Epidemiology of atopic dermatitis
Scroll down this page to learn more about the prevalence and incidence of atopic dermatitis as well as factors that contribute to its development.
Prevalence and incidence of atopic dermatitis
Atopic dermatitis, or atopic eczema, is the most common chronic skin condition and is characterised by acute episodes of eczematous, pruritic lesions over dry skin.
Pathophysiology of atopic dermatitis
A complex range of factors influence the development and onset of atopic dermatitis, but what is the underlying mechanism that drives skin barrier dysfunction and inflammation? Discover how breakdown of the skin barrier can lead to allergen penetration and immune system activation.
In the past, atopic dermatitis was thought to be primarily a consequence of immune dysfunction in susceptible children. However, recent advances point towards a complex pathophysiology with genetic, barrier function, immunity and environmental factors acting together and synergistically to drive barrier dysfunction, inflammation and disease progression (McPherson, 2016).
Burden of atopic dermatitis
As a chronic, relapsing skin condition, atopic dermatitis has a significant impact on patients’ quality of life.
Atopic dermatitis - Disease awareness references
Absolon CM, Cottrell D, Eldridge SM, Glover MT. Psychological disturbance in atopic eczema: the extent of the problem in school-aged children. Br J Dermatol. 1997;137(2):241 –5.
Ali SM, Yosipovitch G. Skin pH: from basic science to basic skin care. Acta Derm Venereol. 2013;93(3):261–7.
Avena-Woods C. Overview of atopic dermatitis. Am J Manag Care. 2017 Jun;23(8 Suppl):S115–S123.
Barbarot S, Auziere S, Gadkari A, Girolomoni G, Puig L, Simpson EL, et al. Epidemiology of atopic dermatitis in adults: Results from an international survey. Allergy. 2018; [epub ahead of print].
Barton M, Sidbury R. Advances in understanding and managing atopic dermatitis. F1000 Res. 2015;4:1–7.
Barnetson RS, Rogers M. Childhood atopic eczema. BMJ. 2002;324(7350):1376–9.
Beattie PE, Lewis-Jones MS. A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. Br J Dermatol. 2006;155(1):145–51.
Bickers DR, Lim HW, Margolis D, Weinstock MA, Goodman C, Faulkner E, et al. The burden of skin diseases: 2004 a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol. 2006;55(3):490–500.
Bieber T. Atopic dermatitis. N Engl J Med. 2008;358:1483–94.
Blume-Peytavi U & Metz M. Atopic dermatitis in children: management of pruritus. J Eur Acad Dermatol Venereol. 2012;26:2–8
Boguniewicz M, Leung DY. Atopic dermatitis: a disease of altered skin barrier and immune dysregulation. Immunol Rev. 2011;242(1):233–46.
Brenninkmeijer EE, Legierse CM, Sillevis Smitt JH, Last BF, Grootenhuis MA, Bos JD. The course of life of patients with childhood atopic dermatitis. Pediatr Dermatol. 2009;26(1):14–22.
Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev. 2010;14(6):359–69.
Cardona ID, Cho SH, Leung DY. Role of bacterial superantigens in atopic dermatitis: implications for future therapeutic strategies. Am J Clin Dermatol. 2006;7(5):273–9.
Chamlin SL, Frieden IJ, Williams ML, Chren MM. Effects of atopic dermatitis on young American children and their families. Pediatrics. 2004;114(3):607–11.
Chamlin SL, Mattson CL, Frieden IJ, Williams ML, Mancini AJ, Cella D, et al. The price of pruritus: sleep disturbance and cosleeping in atopic dermatitis. Arch Pediatr Adolesc Med. 2005;159(8):745–50.
Chernyshov PV. Stigmatization and self-perception in children with atopic dermatitis. Clin Cosmet Investig Dermatol. 2016;9:159–66.
Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015;135(4):984–991.
Danso M, Boiten W, van Drongelen V, Gmelig Meijling K, Gooris G, El Ghalbzouri A, et al. Altered expression of epidermal lipid bio-synthesis enzymes in atopic dermatitis skin is accompanied by changes in stratum corneum lipid composition. J Dermatol Sci. 2017;88(1):57–66.
Daud LR, Garralda ME, David TJ. Psychosocial adjustment in preschool children with atopic eczema. Arch Dis Child. 1993;69(6):670–6.
Dawn A, Papoiu AD, Chan YH, Rapp SR, Rassette N, Yosipovitch G. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol. 2009;160(3):642–4.
De Benedetto A, Rafaels NM, McGirt LY, Ivanov AI, Georas SN, Cheadle C, et al. Tight junction defects in patients with atopic dermatitis. J Allergy Clin Immunol. 2011;127(3):773–86.
