Disease Burden High in Young Children With Atopic Dermatitis

Amy Paller, MD

The disease burden of atopic dermatitis is high among pediatric patients, according to new data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022.

A team, led by Amy Paller, Northwestern University Feinberg School of Medicine, identified the true burden of atopic dermatitis in patients younger than 12 years.

Real-world disease burden of moderate-to-severe atopic dermatitis in pediatric patients younger than 12 years is understudied and not well-defined.

PEDISTAD Study

The investigators used the ongoing, 5-year, international, prospective, non0intervention PEDISTAD study to identify patients younger than 12 years with investigator-assessed moderate-to-severe atopic dermatitis that was inadequately controlled by topical therapies or patients where such therapies are inadvisable.

Each patient was assessed for various baseline-reported measures of disease burden, including physician-assessed Eczema Area and Severity (EASO, 0-72) and atopic dermatitis-affected body surface area (BSA), patient/caregiver-reported Patient-Oriented Eczema Measure (POEM, 0-28), Infant’s Dermatitis Quality of Life (IDQOL, <4 years; 0-30) or Children’s Dermatology Life Quality Index (CDLQI; 4–11 years; 0-30) and worst scratching in the previous 24 hours (0–5 years; 0-10) or worst itching during the previous night/current day (6-11 years; 0-10).

There were 732 patients included in the study with a mean age of 6.2 years and a median age at atopic dermatitis onset of 0.7 years. In addition, 59% of patients had type 2 inflammatory comorbidities.

Disease Burden at Baseline

The baseline data shows significant disease burden, with a mean EASI of 14.4, 33.3% affected by BSA, POEM score of 15.6, IDQOL score of 10.3, CDLQI score of 10.8, worst scratching in 24 hours of 5.9, worst itching-night of 4.9, and worst itching-day of 3.8.

In addition, the frequency and proportion of patients reporting POEM items were itching>Dry/rough skin>cracked skin>flaking skin>disturbed sleep>bleeding>weeping/oozing.

The results were also similar across the different age groups—0-1, 2-5, 5-11—for disease burden outcomes.

“Children with moderate-to-severe AD aged <12 years in PEDISTAD had significant disease burden, reflecting a major unmet need for effective disease control,” the authors wrote.

Pediatric Patients With Atopic Dermatitis

Earlier this year, a new investigation of pediatric patients with atopic dermatitis found increased β- glucocerebrosidase (GBA) activity in addition to increased glucosyl cholesterol levels.

The new data suggested an association between increased GBA activity and inflammation in disturbed lipid processing.

Atopic dermatitis has been characterized by abnormalities in lipid organization as well as immune dysregulations and an impaired skin barrier, with investigators believing that alteration in GBA activity contributes to skin barrier defects in patients with atopic dermatitis.

Investigators observed that GBA activity was significantly higher in patients with atopic dermatitis at baseline as compared to healthy controls but decreased after 6 weeks of therapy.

The same pattern was observed regarding glucosyl cholesterol, as baseline values were higher in patients with atopic dermatitis when compared to healthy controls and decreased after therapy.

However, glucosyl cholesterol and GBA activity were still higher in patients with atopic dermatitis than healthy controls, with both correlating with transepidermal water loss and levels of multiple cytokines including IL1α and IL-18.

The study, “The Patient Burden of Moderate-to-Severe Atopic Dermatitis (AD) in Children Aged,” was published online in the Journal of Allergy and Clinical Immunology.