Skin–mind connection in atopic dermatitis: Associations of disease severity with skin barrier function, stress, anxiety, and quality of life

Abstract

Although skin barrier dysfunction and psychosocial impairment are well-recognized features of atopic dermatitis, its association remains incompletely understood. Evidence integrating objective measures of skin barrier function with stress, anxiety, quality of life, and disease severity is limited. Therefore, the aim of this study was to investigate the associations of disease severity with skin barrier function, psychological status, and quality of life, and in patients with atopic dermatitis. A hospital-based cross-sectional study was conducted at the Dermatology, Venereology, and Aesthetic Outpatient Clinic of Dr. Zainoel Abidin Hospital, Banda Aceh, Indonesia, in 2025. Adults aged ≥20 years with atopic dermatitis diagnosed according to the Hanifin–Rajka criteria were recruited consecutively. Disease severity was assessed using the Scoring Atopic Dermatitis (SCORAD) index. Skin barrier function was evaluated by measuring transepidermal water loss (TEWL) and stratum corneum hydration using a Tewameter and Corneometer, respectively. Anxiety, perceived stress, and quality of life were assessed using the Zung Self-Rating Anxiety Scale (SAS), Perceived Stress Scale (PSS), and Dermatology Life Quality Index (DLQI). Most patients were female (62.5%), and 68.8% had mild disease. Disease severity was not significantly associated with TEWL (p=0.923), skin hydration (p=0.208), SAS (p=0.560), PSS (p=0.841) or DLQI (p=0.621). Spearman's correlation analysis likewise demonstrated no significant correlation between disease severity and TEWL (r=-0.052, p=0.770), skin hydration (r=-0.136, p=0.450), SAS (r=−0.0150, p=0.930), PSS scores (r=–0.155, p=0.390) or DLQI (r=0.062. p=0.730). In conclusion, although greater skin barrier dysfunction and psychosocial burden tended to be observed in patients with moderate and severe atopic dermatitis, no significant associations were observed between disease severity and skin barrier function, anxiety, perceived stress or quality of life. The relatively small sample size and cross-sectional design may have limited the ability to detect significant associations.