Eczema Prevalence
- Approximately 31.6 million people in the United States have some form of eczema 19
Atopic Dermatitis Prevalence
- 15-20% of children globally have atopic dermatitis (AD) 5
- 15.1% of children in the United States have AD 15
- 1-3% of adults globally have AD 5
- 7.3% of adults in the United States have AD 16
Definition of Atopic Dermatitis
Atopic dermatitis, a form of eczema, is a chronic, non-contagious, inflammatory skin condition that causes dry and itchy skin which sometimes weeps clear fluid 1
Causes of Atopic Dermatitis
The exact cause of AD is unknown, but most cases are a combination of genetics and triggers 2
There are several genetic factors which may lead to AD:
- Individuals who have a parent with a history of AD, asthma, or hay fever are more likely to develop AD 3
- Some people have a mutation in the CARD11 gene, which affects immune system cells 3
- Some people with AD have a mutation in the gene responsible for creating filaggrin, which is a protein that helps create a healthy outer layer of skin 3
There are multiple things that may trigger AD symptoms including:
- Cosmetic Products 4,5
- Clothing 4,5
- Dust Mites 4
- Detergents or Soap 4
- Weather 4,5
- Viral Infections 4,5
- Food allergens 5
- Fragrances 5
Symptoms of Atopic Dermatitis
AD affects the skin and common symptoms include:
- Skin itching 6
- Dry skin 6
- Redness 6
- Puffy or swollen skin 6
- Oozing or crusting from skin 6
- Raw Skin 6
- Thick, leathery patches of skin 6
Treatment of Atopic Dermatitis
Treatment of AD may involve a combination of nonpharmacologic and pharmacologic interventions 7
Nonpharmacologic:
- Skin moisturizers – should be applied after bathing 7
- Bathing 7
- Limit use of non-soap cleansers (should be low-pH, hypoallergenic, fragrance free) 7
- Wet-wrap therapy 7
Pharmacologic (under direction of a medical provider):
- Topical corticosteroids (if failure to respond to non-pharmacologic management) 7
- Topical calcineurin inhibitors 7
- Not routinely recommended for management – topical antimicrobial agents or antihistamines 7
- Systemic immunomodulating medications 8
- Biologics (Dupilumab, Tralokinumab-ldrm, Abrocitinib, Upadacitinib, Ruxolitinib ) 19, 20, 21, 22
- Providers may also prescribe phototherapy 8
Atopic Dermatitis Disparities
- AD is more common in black children than other racial or ethnic groups 17
- AD is more common in children from families with higher incomes and education 17
- Blacks and Asians/Pacific Islanders are more likely to seek medical care for AD 18
Atopic Dermatitis Burden
- 91% of patients experience itching on a daily basis 12
- Adults with AD report higher rates of anxiety (29.8%), depression (31.2%) and sleep disturbances (33.2%) than the general population 24
- Adults with AD report that it limits their lifestyle (51.3%), lead to avoiding social interaction (39.1%), and impacted activities (43.3%) 26
- Children and adolescents with AD have higher rates of ADHD (12.6%), conduct disorders (7.74%), anxiety (7.25%), depression (6.52%), and autism (3.97%) than the general population 27
- 15.5% of adolescents with AD report suicidal ideation compared to 9.1% of adolescence without 13
- This increases to 23.8% in adolescence with AD and itching 13
- 47-66% of children with AD experience sleep disturbances 14, 25
Economic Burden of Atopic Dermatitis
The total annual cost of AD increased to estimated $5.3 billion in 2015 10
The direct costs associated with AD were over $1 billion annually in 2004 9
- Average out of pocket expenses are $600 per year, with 42% reporting expenses of over $1000 and 85% reporting expenses over $5000 28
- $636 million for office visits 9
- $154 million for prescription medications 9
- $108 million for outpatient hospital visits 9
- $105 million for emergency department visits 9
- $6 million for inpatient hospital stays 9
The indirect costs associated with AD were $619 million in 2004 9
- $248.5 million for caregiver lost workdays 9
- $188.1 million for restricted activity days 9
- $182.6 million for lost workdays 9
References
- https://www.niaid.nih.gov/diseases-conditionsew/eczema-atopic-dermatitis
- https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/
- https://ghr.nlm.nih.gov/condition/atopic-dermatitis?_ga=2.37823587.1105300427.1584890599-498086770.1584890599#genes
- https://www.ncbi.nlm.nih.gov/pubmed/24630429
- https://www.ajmc.com/journals/supplement/2017/atopic-dermatitis-focusing-on-the-patient-care-strategy-in-the-managed-care-setting
- https://www.sciencedirect.com/science/article/pii/S0190962213010955
- https://www.sciencedirect.com/science/article/pii/S0190962214012572
- https://www.sciencedirect.com/science/article/pii/S019096221401264X
- https://www.sciencedirect.com/science/article/abs/pii/S0190962206015209
- https://www.sciencedirect.com/science/article/pii/S0022202X16321200
- https://www.ncbi.nlm.nih.gov/pubmed/29174063
- https://www.ncbi.nlm.nih.gov/pubmed/19067703
- https://www.ncbi.nlm.nih.gov/pubmed/24496238
- https://www.jacionline.org/article/S0091-6749(18)31176-X/pdf
- https://www.sciencedirect.com/science/article/pii/S1081120620312758
- https://onlinelibrary.wiley.com/doi/10.1111/pde.12237
- https://www.ncbi.nlm.nih.gov/pubmed/12020225
- https://www.ncbi.nlm.nih.gov/pubmed/17498413
Are there other conditions that may look like eczema but are not eczema?
There are other conditions that are different than eczema, but the symptoms, diagnosis and treatment vary depending upon the condition. Here are some of them.