Chronic diseases such as Atopic Dermatitis (AD), beyond physical symptoms, affect multiple dimensions of life, which include relationships, finances, occupational functioning, psychological well-being, self-esteem, body image, sleep, and affect household dynamics.1 We commend Dr. Bressan et al. for addressing the impact of AD on overall sexual function and satisfaction.2 Nevertheless, we’d like to highlight some methodological considerations that warrant caution regarding the interpretation of these findings.

Overall quality-of-life measurements vary according to the study population and cultural context.3 Although the QS-F/M have been validated in Brazilian samples, their internal consistency should be formally assessed for each study population (e.g., using McDonald’s ω) to ensure measurement reliability.4 Additionally, the 10-items of these instruments capture distinct domains of sexuality, which may be differentially affected. The domain-specific information is clinically relevant as it may guide targeted interventions. As the authors did not provide an item-level interpretation, the precision of the information on sexual impairment remains unclear.

The modest sample size results in low statistical power for most comparisons and correlation analyses. This undermines confidence in subgroup-specific conclusions, especially when comparing them. Furthermore, the assertion that women are more affected than men may reflect differential measurement properties of QS-F/M, sociocultural reporting differences, or sampling variability, rather than biological or clinical disparities attributed to AD. In addition, as QS-F/M are sex-specific instruments with different constructs, comparing mean levels across sexes is not straightforward without standardization (e.g., by item-response theory transformation).

Beyond the burden imposed by AD, sexual function may be influenced by several factors, including relationship status, medication, menopause/andropause, obesity, comorbidities, affective disorders, and cultural and religious beliefs.5 Consequently, the correlations between disease severity and QS scores are likely influenced by these variables, hindering causal interpretation.

Thus, we encourage reporting internal consistency, item performance, and standardized QA-F/M scores for sex comparison. Also, clarifying whether QS-F/M analyses were restricted to sexually active participants would present a sensitivity analysis restricted to them.

Moreover, the inclusion of a broad age range (18–79 years) introduces heterogeneity, as age-related physiological and psychosocial changes can modulate sexual function. The lack of a matched control group (healthy individuals or other chronic dermatoses) substantially limits generalizability. Comparisons with population norms for EQ-5D-3L or QS-F/M do not adequately substitute for a contemporaneous control group because they do not account for age, sex, socioeconomic status, or comorbid mental health conditions.

Therefore, the generalization of these findings and the inference that AD exerts a severity-dependent and sex-specific impact on sexual function should be interpreted with caution, given the observational design, potential confounding, and lack of an appropriate control group.