The Impact of Atopic Dermatitis on Childhood Growth: Insights from the PEDISTAD Study

The first-place poster presented at the 2024 American Academy of Dermatology Annual Meeting in San Diego, California, shed light on how atopic dermatitis (AD) holds the potential to disrupt not only a child’s skin but also their very growth trajectory. The study, known as PEDISTAD (NCT03687359), is an ongoing international observational study that aims to understand how moderate to severe AD affects children under 12 years of age, particularly in terms of height, weight, and Body Mass Index (BMI). The objective of the study was to analyze these growth metrics in comparison to the general standardized healthy population and assess the overall impact of AD on childhood growth.¹ Before PEDISTAD, study authors wrote for background contest that “there is a lack of robust and longitudinal long-term data on disease characteristics and typical clinical practice with currently available treatments in children with moderate to severe AD.”²

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Methods and Demographics

The PEDISTAD study enrolled a total of 1329 children aged <12 years, all suffering from moderate to severe AD inadequately controlled by topical therapies and eligible for systemic medications. Baseline demographics revealed a diverse population, with an average age of 5.98 years and a slightly higher percentage of boys (53.2%). The racial distribution included White (59.0%), Black (9.9%), Asian (24.3%), Indigenous (1.3%), and Other (5.5%).

Growth Metrics Analysis

The study assessed height, weight, and BMI by calculating gender and age-specific Z-scores and corresponding percentiles using CDC growth curves algorithms. Results were then compared to the CDC standardized growth curves for healthy children aged 0 to 12 years.

Children with AD exhibited variations in growth metrics compared to the healthy population. The mean percentiles for height, weight, and BMI were calculated, providing valuable insights into the impact of AD on childhood growth.

Top 3 Key Findings

1. Height: Children with moderate to severe AD demonstrated lower mean height percentiles compared to the healthy population. The study noted that this could be attributed to factors such as sleep disturbance caused by itching and the effects of certain AD medications, particularly corticosteroids and immunosuppressants.

2. Weight and BMI: Investigators were surprised to find that children with AD had a higher mean weight and BMI than the reference healthy population. This unexpected finding suggests that while AD may hinder linear growth, it might contribute to increased weight gain in affected children. This could be linked to the chronic sleep disturbance caused by itching, leading to changes in eating habits and overall metabolism.

3. Intervention and Implications: The study highlighted the importance of early intervention with effective targeted therapies to mitigate the negative impact of moderate-to-severe AD on growth. The findings emphasize the need for dermatologists and healthcare professionals to consider the potential effects of AD medications on children's growth and tailor treatment plans accordingly.

Conclusion

In conclusion, the PEDISTAD study provided crucial insights into the impact of moderate to severe AD on childhood growth. By analyzing height, weight, and BMI metrics in comparison to the healthy population, the study sheds light on the complex interplay between AD, chronic sleep disturbance, and the effects of medications on children's growth. The findings underscore the importance of early intervention and targeted therapies to address these concerns and ensure optimal growth in children with AD.

References

1. Paller A, Geng B, Irvine A, et al. Growth analysis in children aged less than 12 years with moderate to severe atopic dermatitis. Poster presented at: 2024 American Academy of Dermatology Annual Meeting; March 8-12; San Diego, CA
2. Paller AS, Guttman-Yassky E, Irvine AD, Baselga E, de Bruin-Weller M, Jayawardena S, Zhang A, Mina-Osorio P, Rizova E, Ozturk ZE. Protocol for a prospective, observational, longitudinal study in paediatric patients with moderate-to-severe atopic dermatitis (PEDISTAD): study objectives, design and methodology. BMJ Open. 2020 Mar 24;10(3):e033507. doi: 10.1136/bmjopen-2019-033507. PMID: 32209624; PMCID: PMC7202692.