interventions aimed at reducing symptom burden and promoting active self-management are essential for improving HRQoL. These findings highlight the need to support adolescents’ independence and underscore the importance of personalized education and effective self-management programs.
-
Key words: Adolescent; Atopic dermatitis; Quality of life; Self-management
INTRODUCTION
Atopic dermatitis (AD) is a chronic and relapsing skin condition characterized by severe itching [
1]. It generally occurs before school age and may improve with age [
2]. However, AD can persist or worsen after school age [
3], and adolescents with AD therefore require continuous attention and appropriate management strategies.
The symptoms of AD include itchiness, rashes, and dryness that become increasingly chronic, with skin thickening, lichenification, and sleep disturbances [
4]. Adolescents with AD often experience a chronic and relapsing disease course characterized by repeated remission and exacerbation of symptoms, making sustained remission difficult [
5]. In this context, they are likely to experience a range of physical, psychological, and social problems [
4,
6].
Adolescents with AD often have visible skin lesions on the face and neck [
7]. Such visible symptoms may negatively affect body image during adolescence, a developmental period marked by increased concern about appearance, and may consequently interfere with the formation of self-concept [
7,
8]. In addition, AD may restrict daily activities, and adolescents may feel embarrassed about their skin condition, which can negatively influence peer relationships—an important aspect of social development during adolescence [
9,
10]. Furthermore, adolescents with AD are required to engage in long-term daily management, including avoidance of environmental triggers, skin care, and medication adherence [
11]. As adolescents spend more time at school than at home, self-management plays a particularly important role in their daily lives.
However, despite the significant impact of AD on adolescents’ HRQoL, research focusing specifically on adolescents remains limited compared to studies on children (or their caregivers) and adults [
12,
13]. Previous studies on adolescents with AD have primarily focused on treatment effects [
14,
15] or have relied on general dermatology-specific quality of life measures [
2,
16], with limited attention to the broader psychosocial and self-management factors influencing HRQoL. Moreover, there is a lack of studies that comprehensively examine these factors, particularly from a conceptual perspective that considers adolescents’ adaptation to chronic conditions. Addressing these gaps is essential to better understand the multidimensional needs of adolescents and to develop effective nursing interventions.
Previous studies have identified several factors associated with HRQoL in adolescents with AD, including symptom experience, body image, peer relationships, self-management [
17-
20]. Therefore, these variables were selected as key factors potentially influencing HRQoL in adolescents with AD. These factors can be conceptually understood using the Adaptation Model by Roy [
21], which offers a useful framework for explaining adaptation to chronic health conditions.
This study aimed to examine HRQoL and its associated factors among adolescents with AD, based on the Adaptation Model by Roy [
21]. In addition, this study sought to explore these factors from a conceptual perspective informed by the Adaptation Model by Roy [
21]. The findings may provide foundational data for developing nursing interventions to support positive adaptation in adolescents with AD.
The Adaptation Model by Roy [
21] has been widely used to understand how individuals adapt to chronic health conditions and maintain quality of life. In this study, the model was used as a conceptual framework to guide the identification and organization of factors potentially associated with HRQoL in adolescents with AD. In the model by Roy [
21], the regulator subsystem processes physiological stimuli through automatic neuroimmune responses-manifesting as symptom experience-while the cognator subsystem appraises these disruptions cognitively and emotionally, shaping adaptive responses across the self-concept (body image), role function (peer relationships), and interdependence (self-management) modes, which collectively determine HRQoL as an indicator of adaptation. Variables such as symptom experience, body image, peer relationships, and self-management were considered in relation to different aspects of adaptation. However, this study focused on examining the associations between these variables and HRQoL rather than testing the theoretical structure of the model.
The conceptual framework of the study is illustrated in
Supplement 1.
METHODS
Ethical statements: This study was approved by the Institutional Review Board (IRB) of Ajou University Hospital (IRB No. AJOUIRB-SB-2023-215). Written informed consent was obtained from the participants as well as their legal guardians.
1. Study Design and Participants
This cross-sectional study was conducted at the allergy department of a university hospital in South Korea from May 17 to August 31, 2023. This study was reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Participants were adolescents aged 13–18 years diagnosed with AD who were able to communicate in Korean. Written informed consent was obtained from both the adolescents and one of their parents. First-time visitors were excluded.
The required sample size was calculated using G*Power ver. 3.1.9.7 (Heinrich-Heine-Universität Düsseldorf) for multiple linear regression analysis (test family: F tests, statistical test: linear multiple regression: fixed model, R2 deviation from zero). Based on an effect size (Cohen’s f2) of .30, and a significance level (α) of .05, a statistical power of .95, and 6 planned predictors, the minimum required sample size was 77. Considering a potential dropout rate of 20%, a total of 97 participants were recruited.
Data were collected using self-report questionnaires, complemented by electronic medical records. Participants were referred by their allergists and completed the questionnaire in the presence of the researcher, who provided assistance if needed. Completion took approximately 20 minutes, and questionnaires were returned in sealed envelopes. Participants received a small gift in appreciation of their participation.
2. Participants’ Characteristics
Participants’ characteristics included general characteristics and disease-related characteristics. General characteristics were collected using a basic data sheet and included sex, age, height, weight, comorbid allergic diseases, family history of AD, and main sources of information about AD. Body mass index (BMI) was calculated based on age- and sex-specific pediatric growth charts.
