Beyond The Itch: Rising Atopic Dermatitis Cases Leaving Lasting Burden On Children And Families

Dermatologists in India are reporting a steady rise in cases of atopic dermatitis (AD), commonly known as eczema, not only among children but also adolescents and adults, with changing lifestyles, pollution and the growing use of fragrance-based personal care products emerging as possible contributors.

Experts warn that the chronic inflammatory skin disease often goes undiagnosed and imposes a significant emotional, physical and financial burden on both patients and caregivers.

This comes amidst a recent multinational ‘Scars of Life’ study, published in the Journal of Investigative Dermatology, which analysed responses from 22,833 participants across 27 countries, including India, and found that atopic dermatitis can leave lasting social, educational and professional consequences.

The study reported that adults whose disease began in childhood were significantly more likely to face restrictions in educational opportunities, career choices and social interactions than those whose symptoms developed later in life.

More than one-third of participants with childhood-onset disease reported limitations in their educational pathways and professional aspirations. Many also reported social avoidance, difficulties in public interactions and workplace discrimination.

When contacted, Dr. Mustaqeem Farooqui, Associate Consultant, Dermatology, Apollomedics Super Speciality Hospitals, Lucknow, who was not part of the study, agreed. “Beyond the physical symptoms, atopic dermatitis can have a significant psychological impact. Patients may experience embarrassment, social withdrawal, anxiety and low self-esteem. In children, the condition can affect school performance due to discomfort and poor sleep, while adults may find it difficult to concentrate at work, affecting their productivity and overall quality of life,” he added.

Dr. Rashmi Sarkar, Director Professor and Head, Department of Dermatology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, added:

“AD is more common in children. However, we are now seeing increasing numbers of cases among adolescents and adults."

“The exact cause remains unclear, but environmental changes, rising pollution levels and chronic stress may be contributing factors. In many adolescents, milder forms of the disease continue from childhood,” she said.

Dr. Sarkar noted that while the condition is usually confined to body folds and the face, severe disease can spread extensively, causing crusting, secondary infections, severe itching and major sleep disturbances.

Dr. Farooqui concurred. “The primary challenge in poorly managed atopic dermatitis is relentless itching. Excessive scratching damages the skin barrier, leading to increased inflammation and creating a vicious itch-scratch cycle. This also raises the risk of secondary bacterial infections.”

Managing the disease often requires lifelong vigilance. “One of the most challenging aspects of atopic dermatitis is the itch-scratch cycle,” said Dr. Radhika Raheja, Consultant Dermatologist and Hair Transplant Specialist, Asian Hospital, Faridabad.

“Scratching further damages the skin barrier and intensifies inflammation. Common triggers include harsh soaps and detergents, excessive sweating, dust mites, seasonal changes, stress and certain fabrics such as wool. Identifying and avoiding individual triggers is an important component of long-term management,” she said.

Dr. Raheja added that advances in treatment are offering new hope to patients.

“There is growing optimism regarding the prognosis of atopic dermatitis. With early diagnosis, personalised treatment, good skin care practices and trigger management, many patients can achieve excellent symptom control and enjoy a good quality of life,” she said.

As per the international study, more than one-third of participants with childhood-onset disease reported limitations in their educational pathways and professional aspirations. Many also reported social avoidance, difficulties in public interactions and workplace discrimination.

“Our findings demonstrate that AD is not merely a skin condition but a chronic disease with lasting consequences on life trajectories,” said Dr. Jonathan I. Silverberg, Professor of Dermatology at the George Washington University School of Medicine and Health Sciences, Washington DC, and lead investigator of the study.

“We were struck by the magnitude of the gap between childhood-onset and adolescent-onset patients across nearly all dimensions studied — educational limitations, career restrictions, social avoidance and workplace discrimination,” he said.

The study identified India among the countries reporting the highest impact of the disease on life choices, with nearly 60% of respondents stating that atopic dermatitis had influenced or restricted their educational opportunities.

“AD leaves invisible scars. Beyond the itch and the sleepless nights, our data show that this disease silently redirects life choices — from the classroom to the boardroom,” said Charles Taieb, co-investigator and member of the Patients Priority Department, European Market Maintenance Assessment (EMMA), Paris.

“We must stop treating AD as merely a skin condition and start recognising it as a chronic disease with lifelong socio-professional consequences,” he added.

The global findings echo concerns raised by Indian researchers. A 2024 study conducted by Dr. Pallavi Ailawadi, Dr. Vishal Pal, Dr. Archana Singal and Dr. Deepika Pandhi of the Department of Dermatology, University College of Medical Sciences (UCMS) and Guru Teg Bahadur Hospital, Delhi, found that atopic dermatitis significantly impairs the quality of life of affected children while imposing a substantial burden on their families.

Published in the Indian Journal of Skin Allergy, the study assessed 30 children diagnosed with atopic dermatitis and compared them with 30 healthy age- and sex-matched controls. Using validated quality-of-life assessment tools, the researchers documented the extent to which the disease affects daily living.

The study found that persistent itching and sleep disturbances were among the most distressing symptoms experienced by children. The impact increased with disease severity, affecting not only physical comfort but also emotional well-being.

“Atopic dermatitis is associated with a lowered quality of life of the patient, which increases with the severity of the disease,” the authors observed.

Importantly, the researchers found that the burden was shared by families, particularly parents who often shoulder the responsibility of long-term care.

“The disease significantly impacted the quality of life of the family,” the authors noted. “The main issue with parents caring for children with atopic dermatitis is continuous expenditure on treatment, emotional distress and physical exhaustion,” said the study, with experts calling for early diagnosis, effective treatment and greater psychosocial support for both patients and caregivers to reduce the long-term burden of the disease.