Table 2.

Data extraction table of included studies, study and sample characteristics, and conclusions

References	Study design, setting of study, sample size	Sample characteristics: age (mean ± standard deviation i.e. SD) or median (interquartile range), diagnosis severity	QoL instrument	Outcome values (mean ± SD)	Conclusions
Ang et al. [33] Singapore	Cross sectional Patients from dermatology clinic 34 AD patients 16 below 5-years old (yo), 18 above 5-years old	Age = 5.3 ± 3.9 Diagnosis: not reported (NR) Severity: SCORe Atopic Dermatitis (SCORAD)—24 mild/mod, 30 severe	IDQoL and CDLQI	IDQoL = 6.8 ± 5.3 CDLQI = 8.8 ± 5.9	QoL affected patients with severe AD patients more than those with mild/moderate severity (p = 0.005) Boys with AD were more impaired in participation in family activities than girls. Girls with AD had greater QoL impairment in social aspects, itching, mood change and sleep disturbance In children ≤ 4 years, mood disturbances were significantly affected in non-Chinese compared to Chinese (p = 0.041). For children ≥ 5 years, aspect of clothing was significantly affected amongst non-Chinese (p = 0.006)
Arima et al. [15] Japan	Cross sectional Population survey 634 AD patients 1268 HCs	Age ≥ 18 years Diagnosis: patient reported physician diagnosis Severity: self rated—344 mild, 290 mod/severe	Japanese version 23 of SF-36v2	SF-36 PCS = 52.04 (AD) vs 54.12 (HCs) (p < 0.001) SF-36 MCS = 42.29 (AD) vs 46.05 (HCs) (p < 0.001) SF-6D utility = 0.71 (AD) vs 0.76 (HCs) (p < 0.001)	Atopic dermatitis patients also reported significantly reduced QoL relative to non-AD controls in both mental and physical domains, and overall utility score Severity did not have statistically significant effect on QoL
Aziah et al. [32] Malaysia	Cross sectional Patients from dermatology clinic 33 AD patients 70 parents of AD patients	0–16-years old, median = 74 months Diagnosis: Hanifin and Rajka criteria Severity: SCORAD = 38.9 ± 15.5	DFI and CDLQI (Malay translated)	CDLQI = 10.0 ± 6.6, DFI = 9.4 ± 5.3	There was a significant difference of the DFI scores between the moderate and severe atopic dermatitis (p = 0.02) Aspects of the DFI most affected were family diet, sleep loss, the parents’ emotional disturbance and their exhaustion Family impact was greater in severe AD vs moderate AD (p = 0.002). While QoL impairment was greater in severe AD, this did not reach statistical significance (p = 0.08)
Bae et al. [52] Korea	Cross sectional Military personnel 68 people with AD	Age = did not state specifically Diagnosis: clinical judgment base on criteria Severity: NR	Skindex-29	Skindex-29 (95CI): symptom = 38.9 (32.1–46.1) Functional = 20.7 (12.5–28.9) Emotional = 27.8 (21.8–33.5) Overall = 29.1 (23.0–35.2)	NIL
Chen et al. [30] Taiwan	Cross sectional Nursing staff from a hospital 90 AD patients 837 HCs	Age: NR Diagnosis: Hanifin and Rajka criteria Severity: NR	SF-36		QoL was significantly lower for patients with AD compared with controls in five out of eight domains, including—bodily pain, general health, mental health, vitality and social functioning
Cheok et al. [16] Singapore	Cross sectional Community-based, from a household survey 89 AD patients n (138 pts ≤ 18, 538 pts-years old > 18-years old) 592 HCs	Age: NR Diagnosis: U.K. Working Party Diagnostic Criteria Severity: clinical—clear: 45%, almost clear: 33%, mild: 13%, mod: 9%	EQ-5D weighted and VAS, DLQI	Not explicitly stated	A greater percentage of participants in AD reported suboptimal global health vs those without AD (89% vs 77.4%, p = 0.016) Difference in QoL between mild and moderate AD patients was statistically significant in adult (> 18) patients but not in < 18-year-old patients
