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Iria Neri,1 Elena Galli,2 Ilaria Baiardini,3,4 Mario Picozza,5,6 Ana B Rossi,7 Paolo Matruglio,8 Devis Moretti,8 Filippo Cipriani8 1Dermatology Unit, IRCCS Azienda Ospedaliero Universitaria Bologna, University of Bologna, Bologna, Italy; 2UOS Immuno-Allergologia dell’Età evolutive, Ospedale S.Pietro-Fatebenefratelli, Rome, Italy; 3Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy; 4Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Milan, Italy; 5National Association of Atopic Dermatitis (ANDeA), Prato, Italy; 6Neuroimmunology Unit, Santa Lucia Foundation IRCCS, Rome, Italy; 7Sanofi, Cambridge, MA, USA; 8Sanofi, Milan, ItalyCorrespondence: Filippo Cipriani, Sanofi, Viale Bodio 37b, Milan, Italy, Email filippo.cipriani@sanofi.comPurpose: Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6– 11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism.Methods: An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥ 8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group.Results: Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤ 0.05) or in other social environments (16.9% vs 3.0%; p≤ 0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤ 0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort.Conclusion: AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.Keywords: atopic dermatitis, absenteeism, presenteeism, sleep impairment, daily drowsiness

Luca Stingeni,1 Anna Belloni Fortina,2 Ilaria Baiardini,3,4 Katharina Hansel,1 Devis Moretti,5 Filippo Cipriani5 1Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, Italy; 2Unit of Dermatology, Department of Medicine - DIMED, University of Padua, Padua, Italy; 3Respiratory Unit for Continuity of Care, IRCCS, Ospedale Policlinico San Martino, Genova, Italy; 4Personalized Medicine Asthma, & Allergy Clinic, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; 5Sanofi Genzyme, Sanofi S.r.l., Milan, ItalyCorrespondence: Anna Belloni FortinaUnit of Dermatology, Department of Medicine – DIMED, University of Padua, Via Gallucci, 4, Padova, 35128, ItalyEmail anna.bellonifortina@unipd.itBackground: Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by recurrent eczematous lesions and intense pruritus. AD patients are known to face a considerable disease burden, including physical and emotional limitations. There is still limited knowledge about daily implications in education and occupation. We describe disease social stigmatization by measuring bullying and self-isolation in students and professional discrimination in workers. Overall loss of productivity, either at school and at the workplace, was quantified as the sum of absenteeism (number of days AD sick leave) and presenteeism (number of days with decreased focus and functionality).Methods: An on-line web survey was sent to 3235 random recipients and 401 met the inclusion criteria (self-reporting AD and ≥ 12 yo). The survey domains included daily limitations, QoL, feelings and relationships, together with specific questions about bullying, discrimination and loss of productivity.Results: AD negatively affected QoL in 51.6% of respondents, whereas 68.8% considered AD as a real limit to daily routine. More in detail, 39.3% of students were victims of bullying and 33.9% of workers felt discriminated because of AD. On average, absenteeism in students was for 17.1 days/year (presenteeism: 19.5 days/year), whereas in workers, the estimate was 10.9 days/year (presenteeism: 13.1 days/year). Absenteeism and presenteeism were more pronounced in bullied/discriminated subjects.Conclusion: AD multidimensional implications deeply affect and undermine personal and professional fulfillments. Our results contribute to a better understanding of what living with AD means.Keywords: atopic dermatitis, discrimination, absenteeism, presenteeism