Disease-related characteristics were obtained from electronic medical records, including the date of first visit, outpatient visit cycle, allergen sensitization, and main treatment. Allergen sensitization was assessed using serum-specific immunoglobulin E tests for common allergens or a skin prick test.
3. Measures
HRQoL was measured using the Korean version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scale, originally developed by Varni et al. [
22] and validated by Kook and Varni [
23]. The instrument includes 23 items across 4 subscales: physical functioning (8 items), emotional functioning (5 items), social functioning (5 items), and school functioning (5 items). All items are rated on a 5-point Likert scale (0=never, 1=rarely, 2=sometimes, 3=often, and 4=almost always). The items are reverse-scored and linearly transformed to a 0–100 scale (0=100, 1=75, 2=50, 3=25, and 4=0). The total HRQoL score is calculated as the mean of the transformed item scores, resulting in a final score ranging from 0 to 100, with higher scores indicating better HRQoL. Cronbach’s α of the PedsQL 4.0 Generic Core Scale was .89 in the original study [
22] and .90 in the Korean validation study [
23]. In this study, Cronbach’s α was .91.
Symptom experience was measured using the Korean version of the Patient Oriented Eczema Measure (POEM), originally developed by Charman et al. [
24]. This tool consists of 7 questions that measure the number of days one experienced the following symptoms of AD in the past week: dry skin, itchy skin, flaking skin, cracking skin, sleep disturbances, bleeding, and weeping. The questions are rated on a 5-point Likert scale (0=none, 1=1–2 days, 2=3–4 days, 3=5–6 days, and 4=every day). The total score ranges from 0 to 28, and higher scores indicate more frequent experience of symptoms. A total score of 0–2, 3–7, 8–16, 17–24, and 25–28 denotes clear/almost clear, mild, moderate, severe, and very severe AD, respectively, according to the tool developer’s classification criteria. Cronbach’s α was .88 when the POEM was developed [
24] and .88 in this study.
Body image was measured using the Body-Esteem Scale for Adolescents and Adults developed by Mendelson et al. [
25] and translated into Korean by Park [
8]. The instrument consists of 23 questions across 3 subscales: weight satisfaction, general feelings about appearance, and evaluations attributed to others about one’s body and appearance. All questions are answered on a 5-point Likert scale (5=very much, 4=somewhat, 3=moderately, 2=not very much, and 1=not at all). Nine questions (Items 4, 7, 9, 11, 13, 17, 18, 19, and 21) are reverse coded. The total scores range from 23 to 115, with higher scores indicating more positive perceptions of and respect for one’s body. Cronbach’s α ranged from .75 to .96 when this tool was developed [
25] and .90 for the total scale in the study by Park [
8]. In this study, Cronbach’s α was .93.
Peer relationships were measured using a scale developed and validated by Bae et al. [
26]. Eight items measure positive peer relationships and 5 measure negative peer relationships. All items are rated on a 5-point Likert scale, ranging from 5 (strongly agree) to 1 (strongly disagree). The 5 items measuring negative peer relationships (Items 9, 10, 11, 12, and 13) are reverse scored. The total score ranges from 13 to 65, with higher scores indicating better peer relationships. The Cronbach’s α at the time of its development was .84, and .84 in this study.
Self-management in adolescents with AD was measured using a modified and adapted version of the treatment adherence tool originally developed by Kim and Choi [
12] for caregivers of infants and toddlers with AD. The original tool consisted of 21 items; the modified tool comprised 15 items. Permission to use and adapt the tool was obtained from the original developers. To ensure its applicability to adolescents, content validity was assessed by 5 experts [
27], including an allergist, a pediatrician, an allergy coordinator, and 2 educational nurses from the Gyeonggi-do Atopic Asthma Education and Information Center. Items with a content validity index of 0.80 or higher were retained. In addition, items were revised based on expert feedback and relevant guidelines for the preventive management of allergic diseases published by the Korea Centers for Disease Control and Prevention in 2022. The final instrument included 4 domains: outpatient visits, skin care, medication adherence, and daily life management. All items are scored on a 5-point Likert scale (1=never, 2=rarely, 3=fairly, 4=fairly well, and 5=very well), with total scores ranging from 15 to 75. Higher scores indicate better self-management. Cronbach’s α was .88 when the tool was developed and .81 in this study. However, the construct validity and factor structure of the modified instrument were not examined in this study. Despite being adapted from a caregiver-reported instrument, the modified self-management tool demonstrated acceptable internal consistency in this adolescent sample.
The data were analyzed using descriptive statistics, independent t-tests, analysis of variance, Pearson correlation coefficients, and multiple regression analysis. All statistical analyses were performed using IBM SPSS Statistics ver. 27.0 (IBM Corp.).
No missing data were observed. Prior to conducting the regression analysis, assumptions including normality, linearity, homoscedasticity, and multicollinearity were examined. Linearity and homoscedasticity were assessed using scatterplots of standardized residuals versus standardized predicted values, and normality was evaluated using normal P–P plots of standardized residuals. Multicollinearity was assessed using variance inflation factors (VIF) and tolerance values. All diagnostic criteria were satisfied.
