Factors Associated With More Severe AD in Children

itch on child
Male doctor examining girl’s arm.
Factors associated with severe atopic dermatitis in later childhood and self-reported triggers are reported.

Factors associated with severe atopic dermatitis (AD) in children include AD onset during the first 6 months of life, AD onset on multiple body regions, having a history of hay fever, low maternal education, as well as parent-reported concentration and sleep problems, according to study findings published in the Journal European Academy of Dermatology and Venereology.

The study relied on web-based questionnaire data of Danish children with hospital diagnoses of AD from 2014 to 2018. All children were identified through the Danish National Patient Registry. Legal parents of these children responded to the questionnaire, which included 158 items regarding family structure, current and prior skin diseases, AD treatment and severity, dietary exclusions, trigger factors, and familial atopic diseases. The severity of AD was evaluated with the 7-item, self-reported Patient-Oriented Eczema Measure (POEM) tool.

Responses from a total of 1343 parents who completed the questionnaire were included in the study. The mean age of the parents’ children with AD was 8.9±4.5 years, and the mean age of the parents was 40.4±6.6 years.

Children with hay fever were significantly more likely to have severe AD vs children without hay fever (adjusted odds ratio [OR], 3.4; 95% CI, 1.7–6.6; P <.0005). The investigators also found an inverse correlation in maternal educational level and current AD severity (Ptrend <.001; adjusted OR, 9.6; 95% CI, 2.6–35.4; P =.001).

In addition, children who experienced AD onset during the first 6 months of life had a significantly higher risk for reporting currently severe AD vs children with AD onset after 6 months of age (adjusted OR, 3.3; 95% CI, 1.7–6.5; P <.0005).

Severe AD was also more common in children who first experienced AD in the face, trunk, extremities, and hands/feet compared with children with currently clear/almost clear AD (25.4% vs 5.4%, respectively; adjusted OR, 8.6; 95% CI, 3.0–24.7; P <.0005).

Also, the researchers found an increasing trend of staying home and increased severity of AD in children (Ptrend <.0005). Approximately 11.3% of children with currently severe AD stayed home more than 10 times during the previous 12 months because of AD compared with 1.1% of children with currently clear/almost clear disease (P <.0005).

Parents also reported more concentration problems in children with currently severe AD (42.3% vs 13.4%; P <.0005). In addition, a greater percentage of children with currently severe AD had trouble falling asleep every night or several times a week because of their disease vs children with currently clear/almost clear AD (65.1% vs 7.0%, respectively; P <.0005).

Limitations of this study included the reliance on questionnaire responses, which may subject the findings to recall bias, and the inclusion of only children with hospital-diagnosed AD.

In spite of the limitations, the researchers suggest the “findings may be valuable in clinical practice to inform about prognosis and educate families about trigger avoidance.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Gerner T, Haugaard JH, Vestergaard C, et al. Disease severity and trigger factors in Danish children with atopic dermatitis: a nationwide study. Published online October 20, 2020. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.17007.