Childhood Atopic Dermatitis Impact Research Articles

175 Impact of childhood atopic dermatitis on cognition and achievement

Atopic dermatitis (AD) often arises in early childhood during a critical period of cognitive development and has been linked to attention deficit hyperactivity disorder, sleep disruptions, and neuropsychiatric comorbidities. However, less is known about the impact of AD on cognition and academic achievement. In a birth cohort of U.S. children followed in the Study of Early Child Care and Youth Development from 1991 to 2007, we conducted a retrospective cohort study comparing 116 children with AD and 1,104 children without AD with respect to the Wechsler Abbreviated Scale of Intelligence in 4th grade and Woodcock-Johnson-Revised (WJ-R) tests of achievement in 3rd and 5th grades.

Impact of childhood atopic dermatitis on family: correlation with disease severity

Background Atopic dermatitis (AD) is a common skin disease that not only severely burdens patients but also their families and society. AD is a chronic inflammatory disease that is usually detected in childhood.Objectives We aim to evaluate the quality of life of parents of children with AD and to crosscheck it with the intensity of the disease.Patients and methods This is a cross-sectional study, where the data of parents of 100 children with AD were collected from the outpatient clinic of the Dermatology, Venereology, and Andrology Department, Assiut University Hospitals, from May 2017 to May 2019. Parents answered the validated Arabic version of the Dermatitis Family Impact (DFI) questionnaire. The disease severity was assessed using the SCORAD index.Results Families of children with severe dermatitis had quite high DFI scores (16.37±3.727) compared with the families of those with dermatitis of moderate intensity (12.10±3.356) and dermatitis of low intensity (8.50±0.707) (P<0.001). It was observed that the impact of dermatitis on families had a positive significant correlation with the degree of intensity of AD (P<0.001, r=0.658). The highest-scoring DFI domains were sleep time, followed by a feeling of tiredness, emotional stability, general life, household work, and expenditure.Conclusion AD directly affects the quality of life of patients’ parents, and the adverse effects on the quality of life are significantly correlated with the disease severity.

27473 Worldwide survey shows that atopic dermatitis in children is associated with a negative impact on their families

Background: Information on the impact of childhood atopic dermatitis (AD) on their families is lacking. This study reports parent-reported impact of childhood AD on their families in 5 regions worldwide.

Association of pediatric atopic dermatitis and psoriasis with school absenteeism and parental work absenteeism: A cross-sectional United States population-based study

The impact of childhood atopic dermatitis (AD) and psoriasis on school absenteeism is not fully elucidated. To determine the burden and predictors of chronic school absenteeism in children with AD and psoriasis. Data were analyzed from the 1999-2015 Medical Expenditure Panel Surveys, cross-sectional, population-based studies of health status and function in the United States. Among 3132 and 200 children with AD and psoriasis, respectively, 1544 (67.7%) and 97 (62.5%) missed ≥1day, and 120 (3.9%) and 5 (3.6%) missed ≥15days (chronically absent) per year due to illness. AD was associated with chronic absenteeism overall (logistic regression; adjusted odds ratio 1.42, 95% CI [1.13-1.78]) and with more severe disease (mild-moderate: 1.33 [1.04-1.70], severe: 2.00 [1.21-3.32]). No statistical difference in chronic absenteeism was found for children with versus those without psoriasis (1.26 [0.51-3.12]). Parents of children with AD were more likely to miss work for caregiving versus those of children without AD, whereas parents of children with psoriasis had similar rates of work absenteeism versus those of children without psoriasis. The severity of AD and psoriasis was assessed by treatment pattern. Children in the United States with AD had increased chronic school absenteeism. Further interventions are warranted to prevent school absenteeism in childhood AD.

Mental Health Symptoms and Functional Impairment in Children With Atopic Dermatitis

The impact of childhood atopic dermatitis (AD) on social and behavioral issues is not well understood. This study sought to determine the prevalence and predictors of social and behavioral symptoms and functional impairment among US children with AD. The 1996 to 2015 Medical Expenditure Panel Surveys were analyzed, including a representative, cross-sectional study of 2553 US children with AD. Behavioral and functional issues were examined using Columbia Impairment Scale (CIS) scores. Childhood AD was associated with behavioral and functional problems, particularly nervousness (odds ratio [OR], 1.18; 95% confidence interval [95% CI], 1.06-1.31), home behavior (OR, 1.18; 95% CI, 1.06-1.32), staying out of trouble (OR, 1.18; 95% confidence interval, 1.06-1.31), and relationships with other kids (OR, 1.17; 95% CI, 1.05-1.31) and with siblings (OR, 1.14; 95% CI, 1.02-1.28). Higher CIS scores were present in children with AD versus without AD (adjusted β, 0.62; 95% CI, 0.22-1.02) and with psoriasis (adjusted β, 0.86; 95% CI, 0.22-1.49). Among children with AD, higher CIS scores were notably associated with male sex, older age, lower household income, public insurance, and comorbid depression and anxiety. AD was associated with behavioral and functional impairment, similar to psoriasis and other common chronic conditions. There are significant sociodemographic differences in CIS scores.

