Cumulative Life Course Impairment (CLCI) in Atopic Dermatitis

Author : Sanofi

Editorial Team

Introduction

What is Cumulative Life Course Impairment and why does it matter for patients with AD?
How does CLCI extend beyond visible skin symptoms to affect multiple life domains?
Why is early intervention critical in preventing irreversible life impairment?

Understanding CLCI in Atopic Dermatitis

Atopic dermatitis (AD) is not merely a skin condition but a systemic inflammatory disease with both visible manifestations (skin lesions) and hidden burdens (systemic inflammation, mental health issues, sleep disturbances)^1,2. Even patients with limited visible symptoms can experience significant life impairment, highlighting the importance of comprehensive assessment beyond skin appearance³.

CLCI refers to potentially irreversible life-long damage accrued across multiple life domains due to inadequate treatment and uncontrolled disease. In atopic dermatitis, CLCI represents the cumulative burden that extends far beyond visible skin symptoms, affecting patients physically, psychologically, and socially over their lifetime^1,4,5.

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Prof. Dr. Jan Gutermuth gives insights into how timely treatment can transform patient outcomes and prevent Cumulative impairment.

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Core components of CLCI

Components with Negative Impact

Skin damage (perception), overt public rejection, self and body image, loss of self-confidence⁶

Comorbidities including anxiety, depression, suicidal ideation, addiction⁸

Comorbidities including type 2 inflammatory diseases, cardiovascular disease, poor bone health⁷

Components with Either Positive or Negative Impact

Maladaptive coping (continued avoidance), limited activity, mental disengagement, denial, minimization¹⁰

Lack of supportive family, friends, or colleagues, limited access to quality care, HCPs, or patient support groups⁹

Identifying patients at risk for CLCI

Patients most vulnerable to developing CLCI include those with inadequate care or treatment, ineffective coping strategies, limited social support, high disease severity, and delayed diagnosis^4,5,6.
Studies show that many patients eligible for systemic therapy don't receive it, despite experiencing uncontrolled symptoms and significant quality of life impact¹¹.

Breaking the cycle: Preventing CLCI through early intervention

Early intervention may help reduce long-term burden, potentially modifying disease progression, lowering the risk of atopic comorbidities, and limiting the development of CLCI. Taking timely action is key to preventing irreversible consequences and addressing the full impact of AD across all aspects of life¹².

Prospective and Retrospective Tools are available for assessing Cumulative Impairments

DermCLCI-p (Prospective tools)

This questionnaire assesses the current CLCI-status and identifies patients at risk for CLCI.

DermCLCI-r (Retrospective tools)

This questionnaire assesses persisting CLCI in patients focusing on irreversible damage that has occurred since disease onset.

Access the Questionnaires here

Conclusion

CLCI represents the cumulative, potentially irreversible impact of uncontrolled AD across multiple life domains. By being aware of the risk factors contributing CLCI, timely and effective interventions can be implemented to prevent life-log impairment. An approach to AD management, addressing both visible and hidden disease burdens, is essential for improving long-term outcomes and quality of life for patients.

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Møller Rønnstad AT, et al. J Am Acad Dermatol. 2024;90:616–618
Kimball AB, et al. J Eur Acad Dermatol Venereol. 2010;24:989–1004.
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Thyssen JP, et al. J Allergy Clin Immunol. 2023;151:1155–1162.
Davis DMR, et al. J Am Acad Dermatol. 2022;86:1335–1336.e18.
Stingeni L, et al. J Asthma Allergy. 2021;14:919–928.
Heratizadeh A, et al. J Eur Acad Dermatol Venereol. 2024;38:157–166.
Bieber T. Nat Rev Drug Discov. 2023;22:662–680.

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