Examining the Impact of Atopic Dermatitis Severity on Families of Pediatric Patients

Increased atopic dermatitis (AD) severity in pediatric patients was associated with a greater physical, emotional, social, and economic impact on families, according to study findings published in The Journal of Pediatrics.

AD is characterized by intense and frequent itch, and during childhood and adolescence it has been linked with adverse effects on parents and caregivers. The additional care required for daily treatment and the need for consultation with health care providers have been noted to exacerbate caregiver burden, including effects on sleep, mental health, and quality of life.

“Much of the information on parent and caregiver burden is based on anecdotal reports or derived from pediatric clinics, which may represent more severe disease not reflective of the general population with atopic dermatitis,” noted the study authors. “Few multinational studies have evaluated the impact of pediatric AD on caregivers and family.”

Researchers utilized data of the Epidemiology of Children with AD Reporting on their Experience (EPI-CARE) cross-sectional, international web-based survey of children/adolescents (6 months to less than 18 years old) with AD and their parents and caregivers across 18 countries to investigate the impact of the disease on families of pediatric patients.

The web-based survey questioned participants on demographic information, disease severity, patient burden of AD, and the impact of the condition on parents and caregivers. AD severity was assessed using the Patient-Oriented Eczema Measure (POEM) and the Patient Global Assessment (PtGA), with impact on families’ lives evaluated using the Dermatitis Family Impact (DFI) questionnaire and stand-alone questions on hours of AD-related care (past week) and missed work days (past 4 weeks) owing to their child’s AD.

A total of 7465 pairs of pediatric participants with AD and their parents or caregivers were surveyed, including 1489 children between the ages of 6 months and 6 years of age, 2898 children 6 years to younger than 12 years of age, and 3078 adolescents 12 years to younger than 18 years of age. Severity of AD was primarily reported as mild or moderate, with consistently low proportions of severe disease reported by POEM (4.1%-13.6%) and PtGA (1.5%-8.7%).

A substanial impact on the families of children with AD was identified in all age groups across geographic areas, in which the DFI questionnaire total score for all regions ranged from 7.1 to 8.6, 13.2 to 14.9, and 17.0 to 17.2 for POEM assessed mild, moderate, and severe AD, respectively.

Subscale scores showed that increased AD severity had a greater impact on all family life domains, including sleep and tiredness. No specific patterns or trends were observed across age groups.

Time spent on childcare and missed work days increased with AD severity. For children with mild AD, parents and caregivers missed up to 3.9 days of work compared with up to 9.7 working days among parents of children with severe AD. Although there was no clear pattern observed for the number of missed work days based on age groups, findings indicated that East Asia generally had the lowest rate of missed work days across age groups and AD severity levels.

“These results emphasize that the burden of AD and its treatment extends beyond the individual patient and potentially impacts parents and caregivers who are committed to meeting the caregiving needs of their children, especially at higher levels of disease severity,” concluded the study authors. “These results also suggest the importance of assessing the broader humanistic and economic impact on parents and caregivers in addition to the patient-reported burden.”

Reference

Barbarot S, Silverberg JI, Gadkari A, et al. The family impact of atopic dermatitis in the pediatric population: Results from an international cross-sectional study. J Pediatr. 2022;246:220-226.e5. doi:10.1016/j.jpeds.2022.04.027