Chuh and Chan [14] Hong Kong	Case–control study Patients in a primary care setting 22 AD patients	Age: NR Diagnosis: U.K. Working Party Diagnostic Criteria Severity: SCORAD = 18.14 ± 9.99	DLQI	DLQI = 12.00 ± 5.38	The main study population was pityriasis rosea patients, with AD patients as the control group QoL strongly correlated with SCORAD scores (p = 0.0083) QOL was significantly more affected in patients with atopic dermatitis than in patients with pityriasis rosea or acne vulgaris
Ghani et al. [28, 29] Malaysia	Cross sectional Patients from dermatology clinic 110 AD patients	Age: 5–18-years old. Median (IQR) = 9.0 (13.0)-years old Diagnosis: NR Severity: SCORAD—mild = 30.9%, moderate = 62.7%, severe = 6.4%	CDLQI, DFI	CDLQI = 8.0 DFI = 7.0	Most affected items were itchiness, sleep loss, embarrassment and treatment difficulty Disease severity (as quantified by SCORAD) was the only significant associated factor (< 0.01). Social factors and medical factors besides severity did not significantly affect QoL Family impact: 2 items most affected were family expenditure and family diet
Higaki et al. [24] Japan	Cross sectional Patients from dermatology clinic 162 AD patients	Age = 29 ± 9 years Diagnosis: NR Severity: Rajka and Langeland criteria score = 6.5 ± 1.5	Japanese version of Skindex-16	Skindex-16 = 50 ± 23	Patients with severe atopic dermatitis had significantly higher QOL impairment, including in symptoms, emotions and functioning Patients with atopic dermatitis significantly higher QOL impairment than patient with isolated lesions, particularly in symptoms and emotions
Ho et al. [21] Singapore	Cross sectional Patients from dermatology center 104 AD patients	Age range 0–16-year old, mean = 6.4 ± 4.3 years Diagnosis: Hanifin and Rajka criteria Severity: SCORAD—value NR	IDLQI, CDLQI, SF-12, DFI	DFI = 7.2 ± 6.5, SF-12 PH = 52.7 ± 4.8, SF-12 MH = 49.7 ± 8.8	The QoL, SF-12 PH, SF-12 MH, and DFIQ scores were significantly correlated with severity (p < 0.05) Family impact was correlated with quality of life (QoL) of AD patients (p < 0.05) Greatest causes of discomfort for infants were itching, sleep problems and influence of disease on mood. For children: itching, sleep problems, impact on swimming and sport and inconvenience because of treatment. Friendship is the least disturbing issue DFI items that were affected: for the mothers, the greatest problems in their physical and MH include (i) limitation of moderate activities such as housework, (ii) less accomplishment because of poor physical or emotional health, (iii) reduction of social activities like visiting friends and relatives
Hon et al. [34] Hong Kong	Cross sectional Patients from dermatology clinic	Age range: 1–18 years, mean age: 10.8 ± 4.9 years Diagnosis: Hanifin and Rajka criteria Severity: POEM, SCORAD—value NR	CDLQI	Not explicitly stated	The Patient-Oriented Eczema Measure (POEM), objective SCORAD and CDLQI were correlated with each other
Hon et al. [35] Hong Kong	Cross sectional Patients from dermatology clinic 126 AD patients	Age: < 18 years, mean = 11.4 ± 5.6 years Diagnosis: Hanifin and Rajka criteria Severity: POEM = 14.8 ± 7.3, NESS = 7.6 ± 3.4, SCORAD = 38.1 ± 18.2	CDLQI	CDLQI = 9.8 ± 7.3	CDLQI was negatively correlated with stratum corneum skin hydration (p < 0.05) QoL impairment was correlated with disease severity. Severity was independently associated with aspects such as pruritus, activities, sleep disturbance, friendship, bullying QoL was dependent on severity of symptoms, including bleeding, cracking and flaking of skin
Hon et al. [53] Hong Kong	Cross sectional Setting: NR 133 AD patients	Age range: 5–16 years, Age = 11.0 (8.4–13.6) Diagnosis: Hanifin and Rajka criteria Severity: NESS, SCORAD	CDLQI	Not explicitly stated	QoL was correlated with severity of AD (p < 0.001) Severity and QoL scores did not differ between male and female patients, or between patients aged ≤ 10 years and those aged > 10 years (p > 0.3 for all) Itch, sleep disturbance, treatment and swimming/sports were the four QoL issues that were most commonly affected
