Atopic dermatitis in children has been associated with disruptions in sleep, attention, and memory in published research. Recently, Joy Wan, MD, MSCE, and colleagues conducted a study that found higher rates of learning disability among children with atopic dermatitis when compared with children who did not have atopic dermatitis in the United States. Learning disabilities may include impairments in various areas of learning, such as reading, writing, and mathematics. “This association was novel and also appeared independent of sociodemographic characteristics and other related medical conditions,” says Dr. Wan.

How Atopic Dermatitis Impacts Learning

Although children with atopic dermatitis appear more likely than children without the condition to be diagnosed with a learning disability, little is known regarding whether this association is directly attributed to the skin condition. To address this issue, Dr. Wan and colleagues conducted a new study, published in JAMA Dermatology, that evaluated the link between the severity of atopic dermatitis and learning problems in a large cohort of US children with the disease. “This is an important topic because atopic dermatitis is very common and most often occurs during childhood, which is a formative period of learning and development,” Dr. Wan says. “A better understanding of how atopic dermatitis impacts learning is critical for guiding treatment and optimizing health and quality of life outcomes for children with this skin condition.”

For the study, the investigators analyzed data from US participants enrolled in the Pediatric Eczema Elective Registry (PEER) from 2004-2019. Participants included children aged 2-17 at enrollment with a physician-confirmed diagnosis of atopic dermatitis and had completed 10 years of follow-up in PEER. The severity of atopic dermatitis was measured using the Patient-Oriented Eczema Measure (POEM) score and self-reports. POEM scores ranged from 0-28, with 0-2 signifying clear or almost clear skin, 3-7 signifying mild, 8-16 signifying moderate, and 17-28 signifying severe or very severe atopic dermatitis. Self-reported atopic dermatitis severity was categorized as clear skin or no symptoms, mild, moderate, or severe.

8.2% Reported a Learning Disability

According to the results, 8.2% of the 2,074 participants with atopic dermatitis reported a diagnosis of a learning disability. “Children with mild, moderate, or severe atopic dermatitis were all significantly more likely to have a learning disability when compared with children who had clear or almost clear skin,” says Dr. Wan (Figure). “These findings were independent of sociodemographic characteristics, sleep problems, and other atopic and neuropsychiatric conditions, such as ADHD.”

Based on POEM scores, 29.8% of children with learning disorders had moderate atopic dermatitis, compared with 17.0% of those without a learning disorder. In addition, 8.9% of participants with a learning disorder had severe to very severe disease, compared with 4.5% of those without a learning disorder. Self-report rates were similar to those measured by POEM scores with regard to rates of moderate and severe atopic dermatitis.

There appeared to be a dose-dependent association between the severity of atopic dermatitis and the presence of a learning disability. “One of the most striking findings from our study was that the worse the atopic dermatitis severity, the higher the odds of a learning disability,” says Dr. Wan. “The most severely affected children had threefold increased odds of having a learning disability.”

Detrimental Effects on Learning & Cognition
Because atopic dermatitis affects up to 20% of children in the US—about one-third of whom have moderate to severe disease—the impact and scope of the study findings may be substantial. “Our findings suggest a dose-responsive association between more severe atopic dermatitis and learning problems,” Dr. Wan says. “The data support the notion that atopic dermatitis may have detrimental effects on learning and cognition. As such, clinicians should proactively ask patients and families how they’re doing with daily activities, such as going to school, learning, developing, and getting adequate sleep, and refer them to further evaluation and treatment when appropriate.”

Dr. Wan notes that while additional research is warranted in this area, formal screening and/or tailored treatments for patients could be considered in the future. “We also need studies that investigate the potential underlying mechanisms of the association between atopic dermatitis and learning disability,” she says. “Additionally, future studies should examine how treatment of atopic dermatitis impacts the development and severity of learning problems.”