Atopic dermatitis (AD) usually presents during childhood and is associated with itch and sleep disturbances. The onset of AD often occurs during the first 6 months of life, and most cases are seen before patients reach the age of 2, according to published studies. “Parents and clinicians often wonder if AD will contribute to other health problems in children,” says Aaron Drucker, MD, ScM, FRCPC.
Recent research suggests that AD may be associated with short stature and obesity in children, but most of these previous studies have been either small or cross-sectional. Studies are lacking in the associations of AD with height and weight trajectories, which are strong indicators of the overall well-being in children. Several small investigations have found that children with AD tend to be shorter in height than children without the skin condition, but other studies found no such association.
To address this research gap, Dr. Drucker and colleagues published a study in JAMA Dermatology that aimed to better characterize the link between AD and growth trajectories. They examined associations between AD with height, BMI, and weight from participants in TARGet Kids! (The Applied Research Group for Kids), an ongoing study that collects data at routine doctors’ office visits throughout childhood.
Associations in Early Childhood May Be Transient
For the study, children aged 5 and younger were followed into adolescence at regular office visits from June 2008 to February 2021. In total, more than 10,600 children were included in the analysis, with about half (47.8%) of the participants being female. Patients were followed for a median of 28.5 months, and about 17% of children had AD during follow-up. The study team found that AD was associated with lower height and higher BMI, but these associations were not static as children aged. In addition, AD was associated with lower length-for-age z scores and lower weight-for-age z scores when compared with children without AD. When compared to children without AD, those with the skin condition were on average 0.5 cm shorter, with 0.2 more BMI units at age 2, and 0.6 cm shorter, with no difference in BMI at age 5.
Importantly, the study demonstrated that associations between AD and height and BMI changed with age, diminishing by age 14 and 5.5, respectively. “While we found some differences between children with and without AD—such as shorter height and higher BMI—these differences were small and appeared to resolve later in childhood,” Dr. Drucker says. The study team also reported there was no evidence of interaction between AD and age with respect to weight. Children with AD were somewhat less heavy than children without AD, and this association did not diminish with age.
Appropriate Treatment of AD Is Key
“Our findings should be reassuring for parents and clinicians,” says Dr. Drucker. “Clinicians should focus on managing AD to minimize its symptoms and reassure parents that, in most cases, any associated impact on growth will not be substantial.” Dr. Drucker also notes that adequate control of AD throughout childhood can usually be achieved by using topical emollients, corticosteroids, and other topical anti-inflammatory medications. These agents might prevent the need for systemic or higher-potency topical corticosteroids.
Prospective studies with longer time horizons are needed to measure longer-term associations, according to investigators, according to the researchers. “Our study did not include an assessment of AD severity or persistence over time,” says Dr. Drucker. “These factors could play a role in any relationship between AD and growth. Future studies that account for AD disease activity would be informative in our efforts to improve care for pediatric patients.”
Aaron Drucker, MD, ScM, FRCPC, has reported receiving compensation from the British Journal of Dermatology (reviewer and Section Editor), the American Academy of Dermatology (guidelines writer), and the National Eczema Association (grant reviewer), and has served as a paid consultant for the Canadian Agency for Drugs and Technologies in Health outside the submitted work discussed in this article.