Fatigue in Childhood Atopic Dermatitis

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In this interview with The Dermatologist, Dr Amy Paller discusses the effect of atopic dermatitis (AD) severity on fatigue in children and how physicians can take a proactive approach to address it based on the recent study, “Prevalence and Associations of Fatigue in Childhood Atopic Dermatitis: A Cross-Sectional Study.”

The Dermatologist: How do AD severity, demographics, and comorbidities affect fatigue in children?

Dr Paller: What we found in our study is that fatigue is strongly correlated with a wide variety of metrics for AD severity. Children who are more severely aff ected [by AD], whether we are talking about the physician score or patient-reported outcome measures related to itch, pain, and sleep, had high correlations with fatigue, which is a domain that we do not usually think about too much in children with AD as opposed to children with a wide variety of chronic diseases.

The Dermatologist: How prevalent is fatigue in children with AD compared with adults?

Dr Paller: Regardless of their demographics or even their comorbidities, although we know that allergic rhinitis, for example, increases fatigue, we saw this correlation [of fatigue] with greater

[AD] severity. Overall, about 30% of patients had moderate or severe fatigue. And that is close to what has been recently reported in the adult community.

The Dermatologist: How can physicians take a proactive approach to addressing fatigue in children with AD?

Dr Paller: First, I want to make sure that we defi ne what we mean by fatigue. We are not talking about sleep disturbance such as poor sleep with frequent awakenings. We are not talking about sleep related impairment either where it is specifically feeling sleepy during the day. It is more this profound tiredness, the lack of energy, the lack of motivation, just feeling exhausted, and sometimes even feeling weak. These are what we call fatigue, especially linked with chronic disorders.

People who have chronic disease have this fatigue, which of course tends to manifest during the day, but is also related to decreased ability to sleep. When we are thinking about AD, we think about itch. We ask, “How well are you sleeping at night? Do you have a feeling of exhaustion all the time? Do you feel energy, motivation? Do you feel tired during the day?”

I hope that this brings awareness to the frequency of children having fatigue, which interestingly was better recognized by parents of adolescents than of younger children. I think parents sometimes do not realize how fatigued their children with moderate and particularly severe AD are.

The Dermatologist: What further research is needed?

Dr Paller: It comes down to better recognition. For the first time, we are bringing out that this is something which can affect children and their productivity, especially with their ability to participate in activities like sports that require energy. The next step for us is to do a much larger, probably multicenter study looking at these relationships between fatigue and itch, pain, sleep, and severity of AD. Then sorting out whether the tools that we are currently using to treat AD take care of not just itch and sleep, but also patient fatigue.

The Dermatologist: Are there any additional tips or insights you would like to share?

Dr Paller: It is such an important aspect of life for these children because [fatigue] affects their psychosocial well-being, and that has a big impact on quality of life. When we are talking to patients and their caregivers, we need to broaden our questions to ask about fatigue and make sure we keep track of it. Tracking fatigue will help us better understand the impact of our care on our patients’ quality of life.

Reference
Rangel SM, Kim T, Sheth A, et al. Prevalence and associations of fatigue in childhood atopic dermatitis: a cross-sectional study. J Eur Acad Dermatol Venereol. 2023;37(4):763-771. doi:10.1111/jdv.18819