Background:
The Vizient Vulnerability Index (VVI) is a neighborhood-level metric describing socioeconomic and structural challenges across nine domains: economic resources, education, healthcare access, neighborhood conditions, housing stability, environmental quality, social context, transportation, and public safety. Given the established link between psychosocial stressors and dermatologic disease, these factors may influence the clinical expression of atopic dermatitis (AD). AD is a chronic inflammatory skin condition characterized by pruritus, xerosis, and episodic flares; in adults it commonly affects the face, neck, and extensor surfaces. Symptoms often worsen during cold weather due to impaired skin-barrier function and reduced humidity. This study explores potential relationships between VVI domain scores, seasonal temperature, and AD severity.

Methods:
We conducted a retrospective chart review of 50 randomly selected Rochester, NY residents who presented with AD in 2024. ZIP code–linked VVI domain scores were used as a proxy for neighborhood-level vulnerability. AD severity was estimated using a structured 1–10 scoring scale informed by SCORAD elements, incorporating body surface area involvement and intensity of clinical findings (e.g. 1–3 = mild, 4–6 = moderate, 7–10 = severe). This approach allowed more standardized comparison of qualitative documentation in the absence of bedside scoring. Analyses evaluated the association between VVI domains, winter presentation, and flare severity.

Results:
Of the 50 charts reviewed, 36 contained sufficient detail for scoring. Participants were predominantly female (66.7%) with a mean age of 32.5 ± 19.3 years. Nearly half presented during winter months (45.9%) when the average high temperature was 57.0 ± 20.1°F, with a mean severity score of 3.56 ± 1.9. No correlation was found between temperature and severity (r² = 0.00091, p = 0.5792), nor between degree of severity in patients presenting during temperatures above vs below 50°F (p = 0.8015). Among VVI domains, Clean Environment demonstrated the strongest—though still weak—association with severity (r² = 0.0243), followed by the Public Safety (r² = 0.0113) and Social domains (r² = 0.0106).

Conclusion:
This pilot analysis represents an early exploration of how neighborhood-level vulnerability and climatic factors relate to AD severity. While preliminary trends emerged, the weak associations observed suggest that AD severity is likely multifactorial and not adequately captured by temperature alone or single-domain VVI measures. Larger cohorts and multivariable or logistic regression models will be needed to more fully account for the complex interactions between social vulnerability, seasonal stressors, and skin disease burden.

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