Age-Specific Burden of Moderate-to-Severe Pediatric Atopic Dermatitis

Key Highlights

• In a real-world cohort of 772 pediatric and adolescent patients with moderate-to-severe atopic dermatitis (AD), approximately 60% experienced a flare in the prior 12 months.
• Adolescents had longer flare duration and higher Investigator Global Assessment severity scores than younger children.
• Itching (38%) and sleep disturbance (16%) were the most reported burdens across age groups.
• Adolescents reported significantly greater psychosocial impact, including anxiety about skin appearance and embarrassment/self-consciousness.

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A real-world, cross-sectional survey of pediatric and adolescent patients with moderate-to-severe atopic dermatitis (AD) demonstrated a high burden of disease, with important differences in clinical severity, treatment patterns, and quality-of-life (QoL) impact between age groups. The findings were published in Pediatrics.

The study evaluated data from the Adelphi Real World Pediatric and Adolescent AD Disease Specific Programme conducted in 2019 across the United States, United Kingdom, France, Germany, Italy, and Spain. Investigators sought to characterize disease burden and identify age-specific needs among patients younger than 18 years with physician-confirmed moderate-to-severe AD who were not enrolled in clinical trials.

Physicians, caregivers, and adolescent patients completed structured surveys assessing clinical characteristics, management patterns, disease burden, and QoL. Physicians recorded data for consecutive patients using standardized patient record forms, including disease severity measures such as the Eczema Area and Severity Index (EASI) and Investigator Global Assessment. Caregivers and adolescents rated the most bothersome symptoms—such as itch, sleep interference, and skin damage—using Likert scales and completed the Children’s Dermatology Life Quality Index (CDLQI). The analysis included 772 patients (393 pediatric patients aged 0–11 years and 379 adolescents aged 12–17 years) and 200 treating physicians.

Study Findings

The mean patient age was 4.9 years; 53% were male and 82% were White. Overall, disease severity was moderate, with a mean EASI score of 9.7. Approximately 60% of patients reported experiencing at least one flare in the 12 months preceding data collection.

Adolescents had significantly longer flare duration compared with pediatric patients (19.1 vs 15.5 days; P = .026) and higher Investigator Global Assessment severity scores (P = .028). Nearly all patients (96%) were receiving treatment. The most common therapies included topical corticosteroids (81%), emollients (72%), and antihistamines (35%).

Treatment patterns differed by age. Adolescents were significantly more likely than younger children to receive systemic corticosteroids (24% vs 12%), phototherapy (15% vs 6%), systemic immunosuppressants (15% vs 6%), and biologics (5% vs 1%) (all P < .0001). In contrast, pediatric patients were more likely to receive emollients (76% vs 69%), bleach baths (14% vs 8%), wet wraps (13% vs 6%), or no treatment (6% vs 2%) (all P < .05).

Across the full cohort, itching was the most frequently cited burdensome symptom (38%), followed by sleep disturbance (16%) and flares (9%). Adolescents reported significantly greater psychosocial burden, including anxiety about their skin (67% vs 49%; P < .01), interference with daily activities (33% vs 25%; P < .05), embarrassment or self-consciousness (P < .0001), impact on friendships (P = .0003), and concern about the extent or location of lesions. Pediatric patients and caregivers more often emphasized sleep disruption, flares, skin damage from scratching, and infections, although these differences were not statistically significant.

Clinical Implications

According to the study authors, the findings suggest that younger children are more affected by sleep disruption related to itching, whereas adolescents experience greater social and emotional consequences associated with visible skin disease. The authors also noted that adolescents demonstrated higher severity scores, longer flares, and greater use of systemic therapies, while younger children were more likely to receive supportive measures or no treatment.

Expert Commentary

“Atopic dermatitis is a disease with significant burden on both pediatric and adolescent patients affecting quality of life in unique ways; pediatric patients are most impacted by disordered sleep due to itching, compared with adolescents facing social and emotional implications of the visual aspects of the disease,” the researchers concluded.

Reference
Reddy NG, Aquino MR. Patient-reported impact of atopic dermatitis on pediatric and adolescent patients with moderate-to-severe disease: results of a real-world, cross-sectional survey. Pediatrics. 2025;156(Suppl 2):S15-S16. doi:10.1542/peds.2025-074246H