Hon et al. [39] Hong Kong	Cross sectional Patients from dermatology clinic 9 AD patients, 4 HCs	Age: < 18 years, mean age (AD) = 11.6 (10.7–12.0) years age (HC) = 13.7 (13.3–14.0) years Diagnosis: Hanifin and Rajka criteria Severity: SCORAD—median = 60.7	CDLQI	Not explicitly stated	CDLQI statistically significantly correlated with Fit 3 ligand, interleukin-8, macrophage inflammatory protein-3a levels
Hon et al. [54] Hong Kong	Cross sectional Patients from a hospital 120 AD patients	Age = 16.0 (14.4–18.2) years Diagnosis: Hanifin and Rajka diagnostic criteria Severity: Nottingham Eczema Severity Score (NESS)	Chinese version of CDLQI	CDLQI: 8 (4–11) (AD) vs 1.5 (1.0–4.8) (control) (p < 0.001)	AD patients (median age 16-years old) had lower SH, higher trans-epidermal water loss, worse CDLQI, and reported higher overall, depressive and stress symptom scores
Hon et al. [36] Hong Kong	Cross sectional Patients from dermatology clinic 157 AD patients	Age: mean = 10.15 Diagnosis: U.K. Working Party Diagnostic Criteria Severity: NESS—value NR	CDLQI	Not explicitly stated	QoL lower in patients with mild eczema vs patients with mod/severe eczema CDLQI was linked to severity, mother and father education and corticosteroid (CS) fear. There was also a correlation between CDLQI with use of oral traditional Chinese herbal medicine
Hon et al. [55] Hong Kong	Cross sectional Patients from a hospital 142 AD patients	Age = 12.0 ± 5.0 years Diagnosis: Hanifin and Rajka diagnostic criteria Severity: NR	CDLQI	CDLQI = 8.2 ± 5.7	NIL
Itakura et al. [17] Japan	Cross-sectional Patients from web-based population study 1668 AD patients	Age = 43.1 ± 10.6 Diagnosis: patient reported physician diagnosis Severity: NR	DLQI	DLQI = 4.8 ± 5.1	Aspects of QoL most affected were “symptoms and feelings” and “daily activities”. “Treatment” was least affected
Jang et al. [31] Korea	Cross sectional Patients from a hospital 78 patients with AD 78 parents of patients with AD	Age: younger than 18-years old Parents = 37.4 ± 5.3 years Children = 65.1 ± 45.7 months Diagnosis: Hanifin and Rajka’s diagnostic criteria Severity: SCORAD = 28.3 ± 16.1	Korean version of PedsQL 4.0, IDQoL, DLQI, DFI	IDQoL = 7.4 ± 5.2, 6.0 (1–23) CDLQI = 4.8 ± 3.6, 4.5 (0–14) DFI = 11.2 ± 6.0 PedsQL = 89.3 ± 9.5, 92.9 (65.2–100)	Patients with a higher severity of AD had 6.6 times (p = 0.018) higher probability of a low family QoL than those with less severe AD Family QoL was more impacted in girls with AD than boys (p = 0.003), and was also significantly correlated with severity, generic QoL (PedsQL), and dermatology QoL (IDQoL and CDLQI) Parents’ life satisfaction was correlated with generic QoL and dermatology QoL of children Parents’ positive affect showed no statistically significant correlation with dermatology QoL of AD children, but parent’s negative affect and parenting stress showed a correlation
Kawashima et al. [25] Japan	Study 1 is cross sectional, study 2 is interventional (not included) Patients from multiple dermatology clinics 106 AD patients	Age = 26.3 ± 7.5 years Diagnosis: NR Severity: Rajka and Langeland—all with mod/severe AD	Japanese version of the WHOQOL-26;	WHOQoL-26 (AD) = 3.1 ± 0.5 vs. (HC) 3.3 ± 0.5, respectively; p < 0.001)	QoL was worse for AD patients in areas of physical health, psychological and general wellbeing (p < 0.001). Support from friends was greater in the AD population compared to the general population (p = 0.009) Among patients with AD, those with steroid phobia had a slightly lower QoL
Kim et al. [23] Korea	Longitudinal study Patients from multiple dermatology clinics 34 AD patients	Age = 15 ± 10 years Diagnosis: NR Severity: EASI, Rajka—values NR	EQ5D-Kor Korean EQ5D- Visual Analog Scale (EQ5D-VAS)	EQ5D-Kor = 0.7 ± 0.2 EQ5D-VAS = 64.1 ± 22.7	EQ5D Kor score indicated a 30% decrease in QoL, while the visual analog scale indicated a 35% decrease in QoL Using EASI or Rajka, there was a statistically significant relationship between severity and QoL measurements
