A comprehensive real-world study examining patient-reported outcomes in children and adolescents with moderate-to-severe atopic dermatitis has revealed significant age-related differences in disease burden, with adolescents experiencing greater psychological distress while younger children face more sleep-related challenges.
The cross-sectional analysis, published in Pediatric Dermatitis and led by Lawrence Eichenfield, MD, chief of pediatric and adolescent dermatology at Rady Children's Hospital-San Diego, evaluated 772 patients across six countries to identify specific needs associated with different age groups in atopic dermatitis management.
Distinct Burden Patterns Emerge Between Age Groups
The study, conducted between February and June 2019 as part of the Adelphi Real World Pediatric and Adolescent Atopic Dermatitis Disease Specific Programme, included 393 children aged 0-11 years and 379 adolescents aged 12-17 years from the United Kingdom, United States, France, Italy, Germany, and Spain.
Adolescent patients demonstrated significantly higher rates of anxiety-related distress compared to younger children (67% versus 49%, P < 0.0001). Using the Children's Dermatology Quality of Life Index, researchers found that adolescents were more affected by embarrassment or feeling self-conscious (P < 0.0001) and reported more frequent social effects on friendships due to their condition (P < 0.05).
"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," the authors explained.
In contrast, pediatric patients were more likely to identify sleep disruption as their most bothersome symptom, with 18% of younger children reporting sleep issues compared to 13% of adolescents. Notably, sleep problems were considered the most troublesome aspect of atopic dermatitis even when accounting for itch, which typically causes sleep disturbances.
Treatment Patterns Reflect Age-Related Differences
The analysis revealed significant disparities in treatment approaches between age groups. Adolescents were substantially more likely to receive systemic therapies, including systemic corticosteroids (24% versus 12%), phototherapy (15% versus 6%), systemic immunosuppressants (15% versus 6%), and biologic drugs (5% versus 1%) compared to children (P < 0.0001 for all comparisons).
Conversely, pediatric patients were more frequently prescribed prescription emollients (76% versus 69%, P = 0.0367), bleach baths (14% versus 8%, P = 0.0144), and wet wraps (13% versus 6%, P = 0.0022). Concerning, younger patients were also more likely to receive no treatment (6% versus 2%, P = 0.0029), suggesting potential undertreatment in this population.
Symptom Burden Across All Patients
Across the entire study population, itch emerged as the most frustrating aspect of the disease, reported by 38% of patients, followed by sleep issues (16%) and disease flares (9%). Two-thirds of all subjects reported high levels of distress due to pruritus, while 59.8% experienced at least one flare-up within the previous year, with an average of three flares annually.
The study's findings align with epidemiological data indicating that approximately 15% of patients under 16 years have atopic dermatitis, with higher prevalence among female patients (adjusted odds ratio 1.56, 95% CI 1.02-2.37) and Black patients (adjusted odds ratio 1.80, 95% CI 1.07-3.01).
Clinical Implications for Treatment Strategy
The research underscores the importance of age-specific approaches to atopic dermatitis management, particularly given concerns about treatment safety in pediatric populations that can lead to suboptimal disease management.
"This study investigated the disease burden of atopic dermatitis, as reported by the patient or their caregiver, to identify specific needs associated with different age groups, thus highlighting opportunities for treatment interventions given the emerging treatment landscape," Eichenfield and colleagues wrote.
The investigators emphasized that their findings demonstrate the need to incorporate disease burden assessments into patient encounters and clinical decision-making for patients under 18 years. They also highlighted the potential value of improved treatment options for both pediatric and adolescent patients with moderate-to-severe atopic dermatitis, particularly as the therapeutic landscape continues to evolve.
The study's comprehensive approach, involving both patient and caregiver perspectives across multiple countries, provides valuable real-world insights that have historically been limited in pediatric atopic dermatitis research. These findings may inform the development of more targeted, age-appropriate treatment strategies that address the specific burden patterns identified in each age group.
