Clinical Phenotyping of Atopic Dermatitis Using Combined Global Severity (POEM) and Facial Burden (BoFA): A French Population-based Observational Study.

Atopic dermatitis (AD) is characterized by substantial clinical heterogeneity. Global severity is typically assessed using scores such as the POEM; however, lesion localization -- particularly on the face -- may generate psychosocial consequences partly independent of overall disease severity. This cross-sectional observational study (VISEABLE) included 1,400 French adults with physician-confirmed AD. Severity was measured using the POEM (Clear/Almost Clear: 0-7 vs. Moderate-severe: ≥8) and facial involvement using the BoFA (0-109; threshold=36, population median). Six phenotypes were defined through a 2×3 combination. The POEM and BoFA correlation was moderate (r=0.365; ρ=0.389; p<0.001). Phenotype Ph3 (Clear/Almost Clear POEM / Severe facial involvement, n=58) exhibited stigmatization scores (PUSH-d=21.93) and life trajectory impact (DLLIM=14.76) not significantly different from Ph4 (Moderate-severe POEM / No facial involvement, n=527; p>0.25 for all comparisons). In multiple regression analysis restricted to patients with facial involvement, BoFA was the dominant independent predictor of stigmatization (β=11.44, p<0.001; partial R²=46.2 %; overall R²=0.532), superseding POEM (p=0.076, ns; partial R²=0.6%). Mild eczema with severe facial involvement generates a psychosocial burden comparable to that of moderate-to-severe eczema without facial involvement. Systematic BoFA assessment is essential in all patients with AD.