282 Eczema is associated with increased hospitalization rates in United States children

Childhood atopic dermatitis (AD) is associated with severe and unpredictable flares, and multiple comorbidities, e.g. atopic, mental health, and infectious disorders, all of which may lead to hospitalization. However, the impact of childhood AD on hospitalizations in the US has not been well described. Data were analyzed from the 1997-2017 National Health Interview Survey, a US population-based household survey (n=251,555 children). In multivariable logistic regression models adjusting for multiple socio-demographics, atopic and mental health comorbidities, children with caregiver-reported eczema compared to those without eczema had significantly higher odds of having 1-2 overnight hospitalizations (logistic regression; adjusted odds ratio [95% confidence interval]: 1.17 [1.05-1.30]) and ≥3 hospitalizations (1.64 [1.19-2.25]) in the past year. In logistic regression models of ≥1 overnight hospitalization with stepwise selection, female sex (1.16 [0.94–1.43]), black race (black: 1.52[1.18–1.96]), Hispanic ethnicity (1.12 [0.88–3.81]), having Medicaid (1.06 [0.97–1.17]), outpatient physician interaction (1.85 [0.90–3.81]), asthma attack (2.11 [1.65–2.70]), feeling depressed (1.41 [1.12-1.78]), attention deficit (hyper)activity disorder (1.33 [0.98-1.82]), hay fever and/or respiratory allergy (2.23 [1.60–3.12]), and digestive allergy (3.19 [2.43–4.19]) were all associated with higher odds of hospitalization in children with eczema. Whereas, Asian race (0.87 [0.45-1.67]), multiracial/other race (0.88 [0.53-1.45]) and non-private insurance (Medicaid: 0.98 [0.77-1.21]; other/none: 0.91 [0.69-1.21]) were associated with lower odds of hospitalization. In conclusion, childhood eczema is associated with higher odds of overnight hospitalization in the US. Future studies are needed to determine optimal strategies to prevent hospitalization in children with eczema.

Broader concepts of quality-of-life measurement, encompassing validation - AY Finlay.

It is difficult to imagine nowadays not taking into account patients’ quality of life. This is largely thanks to Andrew Finlay for drawing out attention to the importance of measuring the burden of skin diseases. In describing in his article1 the journey leading to the development of the DLQI, he highlights the importance of listening to our patients and being good scientists. Because once clinical practice is transformed into science, it can never be suppressed. How many of our patients were suffering and being mistreated before this? How many were not helped in their lives, ravaged by a visible, painful or itchy disease? In how many cases were we unaware of the patients’ discomfort with the treatments we prescribed, in some cases with greasy creams or coloured lotions? The DLQI was wisely developed to adapt to our busy professional lives, as well as to be protected from bad translations, partial use and other misuses that gave it all its power. Andrew Finlay and his team have given a voice to all our patients in everyday consultation. This contributes to a new way of practicing medicine and dermatology, putting the patient in the centre, making a person-centred consultation.2 Moreover, this is also the best way to evaluate the efficacy of new therapies, as for example the biologic therapies that are now available. With the use of this tool, it becomes clear that some of our patients need this therapy, even if it is expensive.3 The DLQI gives a framework to use with the patients who are suffering the most. And the findings do not always coincide with what we think. It is clear now that psoriasis, for example, is a disease that can have a deep impact in the lives of the patients, both in the present and in the future. The burdens of this skin disease can sometime take patients to suicidal ideation.4 We are less likely to overlook those patients if we use the DLQI in routine practice. Andrew Finlay and his team were also the first to evaluate the family impact of childhood atopic dermatitis.5 By developing the Family DLQI, they gave us an easy tool to screen this dimension. And we need to help the parents to cope. For that purpose, atopy schools were created all over the world. Finally, this article opens the door to the strategy used to develop and to go further in this domain. This experience of 30 years is very precious to each of us to understand how to develop other practical tools that can make science help our patients.

