Prevalence and associations of fatigue in childhood atopic dermatitis: A cross-sectional study

Stephanie M. Rangel, Theodore Kim, Anjani Sheth, Alli Blumstein, Jin Shei Lai, David Cella, Amy S. Paller*, Jonathan I Silverberg*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Fatigue is a symptom that can negatively impact patients' quality of life. However, the relationship of AD with fatigue has not been fully studied, especially in children. Objective: To determine the prevalence of fatigue in AD patients, and whether AD severity, demographics and comorbidities are associated with increased fatigue in children. Methods: A cross-sectional observational study was performed among 248 children with AD. Paediatric patients (ages 8–17 years) and parents (of children ages 0–17 years) completed a questionnaire, including demographics, history of atopic comorbidities and validated severity measures of AD, itch, pain, sleep disturbance, sleep-related impairment and fatigue. AD severity was also assessed by clinician-reported Eczema Area and Severity Index (EASI), Scoring AD (SCORAD) and Investigator's Global Assessment (IGA). Fatigue was assessed using Patient Reported Outcome Measurement Information System (PROMIS) Pediatric Fatigue T-score. Results: Most children with AD had no (38.6%) or mild (32.1%) fatigue, with fewer having moderate (27.2%) or severe (2%) fatigue. Moderate/severe PROMIS Pediatric fatigue T-scores were increased with moderate (25.7%/1.4%) and severe (39.3%/5.4%) IGA vs. mild IGA (18.0%/0.0%) and those with 5–6 (44.4%/0.0%) and 7 (44.2%/5.2%) nights of SD from eczema. Moderate–severe PROMIS Pediatric Fatigue T-scores were associated with history of hay fever (adjusted OR [95% Cl]: 2.803 [1.395–5.632]) and family income (<$100,000: 3.049 [1.294–7.181]), but inversely with Black (0.40 [0.168–0.969]) and AAPI (0.285 [0.094–0.859]) race. In multivariable regression models controlling for demographic factors, PROMIS Pediatric Fatigue T-score was significant with more severe scores for IGA, POEM, EASI, SCORAD, NRS-itch, SCORAD-itch, average itch in the past 7 days, PROMIS Pediatric Pain severity, PROMIS Pediatric SD, PROMIS Pediatric SRI, SCORAD-sleep and more frequent SD from AD. Conclusions: Fatigue is a common yet underappreciated symptom in children with AD, particularly those with moderate–severe AD, and warrants more attention in clinical practice and trials.

Original languageEnglish (US)
Pages (from-to)763-771
Number of pages9
JournalJournal of the European Academy of Dermatology and Venereology
Issue number4
StatePublished - Apr 2023

ASJC Scopus subject areas

  • Infectious Diseases
  • Dermatology


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