Kim et al. [26] Korea	Cross sectional study Patients from multiple dermatology clinics 415 AD patients: (71 infants, 197 children and 147 adults)	Age: 14.5 ± 10.8 Diagnosis: Hanifin and Rajka diagnostic criteria Severity: SCORAD infants = 15.8 ± 8.4, children = 16.6 ± 7.9, adults = 19.6 ± 10.0 Rajka: infants = 5.4 ± 1.9, children = 5.8 ± 1.9, adults = 6.2 ± 1.9	IDQOL, CDLQI, DLQI for infant, children and adult, respectively	IDQoL = 7.7 ± 5.5, CDLQI = 6.6 ± 6.3, DLQI = 10.7 ± 7.9	QoL measurements were not significantly affected by gender No significant differences in QoL between infants with AD alone and infants with AD and other concomitant atopic diseases Aspects of QoL most affected were symptoms, mood and sleep, while treatment and social ridicule were less problematic No significant difference in QoL between genders, age groups (5–10-year-old vs 11–16-year-old patients) or presence of concomitant atopic disease
Kwak et al. [18], Lee et al. [19] Korea	Cross sectional Population survey 157 people with AD 11,756 HCs (Kwak et al.) 677 people with AD 36,901 HCs (Lee et al.)	Age: ≥ 19 years, mean = 35.2 ± 1.3 Diagnosis: patient reported Severity: NR	EQ 5D, VAS	EQ VAS (AD) = 70.6 ± 1.39 EQ VAS (HC) = 74.1 ± 0.22	Significant difference in QoL between patients with AD and HCs (p < 0.001), after adjustment for patient characteristics, socioeconomic status and concomitant disease. The presence of AD had statistically significant correlations with psychological stress, depressed mood, depression prevalence, suicidal ideation, but not sleep duration QoL was reduced in AD using the EQ-VAS QoL instrument, but not when using the EQ5D AD impacted the “pain/discomfort” and “anxiety/depression” domains of EQ5D significantly
Lam et al. [22] Hong Kong	Cross sectional Patients from multiple dermatology clinics 120 AD patients (50 adults and 70 children) 2410 HCs	Age: 3–65 years Mean age = 15 Diagnosis: UK Working Party’s diagnostic criteria Severity: SCORAD—value NR	> 16-year-old: 36-item SF-36 and (DLQI). 14–16 year-old: SF-36 and (CDLQI) Aged 3–14 year-old: CDLQI	CDLQI = 7.7 ± 6.0, DLQI = 10.1 ± 6.4, SF-36 PCS = 49.94 ± 8.98 (AD) vs 50.00 ± 10 (control), SF-36 MCS = 45.15 ± 11.28 (AD) vs 50.00 ± 10 (control)	All the SF-36 dimensions were lower than that of the HCs. QoL (as measured by Sf-36 and CDLQI/DLQI) was reduced in AD Symptoms and feelings, leisure, daily activities and sleep were aspects of QoL most affected QoL showed a statistically significant correlation with severity (p < 0.05)
Ng et al. [27] Singapore	Cross sectional Recruited from a pediatric dermatology service 50 AD patients	Age: mean = 13.4 years Diagnosis: UK Working Party’s diagnostic criteria Severity: EASI—mild: 30%, mod: 36%, severe: 34%	CDLQI	CDLQI = 15.2	Neither age, gender nor race impacted QoL Adolescent with severe AD had lower QoL scores than mild and mod 3 most affected domains were “leisure, physical activities”, “Skin itch and soreness” and “sleep interference”
Oh et al. [40] Korea	Cross sectional Setting: patients with AD 28 AD patients 28 age, sex matched HC	Age: mean (AD) = 24.1 years (age range 13–41) mean (HC) = 25.2 years (age range 12–43 years) Diagnosis: Hanifin and Rajka criteria Severity: EASI = 21.9 ± 12.7 (range 5.6–58) VAS for pruritus = 7.1 ± 1.5 (range 5–10) VAS for sleep loss = 5.3 ± 3.2 (range 0–10)	DLQI	Not explicitly stated	Statistically significant positive correlations were observed between QoL and various psychological scales (Beck Depression Inventory, State Anxiety, Trait Anxiety, Interaction Anxiousness Scale, and Private Body Scale)
Yano et al. [37] Japan	Cross sectional Patients from a hospital 112 AD patients	Age = 35.6 ± 10.8 years Diagnosis: NR Severity: SCORAD = 35.5 ± 21.9	DLQI	DLQI = 7.8 ± 5.1	Both total work productivity impairment (TWPI) and total activity impairment (TAI) scores were significantly correlated with the severity and QoL