Pediatric Eczema Severity, Quality of Life Not Influenced by Phototype, Ethnicity

Ethnicity and skin phototype have been shown not to independently impact pediatric patients’ atopic dermatitis severity level or quality of life (QoL), new data suggest, although cultural factors such as caregiver concerns are strongly linked with perceived disease burden.1

These new data were drawn from a study authored by investigators such as Samuel Morriss, MD, of The Royal Children's Hospital in Melbourne, Australia. In their analysis, Morriss et al noted the value of ethnic diversity as a consideration in healthcare research, given Australia's multicultural population.

Additionally, they highlighted the limited information previously available on ethnic differences in QoL and eczema severity, despite the significant impact of atopic dermatitis on children with moderate to severe disease.

“Previous international studies have shown racial and ethnic differences in the epidemiology of AD, with non-Caucasian children having higher incidence and prevalence,” Morriss and colleagues wrote.1,2 “This multicentre study investigates the potential influence of ethnicity on eczema severity and quality of life in paediatric patients.

Study Design Details

Morriss et al worked on this analysis in the period between August - November 2024, using prospective observational study design. They aimed to essentially describe and compare atopic dermatitis severity level and QoL outcomes between groups, measuring via the Infants’ Dermatitis Quality of Life Index (IDQOL) and the Children’s Dermatology Life Quality Index (CDLQI).

Among their secondary aims, the investigators sought to explore any relationships between ethnicity and concerns connected to childrens’ condition or use of treatment, any caregiver-specific management practices, and views on disease burden. This assessment implemented a purpose-built eczema concerns questionnaire. Morriss and coauthors conducted their research within a pair of Australian tertiary pediatric centers: The Royal Children’s Hospital (RCH) in Melbourne and Perth Children’s Hospital (PCH).

Those recruited for the study were children between the ages of 0 - 16 years with an eczema diagnosis. They were enrolled from dermatology outpatient clinics at the aforementioned locations. Caregivers were asked to fill out either the CDLQI or IDQOL, depending on their child’s age, along with the eczema concerns questionnaire. Self-identification of ethnicity was based on Australian Bureau of Statistics categories.

Morriss and colleagues noted clinicians had evaluated atopic dermatitis severity via the Eczema Area and Severity Index (EASI). The investigative team also utilized multivariable linear regression models for the purposes of examining any associations, adjusting for age, hospital site, and level of patient disease severity.

There were 147 children involved in the final analysis. The team pointed to comparable numbers recruited from both hospitals (n = 71, n = 76). Among those taking part as subjects, the median age was 2.0 years (interquartile range [IQR], 0.8–5.5). Morriss and colleagues noted, between both centers, a lack of notable age distribution differences. Males accounted for 56% of the study cohort, and the majority of children (90%) had been born within Australia.

Findings on Ethnicity’s Impact on Eczema

Between both centers, Morriss et al noted differences in patients’ ethnic composition, highlighting the more common enrollment of patients identified as South-Eastern or North-Eastern (SE/NE) Asian at PCH (21%). This was compared with RCH, at a rate of 8.5%. Participants of Oceanian background were noted to have represented more than 50% of the study population at both of the hospitals. Oceanian ethnicity was shown to be most common when ethnicity was described by maternal background (35%). This was then followed by South Central Asian (26%) and SE/NE Asian (21%).

The investigative team pointed to comparable median EASI scores between the 2 centers. They also highlighted a median score of 5 at RCH and 4 at PCH. In contrast, the team noted substantial QoL impairment among children seen at RCH, where the median DLQI was 10.0, as opposed to the score of 5.0 seen at PCH (P < .001). Such a distinction was described by the investigators as likely suggesting increased burden reported by newly referred patients at RCH prior to optimization of their medication.

When outcomes were stratified by patient-reported ethnicity, a lack of statistically significant differences were observed in either severity of disease or QoL measures. Median EASI scores were noted by Morriss and coauthors as 5 (IQR 2–11) for Oceanian children, 4 (IQR 1–12) in the SE/NE Asian arm, 6 (IQR 3–10) in the South Central Asian arm, and 5 (IQR 2–8) in those classified as Other. Corresponding median QoL scores were shown to be 6 (IQR 4–11), 8 (IQR 5–11), 9 (IQR 4–11), and 6 (IQR 2–12), respectively.

“In this study cohort, ethnicity and skin phototype did not independently influence eczema severity or QoL,” they concluded.1 “Cultural factors including treatment preferences and caregiver concerns were strongly associated with perceived disease burden and there was discordance between EASI and QoL scores in some ethnic groups.”

Limitations highlighted by the investigators included unequal distribution of ethnicity, relatively modest sample size, unequal ethnic representation, and varying ways of recruitment between sites.

References

1. Yap M, Morriss S, Rodrigues M, et al. An Exploratory Study of Eczema Severity and Quality of Life in Paediatric Atopic Dermatitis Across Ethnic Groups. Australas J Dermatol. 2026 Jan 9. doi: 10.1111/ajd.70044. Epub ahead of print. PMID: 41517931.

2. Leung DY. Atopic dermatitis: Age and race do matter! J Allergy Clin Immunol. 2015 Nov;136(5):1265-7. doi: 10.1016/j.jaci.2015.09.011. PMID: 26549637.