Patient-Reported Experiences Show Psychological Impact of Atopic Dermatitis on Adolescents

Both children and teens with atopic dermatitis (AD) face a high burden of disease, though the most impactful drivers of burden may differ between the age groups, suggest findings from a new study of patient-reported outcomes.¹

The findings of the study, which interviewed the young group of patients or their caregivers, highlighted the need to improve quality of life for these patients, as real-world data have historically been limited.

Adolescent patients were more likely to be most bothered by feelings of anxiety or atopic dermatitis affecting their daily activities. | Image Credit: InfiniteStudio - stock.adobe.com

“This highlights the need to incorporate disease burden in patient encounters and decision making for patients aged under 18 years and consider the potential value of improved treatment options for both pediatric and adolescent patients with moderate-to-severe AD, given the evolving treatment landscape,” the researchers wrote.

Estimates suggest that approximately 15% of patients under the age of 16 years have atopic dermatitis, with the highest prevalence among those who are female (adjusted odds ratio [aOR], 1.56; 95% CI, 1.02-2.37) or Black (aOR, 1.80; 95% CI, 1.07-3.01).²

The nearly 800 patients and caregivers participating in the newly published study, appearing in Pediatric Dermatology, reported on their experiences with moderate-to-severe AD. All patients were younger than 17 years, with an average age of 10.4 years, and lived across the United States or Europe.¹

Psychological issues were more frequently reported among adolescent patients, who were more likely to be most bothered by feelings of anxiety or AD affecting their daily activities. Findings from the quality of life assessment—using the Children’s Dermatology Quality of Life Index—showed that these adolescent patients were more affected by embarrassment or feeling self-conscious (P < .0001) or feeling like their condition was affecting their friendships (P = .0003).

“Higher emotional burden may be linked with visual aspects, which are a greater bother for adolescent patients but may be related to strain during critical stages of psychosocial development,” explained the authors.

Sleep issues were more common for the youngest patients, with 18% of pediatric patients reporting the issue, compared with 13% of adolescents. Notably, issues with sleep were considered the most bothersome part of AD even when accounting for itch, which is typically associated with causing sleep disturbances. Pediatric patients were also more likely to report disease flare-ups, issues from scratching, and skin infections as the most bothersome part of AD. 

Across the full group of patients, itch was reported as the most frustrating part of the disease (38%), followed by issues with sleeping (16%) and flares (9%). More than half (59.8%) of patients had at least 1 flare-up within the last year, with an average of 3 flares over the course of the year.

Almost all (96%) patients were receiving treatment, though adolescents were more likely to be receiving a systemic corticosteroid (24% vs 12%), phototherapy (15% vs 6%), systemic immunosuppressant (15% vs 6%), or a biologic (5% vs 1%) compared with pediatric patients (P < .0001).

Meanwhile, pediatric patients were more likely to receive prescription emollients (76% vs 69%; P = .0367), bleach baths (14% vs 8%; P = .0144), or wet wraps (13% vs 6%; P = .0022). The younger group of patients was also more likely to not be receiving treatment (6% vs 2%; P = .0029). This finding, said the researchers, suggests that younger patients may be undertreated for their condition.

"This study describes the disease burden in pediatric and adolescent patients with moderate-to-severe AD," the authors wrote. "Both groups of patients had high, but differing, disease burden; adolescent patients were more bothered by the visual and emotional aspects of their disease, whereas pediatric patients were more affected by scratching because of itch and the resulting impact on sleep. This highlights the need to incorporate disease burden in patient encounters and decision-making for patients aged < 18 years and consider the potential value of improved treatment options for both pediatric and adolescent patients with moderate-to-severe AD, given the evolving treatment landscape."

References

1. Eichenfield LF, Shi VY, Yu J, et al. Patient-reported impact of atopic dermatitis on pediatric and adolescent patients with moderate-to-severe disease: results of a real-world, cross-sectional survey. Pediatr Dermatol. Published online April 20, 2025. doi:10.1111/pde.15940

2.McKenzie C, Silverberg JI. The prevalence and persistence of atopic dermatitis in urban United States children. Ann Allergy Asthma Immunol. 2020;124(2):111-115. doi:10.1016/j.anai.2019.05.014