Eczema Potentially Associated With Educational Difficulty

New findings show that the education of adolescents who have atopic dermatitis is more likely to be adversely affected, such that this patient population will encounter more tough times keeping up with their learning, according to the study recently published in Acta Dermato-Venereologica.

“Eczema is estimated to contribute the largest global burden of disability from skin disease; it affects up to 20% of children and is associated with impaired quality of life,” the authors wrote. “Eczema may have an adverse impact on school performance, as it is characteristically pruritic, and hence may lead to poor concentration and inadequate sleep, in addition to absenteeism from school due to illness.”

In addition, they added, previous research has produced conflicting results on a possible association between school performance and eczema.

Swedish survey data on ninth graders were used for this investigation, and there was an 83.4% response rate (n = 2620). Ninety-five percent of participants were aged 15 to 16 years when the survey was administered; participation was voluntary and parental consent was not required. According to the authors, the questionnaire asked about demographic, social, and anthropometric characteristics; school environment; subjective health, including previous or existing medical conditions; and recreational drug use.

Most participants were female patients (50.1%), and an overall 10.1% reported having eczema (n = 250). Of the group with eczema, girls accounted for 64% and 42.6% said they lived with both parents. The top 3 most common comorbidities were asthma (34.2%), sleeping problems (24.9%), and other allergic conditions (15.3%). In contrast among the participants not reporting eczema, fewer patients were girls (48.9%), more lived with both parents (62.4%), and the top comorbidities were sleeping problems (20.9%), asthma (11.7%), and consumed alcohol at least once per week (9.6%).

The authors highlighted that alcohol use was the variable with the most missing information (25.2%). More answers to this question were seen among the patients with eczema who lived with 1 parent vs both parents: 40.5% vs 29.8%. In addition, there were fewer reports of school difficulties and of having attention-deficit/hyperactivity disorder (ADHD) among the students who failed to answer the alcohol question compared with those who did:

• School difficulties: 2.0% vs 7.1%
• ADHD: 1.2% vs 4.7%

Eczema prevalence, meanwhile, was equivalent, with 9.1% of those who did not answer the alcohol question and 10.3% of those who did answer the question reporting they had the skin condition.

Despite there also being missing data for the exposure variable of eczema and several outcomes variables—school work difficulty, ADHD, asthma, rhinitis, sex, and family structure—crude analyses showed eczema to be associated with greater odds of school work difficulty (crude odds ratio [OR], 2.24; 95% CI, 1.45-3.45), even when adjusting for family structure and sex (OR, 2.13; 95% CI, 1.32-3.44), ADHD/sleeplessness (OR, 1.90; (95% CI, 1.15-3.13), and drinking alcohol at least once a week (OR, 1.78; 95% CI, 1.05-3.00), the study authors noted.

Additional analyses showed that boys who had eczema had an approximate 3-fold increase in school difficulties (OR, 3.63; 95% CI, 1.89-7.01) vs girls (OR, 1.59; 95% CI, 0.88-2.88).

The authors underscored the strength of their findings in emphasizing that the association between self-reported eczema and difficulties at school remained after adjusting for confounders. Still, they did note some limits to the generalizability of their findings: chiefly, the cross-sectional nature of the data and that the exposure and outcome data were self-reported. There was also potential for misclassification of measures.

“Future studies should use validated measurements, ideally using standard diagnostic criteria to identify the presence of eczema and validated outcomes to measure eczema severity and study outcomes,” the authors concluded. “The use of longitudinal study designs would also enable future studies to determine temporality and exclude the presence of important reverse causality.”

Reference

Beckman L, Hagquist C, Svensson Ä, Langan SM, Von Kobyletzki L. Relationship between eczema and self-reported difficulties keeping up with school education: a cross-sectional study. Acta Derm Venereol. Published online June 5, 2023. doi:10.2340/actadv.v103.5268