The Impact of Childhood Atopic Dermatitis on the Patients’ Family

Atopic dermatitis is a common childhood disease that impairs quality of life. The study aimed to clarify the impact of childhood atopic dermatitis on family life and to correlate severity of atopic dermatitis with family life. A cross-sectional survey was conducted at Qassim Region of Saudi Arabia over a period of 4 months extending from April to July 2009. The parents of children with atopic dermatitis were asked through a validated "Dermatitis Family Impact Questionnaire" about the impact of the disease on their life. For each questionnaire, a total score of 0 to 5 is considered as normal quality of life, 6 to 10 as low, 11 to 20 as moderate and >20 as high alteration in quality of life. The severity of the disease was evaluated using the SCORAD index. A total of 447 children with atopic dermatitis were included in the study. Their mean age was 65.9 months. Males constituted 57% of the patients. The mean score for quality of life in affected families was 13.9 (minimum 2, maximum 25). Based on our suggested classification, only 15 (3.4%) had normal quality of life, 104 (23.3%) were mildly affected, 297 (66.4%) were moderately affected, while 31 (6.9%) reported severe alternation in their quality of life. Sleep, monthly expenditure, and food preparation were the activities showing the highest level of disturbance. The disturbance in quality of life was significantly correlated to increasing severity of the disease. The study has emphasized the importance of investigating the quality of life of atopic dermatitis families. A simple questionnaire is a useful guide for appropriate management of the disease.

A randomized controlled trial in children with eczema: nurse practitioner vs. dermatologist

Background We hypothesized that a nurse practitioner would improve the quality of life of a child with eczema more than a dermatologist because of a structured intervention and more consultation time. Objectives To compare the level of care by nurse practitioners with that by dermatologists in children with eczema. Methods New referrals aged < or = 16 years with a diagnosis of eczema were recruited. In a randomized, parallel-group study with a follow-up period of 1 year, 160 participants were randomized either to conventional care from a dermatologist or to care from a nurse practitioner. The primary outcome measure was change in quality of life at 12 months, as assessed by the Infants' Dermatitis Quality of Life Index (IDQOL) for children aged < or = 4 years, and by the illustrated version of the Children's Dermatology Life Quality Index (CDLQI) for children aged 4-16 years. Secondary outcomes were changes in IDQOL and CDLQI at 4 and 8 months, family impact of childhood atopic dermatitis (Dermatitis Family Impact Questionnaire, DFI), eczema severity (objective SCORAD) and patient satisfaction (Client Satisfaction Questionnaire-8, CSQ-8) at 4, 8 and 12 months. Results The mean IDQOL in the dermatologist group improved significantly from 11.6 [SD 8.1; 95% confidence interval (CI) 9.0-14.2] at the baseline to 5.6 (SD 3.9; 95% CI 4.3-7.0) at 12 months with a mean change from the baseline of -6.5 (SD 6.6; 95% CI -14.2 to -8.9; P < 0.001). The mean IDQOL in the nurse practitioner group improved significantly from 10.7 (SD 4.9; 95% CI 9.1-12.3) at baseline to 5.7 (SD 5.4; 95% CI 4.0-7.5) at 12 months with a mean change from the baseline of -4.9 (SD 5.5; 95% CI -6.8 to -3.0; P < 0.001). The between-groups difference was (-)1.7 (95% CI -4.6 to 1.2; P = 0.26). The mean CDLQI in the dermatologist group improved significantly from 12.1 (SD 6.3; 95% CI 9.9-14.2) at baseline to 5.6 (SD 4.2; 95% CI 4.2-7.1) at 12 months with a mean change from the baseline of -5.9 (SD 6.0; 95% CI -8.0 to -3.9; P < 0.001). The mean CDLQI in the nurse practitioner group improved significantly from 10.0 (SD 4.4; 95% CI 8.5-11.4) at the baseline to 4.9 (SD 3.5; 95% CI 3.7-6.1) at 12 months with a mean change from the baseline of -5.2 (SD 4.0; 95% CI -6.6 to -3.8; P < 0.001). The between-groups difference was (-)0.7 (95% CI -3.3 to 1.7; P = 0.55). The between-groups comparison was not significant for the IDQOL and the CDLQI at baseline or 4, 8 and 12 months. Both treatment groups showed significant improvement in DFI and objective SCORAD at 12 months. The between-groups comparison was not significant at baseline or 4, 8 and 12 months. Significantly higher satisfaction levels were observed at 4, 8 and 12 months in the nurse practitioner group. Conclusions The level of care provided by a nurse practitioner in terms of the improvement in the eczema severity and the quality of life outcomes was comparable with that provided by a dermatologist. In addition, the parents were more satisfied with the care that was provided by a nurse practitioner.

