These facts and figures represent a summary of the most current information from published scientific literature regarding the prevalence of eczema and the burden people living with eczema face every day.
The big picture
31.6 million people (10.1%) in the U.S. have some form of eczema, and prevalence peaks during early childhood.1–5
It is estimated that 1 in 10 individuals will develop eczema during their lifetime, with prevalence peaking in early childhood.2–6
Overall, 60% of individuals with atopic dermatitis (AD) received a definitive diagnosis within 12 months of initial symptom presentation, while 16% have experienced a diagnostic process that took more than two years. The delay in diagnosis was more pronounced for adult-onset AD, with nearly 20% of adults reporting it took more than two years, compared with less than 10% of children under 18.7
People of all skin colors, races and ethnicities can be affected by eczema:1
- White – 11%
- Black or African American – 10%
- Asian or Pacific Islander – 13%
- Native American – 13%
Prevalence of childhood & adult atopic dermatitis (AD)
Approximately 9.6 million U.S. children under the age of 18 have AD, and one-third have moderate to severe disease.5,8,9
The prevalence of childhood AD has increased from 8% to 15% since 1997.4,10
An estimated 16.5 million U.S. adults (7.3%) have AD, with nearly 40% affected with moderate to severe disease.11
80% of individuals affected by AD experience disease onset prior to 6 years of age.12
AD is not solely a disease of childhood onset; 1 in 4 adults report adult-onset of symptoms.13,14 Some even report onset after 60 years of age (6%).1
Although study percentages vary, adults that are multiracial or white tend to have the highest prevalence of atopic dermatitis.2,11,15
AD affects male and female children similarly, but is more prevalent in adult women.2,5,6,9,16,17
In the U.S., children with AD who are African American/Black or Hispanic tend to have more severe disease than white children.9,15
Children born outside the U.S. have a 50% lower risk of developing AD, which is increased after living in the U.S. for 10 years.18
Current data suggests that 80% of children will “outgrow” their AD by adolescence or adulthood. Children diagnosed at a younger age, with more severe disease and who live in an urban environment have a higher risk for prolonged disease, although AD may persist regardless of severity.19–22
Impacts of eczema
Disease burden & mortality
Itch is the most burdensome symptom of AD, followed by skin redness and sleep loss.7,23,24
60.5% of adults with moderate to severe AD have reported severe or unbearable itch in the past two weeks, 86% reported daily itch and 63% reported itching at least 12 hours per day.25
Skin pain is a newly appreciated symptom of AD, with 61% of affected adults experiencing pain. This pain is most often reported as a burning sensation, but can also feel like tingling or stinging. Pain is sometimes associated with excessive scratching, but can also exist separately. 23,26–28
More than 55% of adults with moderate to severe AD report inadequate disease control.7,29,30
Even when treatments are available, over 50% of adults with AD still face concerns about long-term use, and over 50% have found a treatment to be ineffective. 44% have discontinued prescribed medications for eczema.7
One in four adults with AD rate their health as “fair” or “poor”; more than 16% are “very” or “somewhat” dissatisfied with life. Negative ratings of health and satisfaction increase with disease severity.24
During an AD flare, itch and redness are increased. Flare frequency, duration and average severity increases with disease severity. About half of patients spend more than eight days in a month in a flare.31,32
Compared to the time of symptom onset, nearly half (48%) of AD patients report that at the present time, symptom severity has worsened. Nearly two-thirds (64%) report that more areas or different areas are affected; 49% indicate that the frequency of flares is worse than at onset.7
Hospitalization due to AD flares and related infections is associated with an 8.3 year reduction in lifespan compared to the general population.33 Outside of hospitalization, the risk for death due to any cause is slightly increased in people with AD.34
AD is the leading contributor to skin-related disability and ranks 15th among all non-fatal diseases globally.35 The burden is highest in children and women.36
Sleep disturbances occur in 67% of children with AD, and parents of children with AD are four to eight times more likely to average fewer than six hours of sleep per night. 37,38 Poor sleep may also affect growth in children with AD.39
Around one-third of adults with AD experience sleep-related issues including insomnia, shorter sleep time, daytime sleepiness and fatigue.24,40–42
15-30% of adults with AD rate sleep disturbance as the “most” or “second-most” burdensome symptom.7,24,40–42
Children with AD often develop other atopic conditions often in a sequence of food allergy, allergic rhinitis and asthma – known as the atopic march. Some of these conditions may persist for years; others may resolve with increasing age.43,44
Children who have early-onset, moderate to severe AD are more likely to develop asthma and allergic rhinitis. More than 50% of children with severe AD will develop asthma.44–49
Young children with AD are six times more likely to develop a food allergy compared to children without AD.50–52
Asian children may have an increased risk for food allergy53 and Black children exhibit higher asthma risk.54
More than 20% of adults with AD also have asthma, and they have a two to four times increased risk for having allergic rhinitis and food allergy.2,55
Autoimmune and cardiac disease
AD in adults is associated with other chronic conditions that contribute to poor health including diabetes, obesity, autoimmune disease, high blood pressure and heart disease. Risk for these diseases increases with AD severity.56–60
Children with AD are also at a higher risk for obesity, autoimmune conditions and metabolic syndrome.61
According to the American Academy of Dermatology, AD is associated with a higher risk of osteoporosis and bone fractures. This risk may be higher with more severe AD.62
