Lifelong psychosocial burden linked to early-onset atopic dermatitis

A large-scale study including over 30,000 participants showed that early-onset atopic dermatitis (AD) has a profound and lasting impact on psychosocial well-being. Patients who developed AD in childhood faced more significant obstacles in their professional and personal lives than those with adult-onset AD.

While the physical manifestations of eczema are extensively studied, its psychological and social implications remain less clear. The “Scars of Life” project aimed to explore how the age of onset of AD affects the severity of its symptoms and their impact on daily and occupational life [1]. The study included data from 30,801 adults in 27 countries on 5 continents. A questionnaire was developed in collaboration with multiple patient associations and international AD experts. It not only included questions related to AD severity but also questions regarding stigmatisation in professional and personal life.

This global project grouped participants based on whether their AD began in childhood (before age 10) or adulthood. To address potential biases in baseline characteristics between groups, a 1:1 propensity score matching with replacement was performed. The results were presented by Prof. Jonathan Silverberg (George Washington University School of Medicine, Washington DC, USA).

Among 10,258 individuals with current AD, those with onset during childhood reported significantly higher levels of social and emotional distress compared with those with adult-onset AD. Specifically, people suffering from AD since childhood had a systematically higher sense of stigmatisation, as measured by the Patient Unique Stigmatization Holistic tool in dermatology (PUSH-D) score (23.0 vs 18.1; P<0.0001).

This stigma influenced all major life areas: 37.3% of respondents who suffered AD since childhood declared that they had faced discrimination at work compared with 29.4% of those who only had AD in adulthood. This stigma also influenced personal relationships. “If we drill down in subdomains, those with both childhood and adult AD had significantly worse outcomes. They avoid photos and avoid people or reduce contact with other people,” Prof. Silverberg said (see Figure).

Figure: Patients who suffered from eczema since childhood have a systematically higher sense of stigmatisation [1]



Furthermore, individuals with early-onset AD were more likely to feel that their disease had hindered their professional careers, family planning, and overall self-confidence, indicating that early-onset AD imposes a long-lasting psychosocial burden.

The "Scars of Life" project underscores the necessity of addressing not only the physical but also the social and emotional aspects of AD, particularly for individuals affected during childhood. “Chronicity appears to contribute to the overall disease burden above and beyond disease severity,” Prof. Silverberg concluded. Thus, AD necessitates the early introduction of adequate long-term management.

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   1. Silverberg JI. Impact of atopic dermatitis in adults depends on its age of onset: Results of the “Scars of Life” project. D1T01.2, EADV Congress 2024, 25–28 September, Amsterdam, the Netherlands.

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Posted on 6 November 20246 November 2024