RESULTS
1. Characteristics of the Participants
Table 1 presents the general and disease-related characteristics of the participants. A total of 97 adolescents with AD (60 male and 37 female) aged 13–18 years (mean±standard deviation=15.8±1.7) participated in the study. Of these, 77 participants reported having comorbid allergic diseases (allergic rhinitis, allergic conjunctivitis, asthma, and food allergies). A family history of AD was reported by 46 participants (47.4%). The main source of information about AD was hospitals (healthcare organizations), with 65 participants (67%) receiving the information from hospitals. Furthermore, most participants (94.8%) reported having an allergen, and the most common allergen was house dust mites (91.8%)
2. Levels of Symptom Experience, Body Image, Peer Relationships, Self-management, and HRQoL
Table 2 presents the descriptive statistics of the study variables. The mean score for symptom experience was 9.33±7.27 on a scale of 0 to 28. Regarding symptom severity, 53 participants (54.6%) reported having moderate or more severe symptoms. Dry skin was the most common symptom, followed by itchy skin, flaky skin, cracking skin, sleep disturbances, bleeding skin, and weeping skin.
The scores for body image ranged from 37 to 108 with a mean score of 73.61±15.42. Regarding the subscales, the mean score was 33.22±7.49 for general feelings about appearance, 25.00±6.34 for weight self-esteem, and 15.39±3.89 for evaluations attributed to others about one’s body and appearance, with the mean score being the highest for general feelings about appearance and the lowest for evaluations attributed to others about one’s body and appearance.
The mean score for peer relationships was 51.87±7.16 on a scale from 13 to 65 and 55.31±8.63 for self-management on a scale from 15 to 75. The mean score for the overall HRQoL was 83.45±13.34. Regarding the subscales, the mean score was the highest for the social functioning (92.68±10.97), followed by the physical functioning (82.80±15.82), school functioning (80.00±17.31), and emotional functioning (78.71±20.93).
3. Differences in Symptom Experience, Body Image, Peer Relationships, Self-management, and HRQoL Based on Participants’ Characteristics
As shown in
Table 3, there was a statistically significant difference in symptom experience depending on age (F=3.255,
p=.043), and the 17–18 age group experienced more symptoms than the 15–16 age group. Symptom experience also differed significantly depending on the source of information (F=3.662,
p=.029). Body image differed significantly depending on BMI (t=2.979,
p=.004), and participants with underweight and normal BMI had more favorable perceptions of their body image than those with overweight and obese BMI.
Regarding peer relationships, women scored higher than men on peer relationships (t=–2.139, p=.035). Peer relationships also differed significantly depending on the source of information (F=3.118, p=.049). Self-management scores were higher among the participants who had a family history of allergy diseases (t=–2.410, p=.018). Finally, the HRQoL differed significantly depending on allergen sensitization, with the HRQoL being greater among participants who did not have allergens than among those who had allergens (t=3.223, p=.012).
4. Correlations of Symptom Experience, Body Image, Peer Relationships, and Self-management with HRQoL
As shown in
Table 4, HRQoL was negatively correlated with symptom experience (r=−.488,
p<.001) and positively correlated with body image (r=.413,
p<.001), peer relationships (r=.259,
p=.011), and self-management (r=.324,
p=.001). When symptom experience scores were classified based on severity and the resulting differences in HRQoL were further analyzed, participants with “mild” symptom severity had the highest scores for HRQoL, while those with “very severe” symptom severity had the lowest scores (F=6.932,
p<.001).
Before conducting the multiple regression analysis, assumptions were examined. Multicollinearity was assessed using VIF and tolerance values. All VIF values were below 10 and tolerance values exceeded 0.1, indicating no significant multicollinearity. Other assumptions of regression, including normality, linearity, and homoscedasticity, were also satisfied.
As shown in
Table 5, a multiple linear regression analysis was performed to determine the factors affecting the HRQoL of adolescents with AD. Allergen sensitization (β=−.190,
p=.022), symptom experience (β=−.454,
p<.001), and self-management (β=.248,
p=.004) were statistically significant, explaining approximately 40.0% of the variance.
A post-hoc power analysis was conducted using G*Power ver. 3.1.9.7. Based on the observed effect size (R2=.400), significance level (α=.05), sample size (N=97), and 6 predictors, the statistical power (1−β) was calculated to be .999, indicating sufficient statistical power.
DISCUSSION
This study identified symptom experience, self-management, and allergen sensitization as significant factors influencing the HRQoL of adolescents with AD.
Symptom experience was the most influential factor associated with HRQoL, indicating that the severity and frequency of symptoms are key determinants of adolescents’ quality of life. Adolescents with AD often experience a vicious cycle in which skin barrier damage triggers inflammatory responses, further impairing skin barrier function and leading to persistent symptoms. In this study, 54.6% of participants had moderate to severe AD, and more than half reported experiencing dry skin and pruritus for at least 3−4 days per week. These symptoms are known to have the greatest impact on quality of life in individuals with AD [
4,
28]. Effective management of these symptoms is essential to prevent disease progression and chronicity [
29]. Therefore, nursing interventions should focus on early symptom recognition and continuous symptom monitoring, as well as individualized strategies to manage fluctuation in symptom severity. In addition, practical education is needed to help adolescents manage common symptoms such as pruritus and dry skin in their daily lives.
