Eczema (Atopic Dermatitis) Statistics

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

1. https://www.niaid.nih.gov/diseases-conditionsew/eczema-atopic-dermatitis 
2. https://nationaleczema.org/eczema/causes-and-triggers-of-eczema/ 
3. https://ghr.nlm.nih.gov/condition/atopic-dermatitis?_ga=2.37823587.1105300427.1584890599-498086770.1584890599#genes 
4. https://www.ncbi.nlm.nih.gov/pubmed/24630429 
5. https://www.ajmc.com/journals/supplement/2017/atopic-dermatitis-focusing-on-the-patient-care-strategy-in-the-managed-care-setting 
6. https://www.sciencedirect.com/science/article/pii/S0190962213010955
7. https://www.sciencedirect.com/science/article/pii/S0190962214012572
8. https://www.sciencedirect.com/science/article/pii/S019096221401264X
9. https://www.sciencedirect.com/science/article/abs/pii/S0190962206015209
10. https://www.sciencedirect.com/science/article/pii/S0022202X16321200
11. https://www.ncbi.nlm.nih.gov/pubmed/29174063 
12. https://www.ncbi.nlm.nih.gov/pubmed/19067703 
13. https://www.ncbi.nlm.nih.gov/pubmed/24496238
14. https://www.jacionline.org/article/S0091-6749(18)31176-X/pdf
15. https://www.sciencedirect.com/science/article/pii/S1081120620312758
16. https://onlinelibrary.wiley.com/doi/10.1111/pde.12237 
17. https://www.ncbi.nlm.nih.gov/pubmed/12020225 
18. https://www.ncbi.nlm.nih.gov/pubmed/17498413