Crisis Planning for Peer-Led Online Support.

Atopic dermatitis (AD) is a chronic inflammatory disease affecting approximately 5–10% of adults in high-income countries (, ). AD shows considerable clinical heterogeneity, both in lesion severity and anatomical distribution. This heterogeneity is associated with major psychosocial consequences, including impaired quality of life, difficulties with professional integration and interpersonal relationships and increased rates of depression and anxiety (, ). Severity assessment tools such as the POEM (Patient-Oriented Eczema Measure) provide a global, patient-reported evaluation of disease activity over a 7-day period; however, they do not capture location-specific features. POEM was selected as the global severity measure for this study because it is the recommended patient-reported outcome for AD severity in European clinical guidelines (), demonstrates superior responsiveness and patient acceptability compared with physician-reported scales in real-world settings (), and its binary categorization (Clear 0–7/Moderate-severe≥8) provides a clinically interpretable anchor for phenotype definition. Facial involvement constitutes a specific clinical challenge in AD. The permanent visibility of facial lesions exposes patients to heightened social stigmatization, impaired body image and profound repercussions on social and professional functioning. Several recent studies suggest that facial involvement is an independent predictor of psychosocial burden, beyond overall clinical severity (, ). In a large international survey of 13,045 patients with visible dermatoses, Richard et al. () reported that approximately 30% considered their condition a handicap in their professional, social and intimate lives, with a disease burden on quality of life twice as high as dermatoses localized to less visible areas. While this figure reflects a heterogeneous population and multiple contributing factors, it underscores the disproportionate burden associated with facial involvement. The development and validation of the BoFA (Burden of Face Affected) questionnaire have provided a specific and sensitive instrument to quantify this facial burden (). In parallel, Chovatiya et al. demonstrated in 2021, in a prospective American cohort (=592), that combining pruritus severity with lesional severity enabled the definition of 4 distinct clinical phenotypes. Notably, they identified a group with severe pruritus but mild lesions (SI-ML) with a burden comparable to the group with severe lesions without intense pruritus (MI-SL) (). This 2-dimensional phenotyping approach illustrates that neither pruritus nor lesions alone fully predict disease burden – it is their combination that matters.