Self-management was also identified as a significant factor influencing HRQoL. In this study, adherence to outpatient visits and medication was relatively high, whereas scores for skin care and daily life management—including indoor temperature and humidity control, dietary management, and bathing habits-were relatively low. This indicates that caregiver-led management is well established, while adolescents’ active self-management remains insufficient. Although symptom experience showed the strongest association with HRQoL, self-management also demonstrated a meaningful and independent effect, indicating that adolescents who actively engage in managing their condition tend to report better HRQoL. Self-management has been shown to improve quality of life in adolescents with chronic disease [
30]. The European Academy of Allergy and Clinical Immunology also emphasizes that strengthening self-management in adolescents with allergic diseases can help reduce dependence on caregivers. Given that AD is a chronic condition that often persists from childhood into adulthood, it is important to support adolescents in gradually taking responsibility for their own care.
Although self-management programs for adolescents with AD are still limited, similar programs have been widely implemented in other chronic conditions, such as asthma and type 1 diabetes [
31,
32]. Previous studies have shown that educational interventions, including those delivered by nurses, can improve disease knowledge and self-management behaviors in adolescents with chronic conditions [
31,
33]. Therefore, nursing interventions should not only focus on symptom reduction but also support adolescents in developing practical self-management skills in their daily lives. For example, nurses can provide individualized education on skin care routines, itch management strategies, and environmental control, while also encouraging adolescents to monitor their symptoms and treatment adherence. Supporting adolescents’ active engagement in daily self-management may help improve HRQoL.
Allergen sensitization was also found to be associated with HRQoL. This may reflect the burden and fatigue associated with long-term avoidance of triggering factors. However, this finding should be interpreted with caution, as the number of participants without identified allergens was relatively small. In addition, allergen sensitization was assessed based on medical records, and it was not confirmed whether adolescents were aware of their own triggers. Future studies should examine adolescents’ awareness of allergen triggers, their coping strategies, and their impact on HRQoL.
In this study, HRQoL was measured using the PedsQL 4.0 Generic Core Scale. While many previous studies in patients with AD have used dermatology-specific instruments such as the Children’s Dermatology Life Quality Index [
2,
16,
17], limiting direct comparisons, the use of a generic HRQoL measure allowed comparison with adolescents with other chronic conditions. The HRQoL of adolescents with AD in this study was found to be comparable to that of adolescents with other chronic conditions reported in previous studies [
34,
35]. These findings suggest that although AD is not a life-threatening condition, its chronic and relapsing nature can have a substantial impact on multiple aspects of adolescents’ lives [
19]. Therefore, it is important to assess and address not only dermatological symptoms but also overall HRQoL in adolescents with AD.
Overall, the findings of this study emphasize the importance of a comprehensive approach to improving HRQoL in adolescents with AD, including effective symptom management, enhancement of adolescents’ self-management capacity, and consideration of environmental factors. These results provide important implications for the development of nursing interventions aimed at supporting adolescents’ adaptation to chronic conditions.
This study has several limitations. First, the relatively small sample size and the use of convenience sampling from a single university hospital may limit the generalizability of the findings and introduce potential regional bias. Second, although the self-management instrument was adapted for adolescents, its psychometric properties were not fully validated in this population. While content validity was established, construct validity and factor structure were not examined, which may limit the interpretation of the findings. Therefore, the results related to self-management should be interpreted with caution. Third, data were collected using self-reported questionnaires, which may have introduced response bias. In addition, allergen sensitization was assessed based on medical records, and participants’ awareness of their own allergen triggers was not evaluated.
Future studies should include larger, multi-center samples with adolescents with AD from diverse regions, clinical settings, and varying levels of disease severity to enhance the generalizability of the findings. In addition, longitudinal study designs are needed to better understand changes in HRQoL over time. Further research is also required to validate the psychometric properties of the self-management instrument for adolescents with AD, including construct validity and factor structure assessment. Moreover, future studies should explore adolescents’ awareness of allergen triggers and their coping strategies in relation to HRQoL.
CONCLUSION
This study identified symptom experience, self-management, and allergen sensitization as key determinants of HRQoL in adolescents with AD. Pediatric nurses play an important role in supporting adolescents to develop the knowledge and skills necessary for proactive symptom management. Nursing interventions should consider strategies to reduce symptom experience, particularly itchiness and dry skin, and provide individualized education tailored to adolescents’ needs. In addition, appropriate self-management programs, including guidance on skin care, lifestyle management, and allergen avoidance, may help adolescents actively manage their condition. Such approaches may contribute to improvements in HRQoL and support better long-term health outcomes.
