Clinical characterization of skin pain in children with atopic dermatitis

Abstract

Previous studies have identified skin pain as a symptom of pediatric atopic dermatitis (AD). However, the burden of skin pain in AD is not well-characterized. We examined associations of skin pain intensity with clinical features and functional outcomes in pediatric AD. This was a cross-sectional, nationwide survey of 180 children (ages 5-17 years) with AD in the US. Skin pain (0-10 scale) was reported by parent proxy. Multivariable linear regression models were constructed to examine associations of skin pain intensity with AD characteristics, Patient-Reported Outcome Measurement Information System (PROMIS) pain interference, PROMIS profile, and Children’s Dermatology Life Quality Index (CDLQI). The mean±standard deviation age was 10.5±0.3 years, with 56% male, 32% African-American, and 83% moderate/severe AD. Almost half (49%) had skin pain, with mean intensity of 5.4 [95% confidence interval: 4.6-6.3]. In children with skin pain (n=88), after adjusting for sex, race, age, AD severity, pain intensity was associated with frequent (5-7 days/week) itch (adjusted beta [95% CI]: 1.51 [0.61, 2.41]), bleeding (1.39 [0.42, 2.36]), weeping/oozing (1.02 [0.19, 1.85]), and cracking (0.99 [0.14, 1.85]), and with difficulty sleeping (0.95 [0.09, 1.81]), paying attention (1.24 [0.38, 2.09]), and running (1.09 [0.10, 2.07]). Skin pain intensity was associated with depression/sadness (2.21 [0.87, 3.54]), fatigue (2.22 [0.90, 3.54]), and anxiety/fear (2.31 [0.67, 3.96]) and decreased CDLQI scores (-1.75 [-2.35, -1.14]). Skin pain in pediatric AD is associated with heterogeneous skin symptoms and significant QOL burden. Clinicians should consider screening for skin pain when treating children with AD.