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Atopic Dermatitis of Childhood Onset Significantly Impacts "Life Trajectory" According to Scars of Life Survey
The impact of childhood onset AD on adult psychosocial experience, including employment and the decision to become a parent, is profound, this study reveals.
Findings from a survey of more than 30,000 adults with atopic dermatitis in 27 countries and across 5 continents found that individuals whose disease onset occurred in childhood had significantly more difficulties in several crucial areas of life than those who developed the condition as teens or in adulthood.
Analysis of the data from the “Scars of Life” project revealed long-term effects on psychological and social wellbeing including job performance, romantic involvement, and sexuality. The results were reported in an ePoster at the American Academy of Dermatology 2025 annual meeting, March 7-11, 2025, in Orlando, FL.
The final cohort for the study analysis numbered 10,258 with current AD. The mean age of participants was 41.8 years and 57.8% were women. Within this population, 2,875 individuals (28%) were identified as having childhood-onset atopic dermatitis, while 7,883 individuals (72%) had adult-onset disease, according to the findings. Equal proportions of each group reported mild (38.8%) and severe (60.1%) disease. Given the authors’ objective to examine the “long-term effects of [AD] on a life trajectory,” the study population was limited to individuals aged 30 years and older, they wrote.
Led by Jonathan Silverberg, MD, PhD, MPH, associate professor of dermatology, and director of clinical research and contact dermatitis at The George Washington University School of Medicine and Health Sciences in Washington, DC, the researchers reported that in daily life overall, 31.6% of respondents reported that others avoided shaking hands with them due to visible signs of their AD. A similar proportion (29.1%) said they had experienced discrimination in the workplace. On a personal level, more than one-quarter (28.5%) of participants reported rejection by an intimate partner because of their eczema and equally as many (28.1%) of survey respondents had experienced a sense of shame from family members or relatives. More than one-third of the adults (39.2%) reported feeling self conscious and trying to hide the condition.
31.6% said others avoided shaking hands with them due to to visible signs of AD
29.1% had experienced discrimination in the workplace
28.5% reported rejection by an intimate partner because of their AD
28.1% had experienced a sense of shame from family members or relatives
39.2% feel self conscious and try to hide the condition
Silverberg et al reported that adults whose AD began in childhood (ECA) faced greater psychological and social challenges compared to those whose condition began in adulthood (EOA). When propensity score matching was used to create 2 groups of 5,750 respondents comparable on gender, AD severity and age the analysis showed that those with childhood onset AD experienced significantly higher levels of stigma, as measured by the Patient Unique Stigmatization Holistic tool in Dermatology scale, with a score of 23.0 ± 20.1 compared to 18.1 ± 17.6 in the adult-onset group. In the workplace, 37.3% of those affected since childhood reported discrimination compared with 32.7% of those with adult-onset AD (all differences P < .001).
In a disturbing finding, adults with childhood-onset AD were more likely to report that the condition presented a barrier to becoming a parent (35.7% vs 23.8%), affected their love life and sexuality (40.2% vs 31.5%), negatively impacted their self-image and self-confidence (49.0% vs 35.4%), and hindered their professional career (39.4% vs 29.5%) (P <.001 for all).
The findings indicate that early-onset AD not only has a profound impact on physical health but also deeply affects psychological and social aspects of life, influencing relationships, daily activities, and career opportunities. By providing comprehensive data on how the age of onset affects the severity of its impact, the study underscores the need for more holistic treatment strategies that address both the physical and emotional well-being of AE patients.
"These results higlight the importance of a proactive and preventive approach to managing [AD]. It is essential that clinicians and policy makers provide children with effective prevention and treatment services for eczema," the investigators concluded.
