Atopic Dermatitis in Children: Monitor the Comorbidities

atopic dermatitis eczema girl itch
Girl scratching her hand in park.
Childhood atopic dermatitis is often associated with neuropsychiatric, visual, cardio-metabolic and autoimmune disorder, which should be monitored to improve patient outcome.

The sociodemographic and clinical characteristics of children with atopic dermatitis (AD) were described in study data published in the Journal of Clinical Medicine. In a large cohort study of children living in Spain, the overall prevalence of AD was 15.5%. Multimorbidity was common, with many patients also diagnosed with asthma, allergic rhinitis, or irritable bowel disease (IBD).

Investigators extracted data from the EpiChron Cohort, which comprises the electronic health records of approximately 1.3 million residents of the Aragón region in Spain. All patients who use the public health system of Aragón are included in the EpiChron database. For the present study, EpiChron data were analyzed from patients aged 17 years or younger. The primary outcome was clinical diagnosis of AD, identified using associated diagnostic codes. Logistic regression was performed to identify correlates of AD diagnosis. Models were adjusted by age, sex, race/ethnicity, area of residence, and deprivation index.

The study cohort comprised 216,291 children, of whom 33,591 had a diagnosis of AD. The overall prevalence rate of AD was 15.5%. Prevalence was slightly higher in girls compared with boys (15.8% vs 15.3%) (odds ratio [OR], 1.04; 95% confidence interval [CI], 1.01-1.06; P =.002). Patients aged 3 to 9 years had the greatest prevalence of AD (20.8%), compared with patients aged 0 to 2 (12.5%), 10 to 14 (13.7%), and 15 to17 (7.42%) years. Higher AD prevalence was observed in children of Spanish nationality (16.1%) compared with patients from other regions (range, 8.54-13.3%). Deprivation index was significantly associated with AD prevalence; compared with the least deprived areas, children living in the most deprived areas were significantly less likely to have AD (adjusted OR [aOR], 0.86; 95% CI, 0.84-0.89; P <.001). Comorbidities were present in 43.4% of children with AD. The most frequent chronic comorbidities were asthma (13.1%), psychosocial disorders (7.1%), and visual impairment (7.8%). In adjusted models, AD was significantly associated with comorbid asthma (OR, 2.10; 95% CI, 2.02-2.17), allergic rhinitis (OR, 2.00; 95% CI, 1.91-2.10), and IBD (OR, 1.90; 95% CI, 1.56-2.31). The most significantly associated neuropsychiatric comorbidities were childhood psychosocial disorders (OR, 1.53; 95% CI, 1.46-1.60), developmental disorders (OR, 1.36; 95% CI, 1.27-1.45), attention deficit/hyperactivity disorder (OR, 1.37; 95% CI, 1.24-1.52), and sleep disorders (OR, 1.72; 95 %CI, 1.55-1.90).  Several chronic cutaneous and musculoskeletal disorders were also nominally associated with AD.

These data describe the prevalence of AD and multimorbidity in pediatric users of the public healthcare system of Spain. The primary study limitation is its cross-sectional design, which prevents the assertion of causality between AD and certain comorbidities. Even so, the current evidence suggests that AD is prevalent in children and may be predictive of certain nondermatologic disorders. “Our results highlight the importance of monitoring the array of comorbidities surrounding AD during childhood, which could help improve their clinical management and plan interventions aimed at preventing their development,” investigators wrote.


Gilaberte Y, Pérez-Gilaberte JB, Poblador-Plou B, Bliek-Bueno K, Gimeno-Miguel A, Prados-Torres A. Prevalence and comorbidity of atopic dermatitis in children: a large-scale population study based on real-world data. J Clin Med. 2020;9(6):E1632.