Denecker G, Hoste E, Gilbert B, Hochepied T, Ovaere P, Lippens S, et al. Caspase-14 protects against epidermal UVB photodamage and water loss. Nat Cell Biol. 2007;9(6):666–74.
Dieris-Hirche J, Gieler U, Petrak F, Milch W, Te Wildt B, Dieris B, et al. Suicidal ideation in adult patients with atopic dermatitis: a German cross-sectional study. Acta Derm Venereol. 2017;97(10):1189–95.
Drucker AM. Atopic dermatitis: burden of illness, quality of life, and associated complications. Allergy Asthma Proc. 2017;38:3–8.
Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol. 2017a;137(1):26–30.
Drucker AM, Qureshi AA, Amand C, Villeneuve S, Gadkari A, Chao J, et al. Health care resource utilization and costs among adults with atopic dermatitis in the United States: A Claims-Based Analysis. J Allergy Clin Immunol Pract. 2017b;[epub ahead of print].
Eckert L, Gupta S, Amand C, Gadkari A, Mahajan P, Gelfand JM. Impact of atopic dermatitis on health-related quality of life and productivity in adults in the United States: An analysis using the National Health and Wellness Survey. J Am Acad Dermatol. 2017;77(2):274–9.
Eckert L, Gupta S, Amand C, Gadkari A, Mahajan P, Gelfand JM. The burden of atopic dermatitis in US adults: Health care resource utilization data from the 2013 National Health and Wellness Survey. J Am Acad Dermatol. 2018;78(1):54–61.
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338–51.
Elias PM, Hatano Y, Williams ML. Basis for the barrier abnormality in atopic dermatitis: outside-inside-outside pathogenic mechanisms. J Allergy Clin Immunol. 2008;121(6):1337–43.
Ellinghaus D, Baurecht H, Esparza-Gordillo J, Rodríguez E, Matanovic A, Marenholz I, et al. High-density genotyping study identifies four new susceptibility loci for atopic dermatitis. Nat Genet. 2013;45(7):808–12.
Emerson RM, Williams HC, Allen BR. Severity distribution of atopic dermatitis in the community and its relationship to secondary referral. Br J Dermatol. 1998;139(1):73–6.
Glatz M, Jo JH, Kennedy EA, Polley EC, Segre JA, Simpson EL, et al. Emollient use alters skin barrier and microbes in infants at risk for developing atopic dermatitis. PLoS One. 2018;13(2):e0192443.
Gregory AM, Van der Ende J, Willis TA, Verhulst FC. Parent-reported sleep problems during development and self-reported anxiety/depression, attention problems, and aggressive behavior later in life. Arch Pediatr Adolesc Med. 2008;162(4):330–5.
Gruber R, Börnchen C, Rose K, Daubmann A, Volksdorf T, Wladykowski E, et al. Diverse regulation of claudin-1 and claudin-4 in atopic dermatitis. Am J Pathol. 2015;185(10):2777–89.
Gustafsson D, Sjöberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis--a prospective follow-up to 7 years of age. Allergy. 2000;55(3):240–5.
Halvorsen JA, Lien L, Dalgard F, Bjertness E, Stern RS. Suicidal ideation, mental health problems, and social function in adolescents with eczema: a population-based study. J Invest Dermatol. 2014;134(7):1847–54.
Hanifin JM and Reed ML. A population-based survey of eczema prevalence in the United States. Dermatitis. 2007;18(2):82–91.
Harrop J, Chinn S, Verlato G, Olivieri M, Norbäck D, Wjst M et al. Eczema, atopy and allergen exposure in adults: a population-based study. Clin Exp Allergy. 2007;37(4):526–35.
Hart CN, Palermo TM, Rosen CL. Health-related quality of life among children presenting to a pediatric sleep disorders clinic. Behav Sleep Med. 2005;3(1):4–17.
Hiscock H, Bayer J, Gold L, Hampton A, Ukoumunne OC, Wake M. Improving infant sleep and maternal mental health: a cluster randomised trial. Arch Dis Child. 2007;92(11):952–8.
Holm EA, Esmann S, Jemec GB. The handicap caused by atopic dermatitis--sick leave and job avoidance. J Eur Acad Dermatol Venereol. 2006;20(3):255–9.
Holm EA, Jemec GB. Time spent on treatment of atopic dermatitis: a new method of measuring pediatric morbidity? Pediatr Dermatol. 2004;21(6):623–7.
Ito S, Ishikawa J, Naoe A, Yoshida H, Hachiya A, Fujimura T, et al. Ceramide synthase 4 is highly expressed in involved skin of patients with atopic dermatitis. J Eur Acad Dermatol Venereol. 2017;31(1):135–41.
