Children with Atopic Dermatitis May Be Shorter in Height

Amy S. Paller, MD

Younger children with moderate to severe atopic dermatitis may experience hindered growth relative to peers their age, according to new findings from an ongoing international, observational study.¹

Data from the PEDISTAD trial—an ongoing 10-year analysis of pediatric patients aged <12 years old with moderate-to-severe, inadequately controlled atopic dermatitis—show that children with eczema have a lower mean height and higher mean weight and body mass index (BMI) than study’s reference healthy population. Presented at the American Academy of Dermatology (AAD) 2024 Annual Meeting in San Diego, CA, this weekend, the findings may be informed by a number of factors including impacted sleep or a prolonged use of growth-affecting therapies for the treatment of their atopic dermatitis.

The Observational Evaluation of Atopic Dermatitis in Pediatric Patients study, or PEDISTAD, is a decade-long assessment sponsored by Sanofi that is observing moderate-to-severe atopic dermatitis in nearly 2000 patients aged <12 years old whose disease is not adequately controlled with topical prescription therapy.² Investigators are seeking primary outcomes including the clinical characteristics of patients globally, as well as the time-course of atopic dermatitis and selected atopic comorbidities in such patients.

In the analysis presented at AAD 2024 by Amy S. Paller, MD, chair of dermatology at Northwestern Medicine, investigators provided a report on the height, weight and BMI of enrolled children in comparison to the general standardized healthy population.¹

“Atopic dermatitis has the potential to impact children’s growth through multiple mechanisms, including chronic sleep disturbance caused by itching and the effects of certain atopic dermatitis medications, particularly corticosteroids and immunosuppressants,” Paller and colleagues wrote.

Growth metrics, gender and age-specific Z-scores, as well as corresponding percentiles relative to healthy children were calculated at baseline for all children. The team used data from the Centers for Disease Control (CDC) growth curves algorithms to define growth rates for the healthy children control aged 0 – 12 years old.³

Their analysis population included 1329 enrolled children. Mean patient age was 5.98 years old; age at disease onset was 1.50 years. A majority (53.2%) of patients were male; 59.0% were White, 24.3% were Asian and 9.9% were Black.¹

Female children aged <12 years old with moderate to severe, inadequately controlled atopic dermatitis were in the following mean growth and size percentiles:

• Height, 50th
• Weight, 50th
• BMI, 59th

Among females aged 5 – 11 years old, such averages were in the 49th, 52nd and 59th percentile, respectively.

Male children aged <12 years old with moderate to severe, inadequately controlled atopic dermatitis were in the following mean growth and size percentiles:

• Height, 46th
• Weight, 51st
• BMI, 58th

Investigators additionally observed only 38% of male children with atopic dermatitis were above the 50th percentile in height, while 69% were above the 50th percentile for BMI. Overall, children with atopic dermatitis were in a lower mean percentile for age-related height than the healthy population—but in a higher mean percentile for both age-related weight and BMI.

“Moderate-to-severe atopic dermatitis may hinder growth in children aged <12 years, possibly due to factors like sleep deprivation, prolonged use of topical or systemic glucocorticoids and immunosuppressants,” Paller and colleagues concluded. “Early intervention with effective targeted therapies may mitigate the negative impact on growth.”

Reference

1. ^{Paller AS, Geng B, Irvine A, Siegried E, et al. Growth Analysis in Children Aged Less Than 12 Years with Moderate-to-Severe Atopic Dermatitis. Paper presented: American Academy of Dermatology (AAD) 2024 Annual Meeting. March 8 – 12, 2024. San Diego, CA.}
2. ^{Paller AS, Guttman-Yassky E, Irvine AD, Baselga E, de Bruin-Weller M, Jayawardena S, Zhang A, Mina-Osorio P, Rizova E, Ozturk ZE. Protocol for a prospective, observational, longitudinal study in paediatric patients with moderate-to-severe atopic dermatitis (PEDISTAD): study objectives, design and methodology. BMJ Open. 2020 Mar 24;10(3):e033507. doi: 10.1136/bmjopen-2019-033507. PMID: 32209624; PMCID: PMC7202692.}
3. ^{Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: Methods and development. National Center for Health Statistics. Vital Health Stat 11(246). 2002}