ARTICLE INFORMATION
Supplementary material
Table 1.Socio-demographic and clinical characteristics of participants (N=97)
|
Characteristic |
Value |
|
Sex |
|
|
Male |
60 (61.9) |
|
Female |
37 (38.1) |
|
Age (yr) |
15.8±1.7 |
|
13–14 |
25 (25.8) |
|
15–16 |
37 (38.1) |
|
17–18 |
35 (36.1) |
|
Education level |
|
|
Middle school |
34 (35.1) |
|
≥High school |
63 (64.9) |
|
Body mass index (kg/m2) |
22.27±4.05 |
|
Underweight |
5 (5.1) |
|
Normal |
61 (62.9) |
|
Overweight |
12 (12.4) |
|
Obesity |
19 (19.6) |
|
Comorbid allergic diseasesa)
|
|
|
0 |
20 (20.6) |
|
1 |
40 (41.2) |
|
≥2 |
37 (38.2) |
|
Allergic rhinitis |
68 (70.1) |
|
Allergic conjunctivitis |
11 (11.3) |
|
Asthma |
19 (19.6) |
|
Food allergy |
32 (33.0) |
|
Family history of ADa)
|
|
|
No |
51 (52.6) |
|
Yes |
46 (47.4) |
|
Parents |
25 (25.8) |
|
Siblings |
23 (23.7) |
|
Other relatives |
6 (6.2) |
|
Information sources |
|
|
Hospital |
65 (67.0) |
|
Internet/media |
24 (24.8) |
|
Family |
8 (8.2) |
|
Treatment period (yr) |
2.0 (0.7–3.8) |
|
<1 |
29 (29.9) |
|
1–2 |
36 (37.1) |
|
≥3 |
32 (33.0) |
|
Outpatient visit cycle (mo) |
1.5 (1.1–2.3) |
|
<1 |
15 (15.4) |
|
1 |
51 (52.6) |
|
≥2 |
31 (32.0) |
|
Allergen sensitization |
|
|
No |
5 (5.2) |
|
Yes |
92 (94.8) |
|
Treatment |
|
|
Basic care/topical medication |
22 (22.6) |
|
Systemic immunosuppressants |
6 (6.2) |
|
Immunotherapy |
54 (55.7) |
|
Biologics |
15 (15.5) |
Table 2.Levels of symptom experience, body image, peer relationships, self-management, and health-related quality of life (N=97)
|
Variable |
Value |
Possible range |
Actual range |
|
Symptom experience |
9.33±7.27 |
0–28 |
0–28 |
|
Clear/almost clear |
25 (25.8) |
|
|
|
Mild |
19 (19.6) |
|
|
|
Moderate |
37 (38.1) |
|
|
|
Severe |
14 (14.4) |
|
|
|
Very severe |
2 (2.1) |
|
|
|
Body image |
73.61±15.42 |
23–115 |
37–108 |
|
Weight satisfaction |
25.00±6.34 |
8–40 |
11–40 |
|
General feelings about appearance |
33.22±7.49 |
10–50 |
18–49 |
|
Evaluations attributed to others about one’s body and appearance |
15.39±3.89 |
5–25 |
7–25 |
|
Peer relationships |
51.87±7.16 |
13–65 |
31–65 |
|
Self-management |
55.31±8.63 |
15–75 |
31–74 |
|
Health-related quality of life |
83.45±13.34 |
0–100 |
44–100 |
|
Physical health |
82.80±15.82 |
0–100 |
18–100 |
|
Emotional health |
78.71±20.93 |
0–100 |
10–100 |
|
Social functioning |
92.68±10.97 |
0–100 |
55–100 |
|
School functioning |
80.00±17.31 |
0–100 |
10–100 |
Table 3.Differences in symptom experience, body image, peer relationships, self-management, health-related quality of life by characteristics of the participants (N=97)
|
Variable |
Symptom experience |
Body image |
Peer relationships |
Self-management |
HRQoL |
|
Mean±SD |
F/t (p) |
Mean±SD |
F/t (p) |
Mean±SD |
F/t (p) |
Mean±SD |
F/t (p) |
Mean±SD |
F/t (p) |
|
Gender |
|
–0.827 (.411) |
|
0.805 (.423) |
|
–2.139 (.035*) |
|
0.980 (.330) |
|
1.626 (.107) |
|
Male |
8.85±6.94 |
|
74.60±15.11 |
|
50.67±7.08 |
|
55.98±7.94 |
|
85.16±12.83 |
|
|
Female |
10.11±7.80 |
|
72.00±15.99 |
|
53.81±6.96 |
|
54.22±9.65 |
|
80.66±13.84 |
|
|
Age (yr) |
|
3.255 (.043*) |
|
0.239 (.788) |
|
0.318 (.728) |
|
0.087 (.917) |
|
1.663 (.195) |
|
13–14a
|
9.00±7.23 |
b<c |
71.80±16.63 |
|
