RALEIGH, N.C. – Pediatric atopic dermatitis has been linked to several previously unreported comorbidities – including increased rates of recurrent ear infections, bleeding gums and other dental problems, and visual difficulties – in a large, national population-based study.
While the dental findings need confirmation, the study provided supportive evidence on behalf of previously reported associations between atopic dermatitis and comorbid asthma and respiratory and food allergies. The study also broke new ground by demonstrating that the more severe the eczema, the greater the severity of the comorbid conditions, according to Dr. Jonathan I. Silverberg of St Luke’s–Roosevelt Hospital and Beth Israel Medical Center, New York.
"In general, food allergy, respiratory allergy, and asthma are more severe in children with concomitant eczema. In addition, the severity of these comorbidities correlates with the severity of the skin disease. Thus, aggressive treatment or prevention of atopic dermatitis might modify the risk of developing these comorbidities," he said.
He presented an analysis of the 2007 National Survey of Children’s Health, a Department of Health and Human Services–funded survey involving in-depth telephone interviews with parents in 91,642 households having one or more children under age 18 years.
The prevalence of pediatric eczema in this national study was 13%. The mean age of affected children was 7.5 years. Parents of kids with eczema characterized the skin disease as mild in 67% of cases, moderate in 26%, and severe in 7%.
Among the notable study findings:
– Among all children without eczema, 13.5% were black. However, black children accounted for 22.2% of all children with eczema.
– Children diagnosed with atopic dermatitis in the previous 12 months were significantly more likely than were children without eczema to have had food allergies in the past 12 months, by a margin of 15.1% to 3.6%. They also were more likely to have had asthma in the past 12 months (19.8% versus 7.9%), as well as respiratory allergies during the same time period (34.4%, compared with a 14.3% rate in children without eczema).
– Among children with asthma and mild or moderate atopic dermatitis, 5.5% had severe asthma in the past 12 months. But among those with comorbid severe atopic dermatitis, 36.1% had severe asthma. The same trend pertained to children with atopic dermatitis and comorbid hay fever or food allergies.
– Only 7.6% of children without eczema had impaired sleep for an average of 4 or more nights per week, compared with 10% of those with mild or moderate eczema and 22.2% of those with severe eczema.
– Recurrent ear infections within the past 12 months were reported for 6% of children with no eczema and 10.4% of those with eczema. Visual problems occurred in 1% of kids without eczema and 2.2% with eczema. These differences were significant; however, the rates of recurrent ear infections and visual problems didn’t rise with increasing eczema severity.
– In contrast, bleeding gums within the past 12 months occurred in 2.9% of children without atopic dermatitis, 4.3% with mild or moderate atopic dermatitis, and 12.6% of those with severe atopic dermatitis. Similarly, broken teeth within the last year were reported in 3.8% of subjects with no eczema, 5.1% with mild eczema, and 10.3% with severe eczema.
– Children with eczema were found to have poorer overall health and used a greater number of health-related services. Thirty-seven percent of them had seen a specialist within the past 12 months, compared with 21% of children without eczema.
Dr. Silverberg reported having no relevant financial disclosures.