A Close Look at the Psychosocial Impact of Psoriasis and AD in Pediatrics

Many skin conditions have a quality-of-life (QOL) effect similar to that of systemic diseases such as renal disease, cystic fibrosis, and asthma.1 Skin diseases also can have emotional and social repercussions on the parents and caregivers of children with dermatology disorders.^2,3

The widely used Children’s Dermatology Life Quality Index (CDLQI) gives the practitioner an understanding of QOL issues in children aged 4 to 16 years.⁴ The latest cartoon version is designed to be easier for children to comprehend and has a validation similar to that of the original scale.⁵ The questionnaire, which uses a recall period of 1 week, assesses various issues including feelings of sadness or self-consciousness, impact on friendships, bullying as a result of the disease, effects on going out or playing sports, interference with sleep, and response to treatment.^4,5 Based on the scoring of the responses, the effect on QOL is stratified as none (0-1), small (2-6), moderate (7-12), very large (1318), or extremely large (19-20).⁶ Findings from a 2016 meta-analysis of all studies using CDLQI, which included data from 7,798 children with more than 20 conditions, concluded that most skin diseases have a major impact on QOL in a small proportion of children.⁷ However, further review of the literature demonstrates that skin disease has a significant impact for many children and their families.

Disease-specific scoring systems have also been developed, such as the Cardiff Acne Disability Index and the Acne Disability Index; the Psoriasis Area Severity Index (PASI) and Physician Global Assessment; and the Infants’ Dermatology Quality of Life, the Childhood Atopic Dermatitis Impact Scale, the Quality of Life Index for Atopic Dermatitis, and Dermatitis Family Impact questionnaire.^8,9

PSORIASIS

Seen in an estimated 0.7% of children, psoriasis has a negative impact on QOL for not only children but also their parents and caregivers, even in the presence of mild disease.^10,11 Results show that 36% of parents and caregivers of children with psoriasis have depressive symptoms.¹²

Compared with systemic diseases using the corresponding Children’s Life Quality Index (CLQI), psoriasis was found to have a greater impairment in QOL compared with enuresis, diabetes, and epilepsy.1 Psoriasis also had a negative influence on self-esteem, bullying, and stigmatization.¹⁰

Investigators of another study concluded that improvement in CDLQI scores to imply no effect (0-1) was associated with a PASI score of 90 or greater, a decrease in body surface area (BSA) involvement of greater than 90%. As a consequence, this may be advised as a reasonable therapeutic goal. It was also noted that systemic therapy including biological and conventional drugs has a better outcome compared with topical agents.¹³

Physicians should use clinical therapy and QOL assessment for evaluations and support.^11,14

ATOPIC DERMATITIS

With an estimated increasing global prevalence of 15.5% to 20% among children,^15,16 atopic dermatitis (AD) is a chronic skin disease with relapses and remissions characterized by a wide array of clinical presentations. The impact on QOL was found to be greater in children with AD compared with children with systemic diseases including renal disease, cystic fibrosis, asthma, and chronic urticaria.¹ Recent findings revealed that 72% to 84% of children with AD experienced at least 1 sleep disturbance. Those with active AD alone had nearly 50% greater odds of reporting sleep-quality disturbances throughout childhood compared with 80% of children who also had asthma and/or allergic rhinitis. Early diagnosis and therapeutic interventions are crucial.¹⁷

Recent findings also revealed a relative risk of 1.4 times for learning disabilities among children with AD, an association independent of sociodemographic factors and other atopic and neurodevelopmental disorders.¹⁸ Significant positive association of atopic disease and childhood AD with memory impairment, developmental delay, and cognitive dysfunction has also been identified.¹⁹

Muhammad Aamir Anees is a medical student at Kanachur Institute of Medical Sciences in Mangalore, India.

References:

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4. Lewis-Jones MS, Finlay AY. The Children’s Dermatology Life Quality Index (CDLQI): initial validation and practical use. Br J Dermatol. 1995;132(6):942-949. doi:10.1111/j.1365-2133.1995.tb16953.x
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19. Revolutionizing atopic dermatitis, 13-14 December 2020. Br J Dermatol. 2021;184(3):e56-e121. doi:10.1111/bjd.19722