Pediatric Atopic Dermatitis Linked to Learning Disabilities

More severe atopic dermatitis may be related to learning disabilities in pediatric populations, a new study suggests.

The research team, led by Joy Wan, MD, MSCE, Department of Dermatology, University of Pennsylvania Perelman School of Medicine, used the Pediatric Eczema Elective Registry (PEER) to examine 2,074 children with physician-confirmed atopic dermatitis.

“Growing evidence indicates that childhood atopic dermatitis is associated with disturbances in sleep, attention and memory,” wrote Wan and colleagues. “Recent population data in the US also show a greater prevalence of learning disabilities in children with atopic dermatitis than in children without.”

They defined learning disabilities as disorders leading to learning disabilities and poor mental health, lower school performance and poorer professional outcomes.

As such, the team sought to set out the available evidence to demonstrate associations between disease severity and disability.

Atopic dermatitis and learning disability

All participants were enrolled in PEER between November 1, 2014 and November 30, 2019 at an average age of 6.0 years. The median age at follow-up was 16.1 years.

In addition, a majority of the participants evaluated were female (53.8%), and most were Black (44.9%) and White (39.4%) race / ethnicity.

The researchers also reported that a majority came from households with an annual income of $ 0- $ 49,000 (52.1%), followed by households with an income of $ 50,000 – $ 99,999 (19.6%).

Analysis showed that 169 (8.2%) participants reported a diagnosis of a learning disability at follow-up.

Thus, according to the Patient-Oriented Eczema Measure (POEM) scores, which measured the severity of atopic dermatitis, patients with learning disabilities were more likely to have worse disease severity (median POEM score, 5 [mild]), compared to people without disabilities (median POEM score, 2 [almost clear skin]P <.001).

Of the patients with a learning disability, 29.8% were diagnosed with moderate atopic dermatitis (versus 17.0% in the non-disabled population) and 8.9% with severe to very severe disease (versus 4.5%; P < .001).

Moreover, the learning disability group was much more likely to self-report a high degree of severity than those who did not report disability (P <.001).

“In multivariable logistic regression models adjusted for sex, age, race / ethnicity, annual household income, age of atopic dermatitis onset, family history of atopic dermatitis and comorbid conditions, participants with mild atopic dermatitis (odds ratio [OR], 1.72; 95% CI, 1.11-2.67), moderate atopic dermatitis (OR, 2.09, 95% CI, 1.32-3.30), and severe to very severe atopic dermatitis (OR, 3.10 ; 95% CI, 1.55-6.19) on the POEM were all significantly more likely to have reported a learning disability than those with clear or nearly clear skin, ”the researchers wrote.

These findings were also consistent across self-reported measures.

Learning disabilities were also common in patients diagnosed with asthma, ADHD, depression, anxiety, behavior or behavior problems, and sleep problems, the team noted.

Conclusion

Despite these findings, the researchers stopped inferring causality in these associations.

“Further research is thus needed to clarify the association of atopic dermatitis with learning and the mechanisms by which this association may be mediated,” said Wan and colleagues. “It is possible that symptoms of atopic dermatitis, such as itching and sleep disturbances, may make learning more difficult.”

They also encouraged the need for direct assessments that can further evaluate timing and phenotypes in children with learning disabilities and atopic dermatitis.

However, they still urged the clinician to consider screening for such disabilities in children with more severe disease presentations.

The study, “Association of Atopic Dermatitis Severity with Learning Disability in Children,” was published online in JAMA Dermatology.

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