Childhood Eczema Rose in Past Two Decades, With Unexplained Racial Divides

The prevalence of eczema among U.S. children has increased over the last 20 years to varying degrees among racial and ethnic groups, a nationwide study found.

In 1997, eczema prevalence was at 7.9% and increased to 12.6% by 2018, reported Siri Choragudi, BS, and Gil Yosipovitch, MD, both of the University of Miami Miller School of Medicine.

During this period, Black and multiracial children both had larger average annual percent changes in the prevalence of this inflammatory skin condition (3.5% and 3.9%) when compared to their white counterparts (2.5%), according to the research letter published in JAMA Dermatology.

Overall, the prevalence across groups increased from:

• Black: 10.1% in 1997 to 18.4% in 2018
• Multiracial: 9.7% to 16.7%, respectively
• Asian: 11.1% to 11.5%
• White: 7.3% to 11.3%
• Alaskan Natives and American Indians: 3.4% to 6.5%

Black children had their increase in eczema prevalence limited to the period from 1997 to 2011, and multiracial children from 1997 to 2009. In contrast, Asian, Hispanic, and white children saw a comparable increase in eczema prevalence through the whole study period.

“These findings suggest changes in the diagnosing of eczema among racial and ethnic minority groups,” Choragudi and Yosipovitch wrote.

“In a 2019 study, African genetic ancestry was not associated with risk of atopic dermatitis compared with European ancestry, suggesting that contextual variables such as socioeconomic status, environment, and healthcare access and quality may be factors in eczema prevalence. However, more research among pediatric racial and ethnic minority populations is warranted,” they said.

The present study supports previous U.S. data that have shown increased incidence and persistence of atopic dermatitis in non-white children, commented Jacob Thyssen, MD, PhD, an eczema specialist at the University of Copenhagen in Denmark.

“We have no great insight in the explanation for these findings, but possible explanations include differences in genetic constitution and environmental exposures,” he told MedPage Today, citing potential differences in emollient use or environmental exposures such as products containing fragrances or nickel.

Emily Petherick, PhD, an epidemiologist at Loughborough University in England, said the findings warrant further study, including the role certain variables — familial history, socioeconomic circumstances, along with exposures to pollutants, racism, and stress — may have contributed to the differences observed in this study, variables that likely differ by racial background.

“One positive interpretation of the findings is that they may suggest that there is better identification of skin diseases in people of color over the study period, but of course [there are] likely to be multifactorial reasons behind the increases,” Petherick told MedPage Today.

Recent reports show that dermatology remains the second-least diverse field of medicine. Despite improvements in reporting on the race and ethnicity of participants in dermatology studies, inclusion of diverse populations still falls short.

The present study used data from the U.S. National Health Interview Survey from 1997 to 2018. A total of 260,888 children were included in the analysis (39.2% were 11-17 years old, 51.1% boys, 75.1% white).

Eczema increased across all age groups included in the study from 1997 to 2010, with children ages 11 to 17 years experiencing a consistent increase in eczema across the entirety of 1997 to 2018.

By sex, girls saw a steady increase in eczema throughout the 22-year study period, whereas boys only saw an increase in eczema prevalence from 1997 to 2010.

Chief among the study’s limitations was the reliance on eczema reported through caregivers attending to patients rather than medical diagnosis. Sample sizes were also low in some demographic groups, including Alaskan Natives and American Indians.