Patient-Reported Impact of Atopic Dermatitis on Pediatric and Adolescent Patients With Moderate-to-Severe Disease: Results of a Real-World, Cross-Sectional Survey

This study aimed to examine the disease burden of pediatric and adolescent patients with atopic dermatitis (AD) and to identify the specific needs associated with patients in different age groups.The retrospective cross-sectional study included surveys from patients and physicians in the Adelphi Real World Pediatric and Adolescent AD Disease Specific Programme (DSP) conducted in the United States, United Kingdom, France, Germany, Italy, and Spain, in 2019. The population included 772 patients, pediatric (ages 0-11 years, 393 patients) and adolescent (ages 12-17 years, 379 patients), and 200 physicians (dermatologists, allergists, pediatricians, primary care clinicians) actively treating patients with AD within this age group. Patients were eligible for inclusion if they were younger than 18 years with moderate to severe disease, had a physician-confirmed diagnosis of AD, and were not currently involved in a clinical trial.Pediatric and adolescent patients with AD, their caregivers, and physicians were queried to understand current clinical practice patterns, burden and impact of disease, quality of life (QoL), and treatment effects. Physicians completed a patient record form on consecutive patients to classify disease severity and describe patient clinical characteristics along with demographics and management history. Caregivers and adolescent participants reported on the most bothersome aspects of AD (itch, sleep interference, skin damage) on a Likert scale; impact on work and daily activities; and impact on QoL using the Children’s Dermatology Life Quality Index (CDLQI).The patient population had a mean age of 4.9 years, with 53% male, 82% white, and with eczema of moderate severity (mean Eczema Area and Severity Index was 9.7). Approximately 60% of patients experienced a flare within the 12 months prior to data collection. Adolescents were noted to have significantly longer duration of flares (19.1 days vs 15.5 days in pediatric patients, P = .0264), in addition to higher Investigator Global Assessment disease severity scores (P = .0284). The majority (96%) of patients were receiving treatment including corticosteroids (81%), emollients (72%), and antihistamines (35%). Adolescent patients were significantly more likely to receive systemic corticosteroids (24% adolescents vs 12% pediatrics), phototherapy (15% vs 6%), systemic immunosuppressants (15% vs 6%), or biologics (5% vs 1%) (all P < .0001). Pediatric patients, however, were significantly more likely to be prescribed emollients (76% pediatrics vs 69% adolescents), bleach baths (14% vs 8%), wet wraps (13% vs 6%), or no treatment (6% vs 2%) (all P < .05). Overall, the most burdensome aspect of AD in all patients was reported to be “itching” (38%), followed by “sleep disturbance” (16%) and “flares” (9%). Adolescents more often experienced anxiety about their skin (67% adolescents vs 49% pediatrics, P < .01), interference with their daily activities (33% vs 25%, P < .05), embarrassment/self-consciousness (P < .0001), impact on friendships (P = .0003), and concern for extent/location of AD involvement. Pediatric patients and their caregivers cited the highest impact being in sleep disruption, flares, skin damage from scratching, and infections associated with AD, although these responses were not significantly different from adolescents.Atopic dermatitis is a disease with significant burden on both pediatric and adolescent patients affecting QoL 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. Adolescent patients were found to have higher severity scores, have longer duration of flares, and be more likely to be prescribed medications for treatment, whereas pediatric patients were more likely to be receiving no treatment or supportive measures.This multinational cross-sectional study sheds light on the significant impact that AD has on different facets of pediatric and adolescent life. The pooling of this large cohort, however, may blur the nuances between US and European practice patterns, patient demographics, and individual experiences. Other limitations of this study include selection bias in the surveyed patient population, representing to a greater extent those that frequently visited their physician, due to either higher severity of disease or more engagement with care. Recall bias exists with the nature of a survey, as well as caregiver-perceived responses in younger children as opposed to self-reported responses in adolescents. This stratified analysis supports the need to provide tailored therapy specific to the demographic of the patient and their concerns. With the advent of newer therapeutics, the capture of disease control at a younger age may be able to reduce the impact later in childhood for patients with AD and improve the course of the disease over time.