Measuring the impact of childhood atopic dermatitis

Measuring the impact of childhood atopic dermatitis

Effects of an episode of specialist care on the impact of childhood atopic dermatitis on the child's family*1

Introduction: Although some preliminary work has examined the impact of atopic dermatitis (AD) on families, no empirical work has examined changes in the impact on families dealing with AD over time. An exploratory analysis of change in impact on families dealing with AD before and after an episode of medical care in a physician office setting was conducted. Method: Baseline and follow-up surveys were completed by 35 parent caregivers before and 1 month after a dermatologist visit for the child at an academic medical center. Results: In the postcare survey, there was a 43% reduction in the Dermatitis Family Impact Questionnaire (DFI) scores (P <.01) compared with baseline. Significant differences were also observed in other parent caregiver-reported characteristics. The significant change in parent caregiver characteristic associated with the decreased DFI score was the increased satisfaction with the medical care related to the child's treatment (P <.01). Discussion: These data reveal that there is a strong decrease in impact on a family associated with an episode of specialist care for children with AD. The importance of pediatric health care professionals in decreasing the impact of AD on families needs further exploration. J Pediatr Health Care. (2003). 17, 184-189.

Effects of an episode of specialist care on the impact of childhood atopic dermatitis on the child's family

Introduction: Although some preliminary work has examined the impact of atopic dermatitis (AD) on families, no empirical work has examined changes in the impact on families dealing with AD over time. An exploratory analysis of change in impact on families dealing with AD before and after an episode of medical care in a physician office setting was conducted. Method: Baseline and follow-up surveys were completed by 35 parent caregivers before and 1 month after a dermatologist visit for the child at an academic medical center. Results: In the postcare survey, there was a 43% reduction in the Dermatitis Family Impact Questionnaire (DFI) scores (P <.01) compared with baseline. Significant differences were also observed in other parent caregiver-reported characteristics. The significant change in parent caregiver characteristic associated with the decreased DFI score was the increased satisfaction with the medical care related to the child's treatment (P <.01). Discussion: These data reveal that there is a strong decrease in impact on a family associated with an episode of specialist care for children with AD. The importance of pediatric health care professionals in decreasing the impact of AD on families needs further exploration. J Pediatr Health Care. (2003). 17, 184-189.

The Impact of Childhood Atopic Dermatitis on Quality of Life of the Family

Background: Atopic diseases have become a major health problem in the western world. Symptoms start mostly with atopic dermatitis (AD) in infancy, a disease characterized by dry and itchy skin with frequent relapses of inflammation. Its chronic course with extreme pruritus and loss of sleep affects the whole family. In order to identify special needs for support it seems important to look at quality of life (QoL) of the parents with special regards to factors influencing it. Patients and Methods: The families of 204 patients participating in a study designed to evaluate an education program for parents could be investigated at baseline. Besides assessment of severity and duration of AD parents filled in questionnaires on medical history, therapeutic efforts, health related QoL, and coping. Results: QoL of parents is heavily impaired compared to healthy controls. Mothers suffer more from the disease than fathers. Severity of the eczema and time spent on therapy only partly explain the impairment of QoL. More of the variance is explained by coping styles. Conclusion: Since familial stress has been shown to be a predictor for bad long-term outcome it is important to support parents in dealing with the chronic condition of their child. This suggests the need for patient and family education programs, which are capable of assisting parents in the management of and adjustment to the disease of their child.

The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire.

Little information is available about the effect of childhood atopic dermatitis (AD) on family function. The aim of this study was to identify the areas of family life most affected and their perceived importance. Intensive qualitative interviews with 34 families were conducted and 11 basic problem areas were identified. A detailed questionnaire was prepared, part of which addressed the perceived importance of particular issues using the framework of multi-attribute utility theory. The results from using this questionnaire in 41 families were analysed and a shorter 10-question one-page Dermatitis Family Impact (DFI) questionnaire designed (maximum score = 30). In affected families the mean DFI score was 9.6 +/- 7.0 (range 0-27, n = 56) and in unaffected families the mean score was 0.4 +/- 0.9 (range 0-3, n = 26, P < 0.0001). The DFI could potentially be used as an extra measure in clinical studies, or to help guide appropriate management of AD.