The Burden of Childhood Atopic Dermatitis in the Primary Care Setting

A Report From the Meta-LARC Consortium

Jinan Al-naqeeb, MD, MPH; Sankirtana Danner, MA, CCRP; Lyle J. Fagnan, MD; Katrina Ramsey, MPH; LeAnn Michaels; Julie Mitchell; Kelsey Branca, MPH; Cynthia Morris, PhD, MPH; Donald E. Nease, Jr., MD; Linda Zittleman, MSPH; Barcey Levy, MD, PhD; Jeanette Daly, RN, PhD; David Hahn, MD, MS; Rowena J. Dolor, MD, MHS; Hywel C. Williams, DSc, FMedSci; Joanne R. Chalmers, PhD, BSc; Jon Hanifin, MD; Susan Tofte, RN, FNP; Katharine E. Zuckerman, MD, MPH; Karen Hansis; Mollie Gundersen; Julie Block; Francie Karr; Sandra Dunbrasky, MD; Kathy Siebe, CPNP; Kristen Dillon, MD; Ricardo Cibotti, PhD; Jodi Lapidus, PhD; Eric L. Simpson, MD, MCR


J Am Board Fam Med. 2019;32(2):191-200. 

In This Article


A total of 652 caregivers with children aged between 0 to 5 years participated in the study with 24% (95% CI, 21–28) overall parent-reported prevalence of AD. The mean ± standard deviation of age of participants was 22.5 ± 19.4 months, and the mean age at which AD first appeared was 9 ± 10.4 months. Those with AD were far more likely to experience dry skin than those in the non-AD group (63% vs 17%, P < .001). There were no significant differences between those with AD compared with the non-AD group in regard to sex, parent language, race/ethnicity, or geographic distribution. Participants' characteristics are summarized in Table 1.

AD Prevalence and severity

As expected, AD prevalence steadily increased with age, ranging from 14.5% among children less than 1 year old to 38% among children 4 to 5 years old (P < .001). Overall, 58% of children with AD had mild symptoms, 39% had moderate, and only 3% (4 children) had severe disease. Among the same children with AD, 21% had reported AD-related sleep disturbance in the previous week. Although we did not detect trends in severity or AD- related sleep disturbance by age, prescriptions for eczema medications were common overall (75% of children with AD) and increased with age. A total of 67% and 69% of children less than 1 year of age and 1 to 2 year olds, respectively, were prescribed medication compared to higher percents, 75% and 86%, for older age groups (2 to 3 years, and 4 to 5 years, respectively; P = .019); see Table 2.

Comorbidities and Family History

Children with AD in this study had a higher reported prevalence of certain comorbidities with known or suspected links to AD. Age adjusted prevalence of asthma was about 3 times as high in the AD group compared to the non-AD group (prevalence ratio [PR], 3.0; P < .001). History of wheezing, including wheezing without a cold, were higher among the AD population compared to the non-AD group (PR, 1.4 and 1.8; P < .05). Food allergies were 3.7 times more common among those with AD (P = .005). Family history of any atopic condition—a known risk factor for AD—was also significantly higher in the AD group (PR, 1.3; P < .001). (Table 3)

Skin Care and Bathing

Use of moisturizer (at any frequency) was common in the whole sample; however, it was found to be significantly higher among the AD group (90%) compared to the non-AD group (74%, P < .001). For children without AD, parents most commonly used lotions (64%) on their children, whereas parents of children with established AD most commonly used oil-rich moisturizers, such as cream or ointment (65%) possibly in response to guideline-driven recommendations for AD treatment by their health practitioners (Table 4). The mean number of days used per week for the overall sample was 4.3 and the mean number of daily bath/showers per week was 4.6. Among those who used moisturizer, the majority (65%) applied it 4 or more days per week and there was no significant difference in moisturizer frequency application when stratified by age (Table 5). Those with AD applied moisturizers more days per week than those in the non-AD group (4 or more days a week = 75% vs 60%, P = .001). Overall, 41% of the children received a bath/shower less than 4 days/week, whereas 59% received a bath/shower 4 or more days per week. There was no significant difference in bathing frequency between those with AD compared to those without AD. When bathing frequency was examined by age, those who were under the age of 1 received less baths/showers per week compared to the older participants regardless of AD status (P < .001). Summaries of skin care practices seem in Table 4 and Table 5.