Atopic Dermatitis Flare Frequency May Predict Future Disease Severity, According to New Findings

A recent cohort study of 878 adults with atopic dermatitis (AD) found that the frequency, duration, and severity of disease flares were significant predictors of future disease severity and were closely associated with reduced quality of life. Using a combination of traditional statistical methods and predictive machine learning models, researchers identified flare characteristics as key variables that could be used to inform prognosis and guide treatment decisions.

Mia-Louise Nielsen, MSc, PhD

Courtesy of Bispebjerg Hospital

First author Mia-Louise Nielsen, MSc, PhD, of the department of dermatolgoy at Copenhagen University Hospital-Bispebjerg, and colleagues leveraged data from the Danish Skin Cohort, which houses data on disease severity and flare patterns. Participants self-reported flare activity in 2022 and AD severity in 2023. The investigators applied quantile regression models to examine associations between the number of flares and severity measures, and used boosted random forest models to explore relative predictors of both annual flare frequency and disease severity.

Of the 878 participants (median age, 49.0 years), 26 reported no flares in 2022, while 405 reported 1 to 5 flares, 169 reported 6 to 10 flares, and 278 reported more than 10 flares, according to Nielsen et al. and colleagues. Flare frequency in 2022 was significantly associated with multiple patient-reported severity outcomes one year later. After adjusting for baseline Patient-Oriented Scoring of Atopic Dermatitis scores, flare frequency remained significantly associated with the Patient-Oriented Eczema Measure (POEM) and the Dermatology Life Quality Index (DLQI).

In the machine learning analysis, the most important predictors of AD severity were flare frequency, duration, and severity while the severity of disease was among the strongest predictors of flare frequency.

Many individuals with AD remain undertreated, the investigators stressed. Despite availability of a range of both topical and systemic agents, response rates are widely variable, leaving a significant proportion of patients with poorly managed disease and the subsequent impact on quality of life.²

“Although a consensus on how many flares are too many remains to be established, the current findings suggest that flares might serve as an early indicator of disease progression or inadequate disease control, highlighting that flares could be relevant in clinical decision-making to support optimal treatment strategies,” the authors concluded.¹

These findings support the integration of flare characteristics into severity assessments and treatment planning to improve disease control and quality of life in patients with AD.

References

1. Nielsen M-L, Nymad LK, Domenech A, et al. Predictors of flares and disease severity in patients with atopic dermatitis using machine learning. JAMA Dermatol. Published online July 16, 2025. doi: 10.1001/jamadermatol.2025.2073

2. 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. doi:10.1001/archderm.140.12.1513