Pediatric atopic dermatitis (AD) is linked to many comorbidities, including some ocular diseases, a Johns Hopkins University School of Medicine research team report in the Journal of the American Academy of Dermatology.

AD, a chronic inflammatory skin condition common in children, is caused by a “dynamic interplay” between genetics, immunological factors, and the environment, according to researchers. A growing body of evidence points to AD’s systemic nature, but analyses of comorbidities in pediatric AD are limited.

To examine the comorbidities in patients under 18 with AD, investigators queried records from January 1, 2017, to December 31, 2017, in the MarketScan Commercial Claims database. Age- and sex-matched analyses were used to compare AD with general population controls. In total, 86,969 pediatric patients with AD and 116,564 matched controls were identified. 


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Researchers found that AD in pediatric patients is associated with a wide range of psychological and systemic comorbidities. Specific to ophthalmology, pediatric AD patients demonstrated a higher likelihood of visual impairment (OR 1.37), eye disorders (OR 1.84), and glaucoma (OR 2.02). This increase may be attributable to the increased physical trauma from eye rubbing, microbial colonization/infections, and adverse effects of AD medications for this population.

The odds of visual impairment with AD in the current study (OR 1.37; 95% CI 1.29-1.45) echoed findings noted in a Spanish study of ambulatory pediatric patients (OR 1.48; 95% CI 1.42-1.55). 

“Together, these data underscore the importance of routine eye examinations in all children with AD to minimize potential ocular sequelae including visual impairment,” th study says.

The study’s authors noted a few limitations, including the study’s retrospective nature, which precluded stratification by AD severity or by demographic variables such as race and ethnicity. Second, the study was unable to demonstrate causation. Third, although matching by age and sex was performed for all comparisons, it is possible that residual confounding may remain. Fourth, the study population of commercially insured patients is likely a conservative estimate of the comorbidity burden since children with Medicaid were found to have worse disease control of AD and higher comorbidity burden when compared with their commercially insured peers. Lastly, the use of claims data to identify diseases associated with AD may not capture comorbidities that are present but for which the patient does not actively receive care.

Disclosure: One study author declared affiliations with the biotech of pharmaceutical industries. Please see the original reference for a full list of authors’ disclosures.

Reference

Huang AH, Roh YS, Sutaria N, et al. Real-world comorbidities of atopic dermatitis in the pediatric ambulatory population in the United States. J Am Acad Dermatol. Published online March 6, 2021. doi:10.1016/j.jaad.2021.03.016.