EADV 2019: Epidemiology and patient-reported burden of atopic dermatitis in adolescents
European Academy of Dermatology and Venereology Congress 2019
The World Health Organization (WHO) Global Burden of Diseases initiative estimates more than 230 million people globally have atopic dermatitis (AD), and that skin diseases continue to be the fourth leading cause of non-fatal disability worldwide.1 Our understanding of AD is evolving rapidly, leading to new approaches to patient management and a pipeline of novel topical and systemic therapies. Despite these advances, recent estimates on the population-based prevalence and severity of AD in adolescents are currently lacking. Further, few multinational studies have addressed patient self-reported disease burden in adolescents with AD.
At the 28thAnnual Congress of the European Academy of Dermatology and Venereology (EADV), held 9-13 October 2019 in Madrid, Spain, researchers presented new data from a cross-sectional study of AD epidemiology2 and patient-reported disease burden3 in adolescents in the United States (US) and Europe. In this week’s commentary, we present their findings.
A cross-sectional study in adolescents
The study was a web-based, self-report survey of adolescents (aged 12–17 years) with AD in the US and Europe (France, Germany, Italy, Spain and the United Kingdom [UK]). In each country, members of online consumer panels who met the inclusion criteria (parents/guardians of adolescents aged 12–17 years) were recruited through broad-reach portals, special interest sites and emailing campaigns. The email did not mention skin disease or AD.
Figure 1. Self-reported assessment of atopic dermatitis.
Abbreviations: AD, atopic dermatitis; ISAAC, International Study for Asthma and Allergies in Childhood.
Data was collected from 26 September 2018 to 20 February 2019 using a 30-minute online survey. To obtain a representative population for each country, quotas were set for numbers of respondents in specific categories relating to age and sex, geographical regions and urban/rural split. Adolescents were categorised as having AD if they met the International Study for Asthma and Allergies in Childhood (ISAAC) criteria and self-reported ever being told by a physician that they suffer from eczema (Figure 1).
Respondents with AD treated with at least one prescription treatment in the past 12 months were stratified by disease severity (mild, moderate or severe) based on Patient Global Assessment (PtGA). Several outcomes were captured during the survey (Table 1).
Table 1. Outcomes captured during the online survey.
Abbreviations: AD, atopic dermatitis; CDLQI, Children’s Dermatology Life Quality Index; health-related quality of life; NA, not applicable; NRS, Numerical Rating Scale; POEM, Patient-Oriented Eczema Measure.
aHigher scores indicate higher severity.
bHigher scores indicate greater impact on quality of life.
Epidemiology of atopic dermatitis in adolescents in the US and Europe
Survey response rates were 9.4% (n=3344) in the US, 18.8% (n=1510) in France, 23.3% (n=1010) in Germany, 16.1% (n=1698) in Italy, 13.2% (n=1160) in Spain and 9.6% (n=1419) in the UK. Baseline demographics and characteristics were similar for all respondents and across disease severity levels for respondents with AD. Patients with AD had a mean age of approximately 15 years and males and females were generally equally distributed.
One-year diagnosed AD prevalence estimates based on overlap between ISAAC and self-report of physician diagnosis of eczema were 9.3% in the US and 14.7% in Europe. Across countries, the prevalence of AD was slightly higher among male adolescents relative to females (male: 8.9–22.1%, female: 8.4–17.2%; Table 2) and among adolescents who lived in a suburban/urban region compared to a rural region (suburban/urban: 9.9–22.1%; rural: 5.1–13.9%; Table 2). The majority of adolescents with AD (88.4–96.7%) received at least one prescription treatment in the previous 12 months and self-reported having mild or moderate AD (Table 2).
In the overall population, a larger proportion of males (7.8–12.3%) were affected by severe AD relative to females (5.3–8.3%). Further, a larger proportion of adolescents with severe AD lived in a suburban or urban region (7.3–11.2%) versus in a rural region (2.2–4.6%).
Table 2. Evaluation of atopic dermatitis prevalence and disease severity.
Abbreviations: AD, atopic dermatitis; POEM, Patient-Oriented Eczema Measure; PtGA, Patient Global Assessment; UK, United Kingdom; US, United States.
Self-reported disease burden of atopic dermatitis in adolescents in the US and Europe
For patient-reported disease burden, a total of 1377 adolescents with AD across the US and Europe were surveyed and stratified by disease severity (mild AD, n=801; moderate AD, n=497; severe AD, n=79). Mean scores of itch, sleep, skin pain and health-related quality of life (HRQoL) increased with higher levels of disease severity. Productivity losses also increased with greater disease severity, with adolescents with severe AD reporting over 10 missed school days, compared with 3.4 and 6.8 for those with moderate and mild AD, respectively. Overall, atopic comorbidities occurred more frequently among adolescents with severe AD (Table 3).
Table 3. Outcome assessment in mild, moderate and severe atopic dermatitis.
Abbreviations: AD, atopic dermatitis; CDLQI, Children’s Dermatology Life Quality Index; HRQoL, health-related quality of life; NRS, Numerical Rating Scale; SD, standard deviation.
aP < 0.01 compared with mild AD.
bP < 0.01 compared with mild and moderate AD.
This cross-sectional survey of adolescents with AD demonstrated that prevalence of diagnosed AD ranges from 8.7% in Germany to 19.8% in Spain, with variability across the six countries. The overall prevalence in the five European countries (14.7%) was higher than that in the US (9.3%). Reported consistently across the countries was the substantial impact of AD in terms of worsening itch, sleep, skin pain and health-related quality of life, as well as comorbidities and productivity losses. The survey also showed that the burden associated with AD increased with increasing disease severity, indicating there is an unmet need in the management of adolescents.
To find out more about reducing patient disease burden with AD, explore our online CME courses:
To test your knowledge of eczema treatment and management as part of patient-centred care, try our ‘Self-assessment in atopic dermatitis’ and ‘Case challenge: 16-year old patient with moderate atopic dermatitis’ modules.
Interested in reading more about the AD research presented at EADV this year? Sign up to Action Eczema and be notified when our EADV 2019 Congress Report is available online for viewing and CME credit.
- Karimkhani C, Dellavalle RP, Coffeng LE, et al. Global skin disease morbidity and mortality: an update from the Global Burden of Disease study 2013. JAMA Dermatol. 2017;153(5):406-412.
- Silverberg JI, Barbarot S, Simpson EL, et al. Epidemiology of atopic dermatitis in the adolescent population: a cross-sectional study in the United States and Europe. Presented at the European Academy of Dermatology and Venerology (EADV) 2019. 9-13 October 2019; Madrid, Spain. Poster session.
- Weidinger S, Simpson EL, Silverberg JI, et al. The patient-reported disease burden in adolescents with atopic dermatitis: a cross-sectional study in the United States and Europe. Presented at the European Academy of Dermatology and Venerology (EADV) 2019. 9-13 October 2019; Madrid, Spain. Poster session.