Implications of Atopic Dermatitis on the Quality of Life of 6–11 Years Old Children and Caregivers (PEDI-BURDEN)

Abstract

Purpose

Atopic dermatitis (AD) is a chronic, relapsing and remitting inflammatory skin disease characterized by intense itch. The disease burden includes physical limitations, psychosocial discomfort, and a reduced quality of life (HRQoL). This study presents the results of a parent-reported survey on the psychosocial impact of AD on Italian pre-adolescent children (6–11 years old), with a specific focus on bullying, self-isolation, absenteeism, and presenteeism.

Methods

An online questionnaire was sent to 3067 random recipients and 160 matched the inclusion criteria for age, self-reported AD diagnosis, localizations (according to ISAAC), and disease severity (POEM ≥8). 100 children, with comparable ages, not matching the inclusion criteria for AD, were recruited as a control group.

Results

Children with AD and their caregivers had a significantly lower quality of sleep (QoS) compared to the control group. The presence of AD was directly responsible for many restless nights, both in children and caregivers (58.9 and 55.4 respectively). Children with AD and their parents also experienced significantly more daytime drowsiness (43.6 and 54.6 days, respectively). Children with AD were more frequently victims of bullying at school (20.0% vs 9.0%; p≤0.05) or in other social environments (16.9% vs 3.0%; p≤0.05). AD caused 17.7 days of absenteeism and 20.1 days of presenteeism per student over the previous 12 months, accounting for 37.8 days of study impairment overall. Severe/very severe AD had a significantly greater impact on presenteeism than moderate AD (25.1 vs 17.5 days; p≤0.05). Presenteeism, which was more pronounced among bullied students, was positively correlated with absenteeism only in the AD cohort.

Conclusion

AD has a detrimental impact on the HRQoL of pediatric patients, causing stigmatization and social isolation. Functional distress was also reported by caregivers. Our study might inform the public and policymakers about the disease burden of AD at a young age.

Keywords:

• atopic dermatitis
• absenteeism
• presenteeism
• sleep impairment
• daily drowsiness

Statement of Compliance

All procedures were in accordance with both national and international ethical standards as well as with the 1964 Helsinki Declaration, its later amendments, or comparable ethical standards. The survey-based study did not require ethics approval from IRB or local ethics committee; participation was voluntary, anonymous, and informed written consent was obtained upfront from all participants.

Acknowledgment

The authors would like to thank responders for their time, making this study possible. Questionnaire development and statistical analysis were performed by DOXA, funded by Sanofi. Medical writing and editorial assistance were provided by Maurizio Tarzia, an independent medical writer, on behalf of Springer Healthcare, and was funded by Sanofi.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

I. Neri acts as advisor, speaker, investigator and/or consultant for Sanofi, Janssen, Roche-Posay, Giuliani, Leo Pharma. E. Galli reports scientific consultations and/or lectures for Lofarma, Hal_Allergy and Sanofi. I. Baiardini IB reports scientific consultations and/or lectures from Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline, Menarini, Novartis, Sanofi, Biofutura, Mundifarma, AstraZeneca. M. Picozza declares no conflicts of interest in this work. AB. Rossi, P. Matruglio, D. Moretti and F. Cipriani are Sanofi employees, and may hold stock and/or stock options in the company.

Additional information

Funding

This work was funded by Sanofi.