Quality of life can be severely impaired for people with AD. Flexures might be sore, making full extension of arms or legs painful, and may prevent participation in social activities or sport. Itching can be so intense it prevents sleep: an itching child's sleeplessness can disturb parents' sleep with knock on effects at work. Career choices, clothing and socialising may all be affected by concerns about AD.12

Of the six million or so people in the UK with eczema at any one time, one in twenty will have severe hand eczema. This significantly interferes in everyday tasks, with patients unable to grasp a zip, do up buttons, or open bottles. Some people need to use rubber gloves to shower.13

European studies looking at the psychological burden of skin diseases have noted an increased association with depression and anxiety compared to the general population, being highest for patients with psoriasis, AD, hand eczema, and leg ulcers. The odds ratio was 3-4 times greater with atopic or hand eczema.14 Parents of chronically ill children are also at great risk of depressive illness.12