For hospitalized adults with AD, the prevalence of serious infections including cutaneous, respiratory and systemic (heart, brain, GI, bone) infections is significantly higher compared to those without AD.63
Adults and children with AD are at an increased risk to develop serious bacterial, viral and fungal skin infections.56,61,62,64
Adults and children with AD have an increased risk of eye-related conditions including conjunctivitis, blepharitis, cataracts, keratitis and keratoconus; this risk increases with AD severity.61,65,66
AD’s negative impact on mental health ranks greater than that for patients with heart disease, diabetes and high blood pressure.24
Recent studies have suggested that those with AD are up to 44% more likely to exhibit suicidal ideation and 36% more likely to attempt suicide.67–71
Adults with AD have a 2.5 to 3-fold higher risk for anxiety or depression, and children with AD are two to six times more likely to have depression or anxiety than children without AD.11,72–76
Children with AD are more likely to be diagnosed with attention deficit hyperactivity disorder (ADHD) and other conduct disorders.56,60,72,77–79
When asked directly about symptoms of depression during the worst point of their eczema, 53% rated their depression symptoms as having been “severe” and 27% rated them as “moderate.” 38% rated those symptoms moderate or severe currently.7
Childhood AD can also affect the emotional and social well-being of parents or other caregivers.80,81
Lifestyle: impacts to patients and caregivers
Half of patients with moderate to severe AD indicate that it significantly limits their lifestyle; nearly 35% of those with mild AD also experience some lifestyle limitations.24
More than one-third of patients say they “often” or “always” feel angry or embarrassed by their appearance due to their disease.82
Having AD leads to a higher likelihood of negative overall health rating and dissatisfaction with life. Over one-fourth of those with AD rate their health as fair or poor.24
As severity of AD increases, so do negative impacts on health rating and life satisfaction.24
Caregivers reported greater time commitment managing their eczema than adult patients, with 33% reporting spending 11 hours or more each week, compared to 23% of adult patients spending that amount of time. 5% of all respondents reported spending 40 hours or more per week.7
The impact of eczema on caregivers is comparable to that of adult eczema patients, with over 50% reporting a high or significant impact in the last month.7
Nearly one-third of adults with AD have experienced challenges in school or their work life, and 14% of adults believe their academic and/or career progression have been hindered by AD.83,84.
Nearly 40% of eczema patients reported that they turned down a job or an educational opportunity due to their disease.15,85
Pre-adolescent girls with AD more frequently report impaired self-perceived health than their male counterparts and are more likely to indicate their disease affects the type of clothes that they wear.86–88
Lifestyle: impacts to relationships
One-third to one-half of adults with AD avoid social interactions because of their appearance.83,867,83,86
One in three adults with AD and their partners have reported that eczema interfered with establishing relationships and their sexual health,83,89,90 and 29% of patients feel that it negatively impacts their sexuality.7,91,92
Children, adolescents and young adults with eczema often feel isolated from their peers.71,93,94 Children with severe AD have fewer friends and spend more time alone than children with moderate AD.95
Nearly 40% of school-aged children and teens with AD have experienced bullying because of their disease.71,95,96
Parents and caregivers of children with AD report feeling embarrassed about their child’s appearance as well as frustration, helplessness, sadness, and guilt, due to their child’s disease.93,97
Bathing and treatment regimens, coordinating with insurance and with doctors for medical appointment, and purchasing treatments all place time and financial demands on families.97,98
Economic & societal impact
Nearly 5.9 million work days annually are lost due to eczema. Adults with AD take, on average, 11 days off of work per year for their disease.95,99
Of children with AD, 67.7% are absent from school more than 1 day per year due to their illness, and 3.9% missed over 15 days.100
People with AD have higher overall work impairment compared to non-affected coworkers. Approximately 15% of the work day can be impacted by disease flares.41,83 This impact is higher for more severe AD.101
Parents of children with AD also experience decreased work productivity and missed work days related to their child’s AD severity.15,100
U.S. adults with moderate to severe AD have nearly 16% less employment than those with mild AD. 102
People with AD have increased healthcare utilization compared to those without AD including:8,99,103
- More outpatient doctor visits – which were even higher for those with moderate to severe AD; 41,104–106
- More visits to urgent/emergency care; 107
- More hospitalizations; 99,108
People with AD report a median annual out of pocket cost for disease management of $600. However, 42% of individuals spend $1,000 or more, and 8.5% report spending $5,000 or more.32,109,110
Black race, worse AD severity and the use of three or more AD therapies are associated with higher OOP costs.109,110
OOP expenses have a significant or devastating impact on personal or family finances for 24.5% of people with AD.
Cost of care considerations have been reported for AD patients:99
- 17.6% delayed care due to concerns about cost;
- 13.1% did not seek care due to concerns about cost;
- 15.7% report an inability to cover the cost of prescriptions.
Inpatient costs for AD reach nearly $8.3 million per year for adults and more than $3.3 million per year for children.111
Total direct medical costs in 2013 averaged $11,660 per AD patient. Costs are higher in patients with more severe disease.105 The annual economic burden of eczema, including direct medical costs, indirect costs from lack of productivity and quality of life impacts is conservatively estimated at $5.3 billion.112
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