52.84±7.82 |
|
54.80±9.88 |
|
85.17±14.21 |
|
|
15–16b
|
7.38±6.34 |
|
73.97±16.41 |
|
51.41±6.24 |
|
55.24±8.37 |
|
85.37±12.83 |
|
|
17–18c
|
11.63±7.75 |
|
74.51±13.70 |
|
51.66±7.72 |
|
55.74±8.17 |
|
80.19±12.97 |
|
|
Education level |
|
–0.825 (.412) |
|
–1.059 (.292) |
|
0.877 (.383) |
|
–1.024 (.308) |
|
1.318 (.191) |
|
Middle school |
8.50±6.90 |
|
71.35±16.30 |
|
52.74±6.99 |
|
54.09±9.19 |
|
85.87±13.44 |
|
|
≥High school |
9.78±7.48 |
|
74.83±14.91 |
|
51.40±7.26 |
|
55.97±8.30 |
|
82.14±13.20 |
|
|
Comorbid allergic diseases |
|
2.754 (.069) |
|
0.322 (.725) |
|
0.611 (.545) |
|
1.038 (.358) |
|
0.186 (.830) |
|
0 |
12.65±7.05 |
|
73.90±18.36 |
|
53.20±5.77 |
|
56.85±6.62 |
|
83.64±11.08 |
|
|
1 |
8.27±6.87 |
|
72.18±14.08 |
|
51.05±6.97 |
|
55.97±8.88 |
|
84.29±15.50 |
|
|
≥2 |
8.68±7.47 |
|
75.00±15.40 |
|
52.03±8.05 |
|
53.76±9.24 |
|
82.43±12.13 |
|
|
Family history of AD |
|
–1.201 (.233) |
|
–1.056 (.294) |
|
0.618 (.538) |
|
–2.410 (.018*) |
|
0.108 (.914) |
|
No |
8.49±7.17 |
|
72.04±15.90 |
|
52.29±7.17 |
|
53.35±8.57 |
|
83.58±12.85 |
|
|
Yes |
10.26±7.33 |
|
75.35±14.86 |
|
51.39±7.20 |
|
57.48±8.25 |
|
83.29±13.99 |
|
|
Information source |
|
3.662 (.029*) |
|
1.754 (.179) |
|
3.118 (.049*) |
|
0.510 (.602) |
|
1.607 (.206) |
|
Hospital |
10.69±7.35 |
|
73.23±15.92 |
|
52.78±6.85 |
|
55.49±8.44 |
|
82.90±12.67 |
|
|
Internet/media |
6.67±6.23 |
|
71.50±12.54 |
|
48.79±7.14 |
|
55.79±8.68 |
|
82.24±14.82 |
|
|
Family |
6.25±7.13 |
|
83.00±17.58 |
|
53.63±7.96 |
|
52.38±10.48 |
|
91.44±12.91 |
|
|
Allergen sensitization |
|
0.933 (.379) |
|
1.011 (.314) |
|
–0.853 (.396) |
|
–1.311 (.193) |
|
3.223 (.012*) |
|
No |
10.60±2.70 |
|
80.40±11.67 |
|
49.20±7.05 |
|
50.40±6.50 |
|
91.30±4.80 |
|
|
Yes |
9.26±7.43 |
|
73.24±15.56 |
|
52.01±7.17 |
|
55.58±8.68 |
|
83.02±13.53 |
|
|
Treatment |
|
2.375 (.075) |
|
1.847 (.144) |
|
0.123 (.946) |
|
0.102 (.959) |
|
1.907 (.134) |
|
Basic care/topical medication |
11.45±7.75 |
|
76.32±17.76 |
|
51.64±5.93 |
|
55.64±8.29 |
|
81.32±12.72 |
|
|
Systemic immunosuppressants |
11.17±5.67 |
|
64.67±11.04 |
|
50.33±6.31 |
|
54.50±4.23 |
|
81.88±10.84 |
|
|
Immunotherapy |
7.61±7.04 |
|
75.13±15.04 |
|
52.00±7.32 |
|
55.54±9.08 |
|
86.09±12.50 |
|
|
Biologics |
11.67±6.89 |
|
67.73±12.89 |
|
52.33±8.97 |
|
54.33±9.32 |
|
77.68±16.51 |
|
|
Body mass index |
|
–0.620 (.537) |
|
2.979 (.004*) |
|
–0.065 (.948) |
|
1.573 (.120) |
|
0.035 (.972) |
|
Underweight/normal |
9.02±6.91 |
|
76.68±15.73 |
|
51.83±7.11 |
|
56.17±9.18 |
|
83.48±12.79 |
|
|
Overweight/obesity |
10.00±8.05 |
|
67.06±12.64 |
|
51.94±7.37 |
|
53.48±7.11 |
|
83.38±14.66 |
|
|
Treatment period (yr) |
|
1.214 (.302) |
|
0.966 (.384) |
|
0.571 (.567) |
|
2.805 (.066) |
|
0.536 (.587) |
|
<1 |
10.56±7.31 |
|
77.07±15.83 |
|
53.00±6.96 |
|
58.33±6.11 |
|
83.70±13.20 |
|
|
1–2 |
10.09±8.03 |
|
71.63±14.19 |
|
51.06±7.57 |
|
53.17±9.97 |
|
81.80±15.06 |
|
|
≥3 |
7.84±6.43 |
|
73.34±16.40 |
|
51.62±6.97 |
|
55.09±8.57 |
|
85.19±11.60 |
|
|
Outpatient visit cycle (mo) |
|
1.591 (.209) |
|
1.144 (.323) |
|
0.329 (.720) |
|
2.892 (.060) |
|
0.857 (.428) |
|
<1 |
9.27±9.56 |
|
77.60±18.91 |
|
52.20±8.19 |
|
59.00±9.46 |
|
80.15±13.32 |
|
|
1 |
