What is the global burden of eczema (atopic dermatitis)?
Atopic dermatitis (AD) is one of the most prevalent health conditions worldwide – yet as it is neither life-threatening nor contagious, it may be overlooked by the medical profession. But the health/ wellbeing and financial impacts of this chronic and often debilitating condition are considerable, and some groups of people bear the brunt of the burden. Let’s explore the topic of AD in numbers.
What is atopic dermatitis?
AD causes inflamed, scaly and itchy skin that may ooze clear fluid, crust or swell. It’s uncomfortable or even painful as well as unsightly, and can occur anywhere on the body.
AD is linked to several other conditions: up to 60% of patients develop either asthma or hayfever, and up to 30% have food allergies. The more serious the AD, the greater the risk of developing asthma.
People with AD are also at greater risk of developing several illnesses related to inflammation: e.g. inflammatory bowel disease, rheumatoid arthritis and alopecia areata.
What is the health & wellbeing burden of AD?
AD can be a debilitating, affecting patients’ everyday lives. For most, the main symptom is itchiness: 91% experience this on a daily basis. Yet that is far from the only issue.
Children and adolescents have higher rates of a range of disorders than the general population: including ADHD (12.6%), conduct disorders (7.74%), anxiety (7.25%), depression (6.52%), and autism (3.97%).
Some 15.5% of adolescents have suicidal ideation, against 9.1% of those without AD. Among those who experience AD and itching, the rate is 23.8%.
Impaired sleep is common, affecting 47-66% of children with AD.
Among adults, there are higher rates of anxiety (29.8%), depression (31.2%) and sleep disturbances (33.2%). Half of all adults with AD say it limits their lifestyle, prompting them to avoid social interaction (39.1%) and impacting their activities (43.3%).
Disability adjusted life years (DALYs) are a measurement of disease burden on a given population, calculated as years lost to ill health, disability or early death. AD has the highest age-standardised global DALY rate of all skin diseases and the 15th of all non-fatal diseases. Overall, it ranks 59th of all diseases: above cirrhosis/ chronic alcohol-related liver disease, and below measles.
The economic burden of AD
AD carries considerable direct and indirect costs: in the USA, these were estimated at $5.3 billion in 2015. Direct costs include visits to doctors, prescriptions, emergency outpatients visits, and hospital stays; indirect costs cover caregiver and patient lost workdays, and restricted activity days.
In Sweden, a 2022 study compared costs for patients with AD with a control group. It found the annual mean per-patient healthcare/ direct costs in the first year following diagnosis were €941 higher for paediatric patients with mild-to-moderate (M2M) AD and €1259 for those with severe AD. Among adolescents, the figures were €816 and €1260 higher respectively, and among adults, €1583 and €2963.
The total incremental societal economic burden for AD was €351 and €96 million higher in patients with M2M and severe AD respectively, compared to controls. Management of comorbidities was a significant driver of costs.
Who gets AD?
There are distinct demographic groups who are more at risk of developing the condition.
The most pronounced effect is youth. While people of any age may have AD, infants are worst affected: some 80% of AD cases take place in those aged under six. Globally, 10-30% of children have AD, compared to 2-10% of adults. However, rates of active disease are also high among older adults, with 8.7% of those aged 75+ affected.
In terms of ethnicity, AD may be more common in black children, with black people and Asian/ Pacific Islanders more likely to seek medical care. Some studies have found higher rates among females than males. Others have found no difference in sex or ethnicity.
What are the drivers of AD?
Anybody can develop AD, but there are also known genetic and environmental or lifestyle triggers.
People with a parent with a history of AD, asthma or hay fever are more likely to be affected.
Some individuals also have a gene mutation: either in the CARD11 gene, affecting immune system cells; or in the gene responsible for creating filaggrin, the protein that contributes to creating an outer layer of skin.
Environmental triggers are widespread, making AD hard to avoid for many people. They include: cosmetics; clothing; dust mites; detergents and soap; weather; viral infections; food allergens; and fragrances.
There is also evidence that children in families with higher incomes and education are more likely to develop AD.
Treating atopic dermatitis
Current treatments range from over-the-counter skin moisturisers to pharmacological treatments such as topical corticosteroids, but are not always effective for every patient.
Arctic Therapeutics is committed to developing novel and transformative medicines to create a better future for people in critical need of new treatment options. Find out more about our treatment for inflammatory skin diseases.