Prevalence and associations of fatigue in childhood atopic dermatitis: a cross-sectional study

Authors

Stephanie M. Rangel, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Theodore Kim, Departments of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Anjani Sheth, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Alli Blumstein, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Jin-Shei Lai, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
David Cella, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Amy S. Paller, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Jonathan I. Silverberg, School of Medicine and Health Sciences, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.

Document Type

Journal Article

Publication Date

12-21-2022

Journal

Journal of the European Academy of Dermatology and Venereology : JEADV

DOI

10.1111/jdv.18819

Abstract

BACKGROUND: Fatigue is a symptom that can negatively impact patients' quality of life. However, the relationship of AD with fatigue has not been fully studied, especially in children. OBJECTIVE: To determine the prevalence of fatigue in AD patients, and whether AD severity, demographics and comorbidities are associated with increased fatigue in children. METHODS: A cross-sectional observational study was performed among 248 children with AD. Pediatric patients (ages 8-17 years) and parents (of children ages 0-17 years) completed a questionnaire, including demographics, history of atopic comorbidities, and validated severity measures of AD, itch, pain, sleep disturbance, sleep-related impairment and fatigue. AD severity was also assessed by clinician-reported Eczema Area and Severity Index (EASI), Scoring AD (SCORAD) and Investigator's Global Assessment (IGA). Fatigue was assessed using Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Fatigue T-score. RESULTS: Most children with AD had no (38.6%) or mild (32.1%) fatigue, with fewer having moderate (27.2%) or severe (2%) fatigue. Moderate/severe PROMIS Pediatric fatigue T-scores were increased with moderate (25.7%/1.4%) and severe (39.3%/5.4%) IGA vs. mild IGA (18.0%/0.0%) and those with 5-6 (44.4%/0.0%) and 7 (44.2%/5.2%) nights of SD from eczema. Moderate-severe PROMIS Pediatric Fatigue T-scores were associated with history of hay fever (adjusted OR [95% Cl]: 2.803 [1.395-5.632]) and family income (<$100,000: 3.049 [1.294-7.181]), but inversely with Black (0.40 [0.168-0.969] and AAPI (0.285 [0.094-0.859]) race. In multivariable regression models controlling for demographic factors, PROMIS Pediatric Fatigue T-score were significant with more severe scores for IGA, POEM, EASI, SCORAD, NRS-itch, SCORAD-itch, average itch in the past 7 days, PROMIS Pediatric Pain severity, PROMIS Pediatric SD, PROMIS Pediatric SRI, SCORAD-sleep, and more frequent SD from AD. CONCLUSIONS: Fatigue is a common yet underappreciated symptom in children with AD, particularly those with moderate-severe AD, and warrants more attention in clinical practice and trials.

APA Citation

Rangel, Stephanie M.; Kim, Theodore; Sheth, Anjani; Blumstein, Alli; Lai, Jin-Shei; Cella, David; Paller, Amy S.; and Silverberg, Jonathan I., "Prevalence and associations of fatigue in childhood atopic dermatitis: a cross-sectional study" (2022). GW Authored Works. Paper 2068.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2068

Department

Dermatology