Symptom burden of atopic dermatitis in early childhood assessed from daily monitoring of symptoms and topical steroid use

Abstract

Background: To our knowledge, disease burden of atopic dermatitis (AD) as number of days with symptoms and medical treatment has never been studied as measure of severity.

Objectives: To investigate risk factors for AD burden in the first 3 years of life.

Methods: The Copenhagen Prospective Studies on Asthma in Childhood₂₀₁₀ included 700 children. AD burden was assessed by daily diary entries with information on AD and steroid days measuring 18 possible heritable, prenatal, and postnatal environmental exposures.

Results: The children with AD had a median (interquartile range) of 136 symptom days (61-294 days) and 72 steroid days (27-145 days) during the first 3 years of life, with the highest disease burden in the second year of life. The multivariable risk factor analysis showed that maternal AD and childhood allergic sensitization were associated with a higher number of AD days and maternal AD, filaggrin mutation, and allergic sensitization were associated with a higher number of steroid days.

Limitations: Participants with a personal interest in atopic diseases could be more likely to participate.

Conclusion: Children's burden of AD, assessed quantitatively as AD and steroid days, demonstrated positive associations with maternal AD, filaggrin mutation, and early-life allergic sensitization, with the highest disease burden in the second year of life.

Keywords: atopic dermatitis; burden of disease; corticosteroids; eczema severity; filaggrin; pediatrics.