Atopic dermatitis unlikely to negatively impact kids’ academic performance, study shows

Atopic dermatitis (AD) does not appear to worsen academic performance in school-aged children, according to the results of two parallel cohort studies from Denmark and England, published recently in JAMA Dermatology.

To come to this conclusion, a team of researchers, including corresponding author Rita J. Iskandar, M.D., M.Sc., from the Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, studied the grades of 782,837 children living in either Denmark or England, with or without AD, taking their final compulsory exams. Participants were an average of 16 years old.

Iskandar and her colleagues hypothesized that AD might contribute to poor academic performance because it has been known to impact other areas of life, including sleep. For example, 89% of adults report losing sleep during an AD flareup.

In Denmark, where the study included more than 776,000 children, the results showed almost no difference between students with and without eczema. Approximately 12.0% of children with eczema failed their final compulsory exams, compared with 11.2% of those without the condition. Average grades were also nearly identical, with eczema patients scoring 6.53 compared with 6.60 among their peers on a standardized Danish grading scale.

Analyses by disease activity showed slightly higher non-passing rates among children with active atopic dermatitis (13.7%) compared with inactive disease (11.5%), but the magnitude of this difference was small. Sibling comparisons, used to account for shared genetic and household factors, produced similar estimates, suggesting that unmeasured family-level confounding was unlikely to substantially change the results.

Findings were similar in England among the approximately 6,600 children studied, although those with eczema seemed to perform somewhat better on average. The non-passing rate was 37.7% for children with eczema, compared with 47.4% for those without. Students with eczema also scored about 10 points higher on average.

“Phenotype analyses showed that better performance in children with moderate-declining and moderate-frequent AD primarily explained these results, whereas those with mild-intermittent or severe-frequent AD performed similarly to the unaffected or rare comparator,” Iskandar and her colleagues write in the study. “Overall, no consistent variation by disease phenotype or socioeconomic background was found across academic performance outcomes and settings.”

AD is the most common chronic skin disorder in children, occurring in 10% to 20% of children worldwide — and rates are increasing. From the year 2000 to 2021, the global prevalence of atopic dermatitis rose by 6.2%. There are many triggers for AD, including stress, allergies and sweating. Symptoms include dry, scaly skin; redness; swelling and thickened skin from repeated scratching.

“The parallel studies’ results are reassuring for clinicians, educators, and families and do not support routine expectations of academic underperformance due to AD among adolescents taking national compulsory examinations,” Iskandar and her team continue. “Nevertheless, because children with AD may experience symptoms interfering with concentration, sleep or participation, a tailored, needs-based approach remains important to improve quality of life.”

The American Academy of Pediatrics currently recommends the use of moisturizers as the “cornerstone” of atopic dermatitis treatment. Itch and inflammation may be controlled by applying a topical corticosteroid twice a day.

Ongoing research continues to evaluate long-term outcomes and optimize individualized care strategies for children living with chronic atopic dermatitis management.