10.45±6.80 |
|
71.49±13.68 |
|
52.29±7.00 |
|
55.76±8.66 |
|
83.14±14.71 |
|
|
≥2 |
7.52±6.62 |
|
75.16±16.24 |
|
51.00±7.06 |
|
52.77±7.57 |
|
85.55±10.76 |
|
Table 4.Correlation matrix of variables and health-related quality of life (N=97)
|
Variable |
V1 |
V2 |
V3 |
V4 |
V5 |
|
V1. HRQoL |
1 |
|
|
|
|
|
V2. Symptom experience |
–.488*** (<.001) |
1 |
|
|
|
|
V3. Body image |
.413*** (<.001) |
–.212* (.037) |
1 |
|
|
|
V4. Peer relationships |
.259* (.011) |
.011 (.914) |
.443*** (<.001) |
1 |
|
|
V5. Self-management |
.324** (.001) |
–.054 (.597) |
.318** (.001) |
.180 (.078) |
1 |
Table 5.Factors influencing health-related quality of life (N=97)
|
Variable |
Multiple linear regression (enter method) |
|
B |
SE |
β |
t |
p
|
Tolerance |
VIF |
|
(Constant) |
55.111 |
10.239 |
|
5.382 |
<.001 |
|
|
|
Allergen sensitization |
–11.410 |
4.914 |
–.190 |
–2.322 |
.022 |
.932 |
1.073 |
|
Symptom experience |
–0.832 |
0.150 |
–.454 |
–5.547 |
<.001 |
.934 |
1.071 |
|
Body image |
0.122 |
0.083 |
.142 |
1.467 |
.146 |
.671 |
1.491 |
|
Peer relationships |
0.321 |
0.168 |
.173 |
1.917 |
.058 |
.772 |
1.296 |
|
Self-management |
0.384 |
0.131 |
.248 |
2.932 |
.004 |
.870 |
1.150 |
|
Model fit |
R2=.431, adjusted R2=.400, F=13.797, p<.001 |
REFERENCES
- 1. Frazier W, Bhardwaj N. Atopic dermatitis: diagnosis and treatment. Am Fam Physician. 2020;101(10):590-598.
- 2. Jeon YH, Ahn K, Kim J, Shin M, Hong SJ, Lee SY, et al. Clinical characteristics of atopic dermatitis in Korean school-aged children and adolescents according to onset age and severity. J Korean Med Sci. 2022;37(4):e30. https://doi.org/10.3346/jkms.2022.37.e30
- 3. Silverberg NB, Durán-McKinster C. Special considerations for therapy of pediatric atopic dermatitis. Dermatol Clin. 2017;35(3):351-363. https://doi.org/10.1016/j.det.2017.02.008
- 4. Grant L, Seiding Larsen L, Trennery C, Silverberg JI, Abramovits W, Simpson EL, et al. Conceptual model to illustrate the symptom experience and humanistic burden associated with atopic dermatitis in adults and adolescents. Dermatitis. 2019;30(4):247-254. https://doi.org/10.1097/DER.0000000000000486
- 5. Abuabara K, Margolis DJ, Langan SM. The long-term course of atopic dermatitis. Dermatol Clin. 2017;35(3):291-297. https://doi.org/10.1016/j.det.2017.02.003
- 6. Lifschitz C. The impact of atopic dermatitis on quality of life. Ann Nutr Metab. 2015;66 Suppl 1:34-40. https://doi.org/10.1159/000370226
- 7. Mikołajczyk J, Rzepa T, Król J, Żaba R. Body image assessment and quality of life in patients with atopic dermatitis. Dermatol Rev. 2017;104(2):92-102. https://doi.org/10.5114/dr.2017.67383
- 8. Park W. The effects of adolescents' body mass index, self-esteem, family criticism and media exposure on their body image [master's thesis]. Seoul: Yonsei University; 2009.
- 9. Brenninkmeijer EE, Legierse CM, Sillevis Smitt JH, Last BF, Grootenhuis MA, Bos JD. The course of life of patients with childhood atopic dermatitis. Pediatr Dermatol. 2009;26(1):14-22. https://doi.org/10.1111/j.1525-1470.2008.00745.x
- 10. Cho SI, Kim JH, Chung BY, Ahn IS, Kim HO, Park CW, et al. Quality of life in children and adolescents with atopic dermatitis. Korean J Dermatol. 2011;49(5):415-421.
- 11. Jee HM, Han MY. Therapeutic approach to atopic dermatitis in children. J Korean Med Assoc. 2022;65(10):675-680. https://doi.org/10.5124/jkma.2022.65.10.675
- 12. Kim MJ, Choi MH. Knowledge, compliance and quality of life of mothers of children with atopic dermatitis. J Korean Acad Child Health Nurs. 2011;17(4):272-280. https://doi.org/10.4094/jkachn.2011.17.4.272
- 13. Kwak Y, Kim Y. Health-related quality of life and mental health of adults with atopic dermatitis. Arch Psychiatr Nurs. 2017;31(5):516-521. https://doi.org/10.1016/j.apnu.2017.06.001
- 14. Cork MJ, McMichael A, Teng J, Valdez H, Rojo R, Chan G, et al. Impact of oral abrocitinib on signs, symptoms and quality of life among adolescents with moderate-to-severe atopic dermatitis: an analysis of patient-reported outcomes. J Eur Acad Dermatol Venereol. 2022;36(3):422-433. https://doi.org/10.1111/jdv.17792
- 15. Silverberg JI, Thyssen JP, Simpson EL, Yosipovitch G, Ständer S, Valdez H, et al. Impact of oral abrocitinib monotherapy on patient-reported symptoms and quality of life in adolescents and adults with moderate-to-severe atopic dermatitis: a pooled analysis of patient-reported outcomes. Am J Clin Dermatol. 2021;22(4):541-554. https://doi.org/10.1007/s40257-021-00604-9
- 16. Ng MS, Tan S, Chan NH, Foong AY, Koh MJ. Effect of atopic dermatitis on quality of life and its psychosocial impact in Asian adolescents. Australas J Dermatol. 2018;59(2):e114-e117. https://doi.org/10.1111/ajd.12632
- 17. Ezzedine K, Shourick J, Merhand S, Sampogna F, Taïeb C. Impact of atopic dermatitis in adolescents and their parents: a French study. Acta Derm Venereol. 2020;100(17):adv00294. https://doi.org/10.2340/00015555-3653
- 18. Kelly KA, Balogh EA, Kaplan SG, Feldman SR. Skin disease in children: effects on quality of life, stigmatization, bullying, and suicide risk in pediatric acne, atopic dermatitis, and psoriasis patients. Children (Basel). 2021;8(11):1057. https://doi.org/10.3390/children8111057
- 19. Ricci G, Bellini F, Dondi A, Patrizi A, Pession A. Atopic dermatitis in adolescence. Dermatol Reports. 2011;4(1):e1. https://doi.org/10.4081/dr.2012.e1
- 20. Lundin S, Jonsson M, Wahlgren CF, Johansson E, Bergstrom A, Kull I. Young adults’ perceptions of living with atopic dermatitis in relation to the concept of self-management: a qualitative study. BMJ Open. 2021;11(6):e044777. https://doi.org/10.1136/bmjopen-2020-044777
- 21. Roy SC. The Roy adaptation model. 3rd ed. Pearson Education; 2009.
- 22. Varni JW, Seid M, Rode CA. The PedsQL: measurement model for the pediatric quality of life inventory. Med Care. 1999;37(2):126-139. https://doi.org/10.1097/00005650-199902000-00003
- 23. Kook SH, Varni JW. Validation of the Korean version of the pediatric quality of life inventory 4.0 (PedsQL) generic core scales in school children and adolescents using the Rasch model. Health Qual Life Outcomes. 2008;6:41. https://doi.org/10.1186/1477-7525-6-41
- 24. Charman CR, Venn AJ, Williams HC. The patient-oriented eczema measure: development and initial validation of a new tool for measuring atopic eczema severity from the patients’ perspective. Arch Dermatol. 2004;140(12):1513-1519. https://doi.org/10.1001/archderm.140.12.1513
- 25. Mendelson BK, Mendelson MJ, White DR. Body-esteem scale for adolescents and adults. J Pers Assess. 2001;76(1):90-106. https://doi.org/10.1207/S15327752JPA7601_6
- 26. Bae SM, Hong JY, Hyun MH. A validation study of the peer relationship quality scale for adolescents. Korean J Youth Stud [Internet]. 2015 [cited 2026 Feb 10];22(5):325-344. Available from: https://kiss.kstudy.com/Detail/Ar?key=3332003
- 27. Lynn MR. Determination and quantification of content validity. Nurs Res. 1986;35(6):382-385.
- 28. Silverberg JI, Gelfand JM, Margolis DJ, Boguniewicz M, Fonacier L, Grayson MH, et al. Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Ann Allergy Asthma Immunol. 2018;121(3):340-347. https://doi.org/10.1016/j.anai.2018.07.006
- 29. Li K. Itch in atopic dermatitis: from pathogenesis to treatment. Allergy Asthma Respir Dis. 2014;2(1):8-15. https://doi.org/10.4168/aard.2014.2.1.8
- 30. Gauci J, Bloomfield J, Lawn S, Towns S, Steinbeck K. Effectiveness of self-management programmes for adolescents with a chronic illness: a systematic review. J Adv Nurs. 2021;77(9):3585-3599. https://doi.org/10.1111/jan.14801
- 31. Alquran A, Lambert KA, Farouque A, Holland A, Davies J, Lampugnani ER, et al. Smartphone applications for encouraging asthma self-management in adolescents: a systematic review. Int J Environ Res Public Health. 2018;15(11):2403. https://doi.org/10.3390/ijerph15112403
- 32. Orpin J, Rodriguez A, Harrop D, Mills E, Campbell F, Martin-Kerry J, et al. Supportive use of digital technologies during transition to adult healthcare for young people with long-term conditions, focusing on Type 1 diabetes mellitus: a scoping review. J Child Health Care. 2025;29(1):204-221. https://doi.org/10.1177/13674935231184919
- 33. Choi EK, Jung E, Ji Y, Bae E. A 2-step integrative education program and mHealth for self-management in Korean children with spina bifida: feasibility study. J Pediatr Nurs. 2019;49:e54-e62. https://doi.org/10.1016/j.pedn.2019.09.002
- 34. Jin EJ. Factors affecting health-related quality of life in adolescents with congenital heart disease after open-heart surgery [master’s thesis]. Seoul: Yonsei University Graduate School of Nursing; 2015.
- 35. Park MN. Associations among ego identity, resilience, and health-related quality of life in adolescent survivors of childhood cancer [master’s thesis]. Seoul: Yonsei University Graduate School of Nursing; 2016.