Jang H, Matsuda A, Jung K, Karasawa K, Matsuda K, Oida K, et al. Skin pH Is the Master Switch of Kallikrein 5-Mediated Skin Barrier Destruction in a Murine Atopic Dermatitis Model. J Invest Dermatol. 2016;136(1):127–35.
Jemec GB, Esmann S, Holm EA, Tycho A, Jørgensen TM. Time spent on treatment (TSOT). An independent assessment of disease severity in atopic dermatitis. Acta Dermatovenerol Alp Pannonica Adriat. 2006;15(3):119–24.
Johansson EK, Ballardini N, Kull I, Bergström A, Wahlgren CF. Association between preschool eczema and medication for attention‐deficit/hyperactivity disorder in school age. Pediatr Allergy Immunol. 2017;28:44–50.
Karimkhani C, Dellavalle RP, Coffeng LE, Flohr C, Hay RJ, Langan SM, et al. Global skin disease morbidity and mortality: an update from the Global Burden of Disease Study 2013. JAMA Dermatol. 2017;153(5):406–12.
Kaufman BP, Guttman-Yassky E, Alexis AF. Atopic dermatitis in diverse racial and ethnic groups - variations in epidemiology, Genetics, Clinical Presentation, and Treatment. Exp Dermatol. 2018; [epub ahead of print].
Kim BE, Leung DYM. Significance of skin barrier dysfunction in atopic dermatitis. Allergy Asthma Immunol Res. 2018;10:207–15.
Kim D, Lee NR, Park SY, Jun M, Lee K, Kim S, et al. As in atopic dermatitis, nonlesional skin in allergic contact dermatitis displays abnormalities in barrier function and ceramide content. J Invest Dermatol. 2017;137(3):748–50.
Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis (AD): A systematic review and meta-analysis. J Am Acad Dermatol. 2016;75(4):681–7.
Kuo IH, Carpenter-Mendini A, Yoshida T, McGirt LY, Ivanov AI, Barnes KC, et al. Activation of epidermal toll-like receptor 2 enhances tight junction function: implications for atopic dermatitis and skin barrier repair. J Invest Dermatol. 2013;133(4):988–98.
Lawson V, Lewis-Jones MS, Finlay AY, Reid P, Owens RG. The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire. Br J Dermatol. 1998;138(1):107–13.
Lee SI, Kim J, Han Y, Ahn K. A proposal: Atopic Dermatitis Organizer (ADO) guideline for children. Asia Pac Allergy. 2011;1(2):53–63.
Leung DY. New insights into atopic dermatitis: role of skin barrier and immune dysregulation. Allergol Int. 2013;62:151–61.
Lewis-Jones S. Quality of life and childhood atopic dermatitis: the misery of living with childhood eczema. In J Clin Pract. 2006;60:984–92.
Li S, Villarreal M, Stewart S, Choi J, Ganguli-Indra G, Babineau DC, Philpot C, et al. Altered composition of epidermal lipids correlates with Staphylococcus aureus colonization status in atopic dermatitis. Br J Dermatol. 2017;177(4):e125-e127.
Margolis JS, Abuabara K, Bilker W, Hoffstad O, Margolis DJ. Persistence of mild to moderate atopic dermatitis. JAMA Dermatol. 2014;150(6):593–600.
Margolis DJ, Mitra N. Heterogeneity of data included in meta-analysis on persistence of atopic dermatitis changes interpretation. J Am Acad Dermatol. 2017;76(5):e181.
Martin PE, Matheson MC, Gurrin L, Burgess JA, Osborne N, Lowe AJ et al. Childhood eczema and rhinitis predict atopic but not nonatopic adult asthma: a prospective cohort study over 4 decades. J Allergy Clin Immunol. 2011;127(6):1473–9.
McPherson T. Current understanding in pathogenesis of atopic dermatitis. Indian J Dermatol. 2016;61(6):649–55.
Merriman JA, Mueller EA, Cahill MP, Beck LA, Paller AS, Hanifin JM, et al. Temporal and racial differences associated with atopic dermatitis Staphylococcus aureus and encoded virulence factors. mSphere. 2016;1(6).
Moore K, David TJ, Murray CS, Child F, Arkwright PD. Effect of childhood eczema and asthma on parental sleep and well-being: a prospective comparative study. Br J Dermatol. 2006;154(3):514–8.
Nakamura Y, Oscherwitz J, Cease KB, Chan SM, Muñoz-Planillo R, Hasegawa M, et al. Staphylococcus δ-toxin induces allergic skin disease by activating mast cells. Nature. 2013;503(7476):397–401.
Napolitano M, Megna M, Patruno C, Gisondi P, Ayala F, Balato N. Adult atopic dermatitis: a review. G Ital Dermatol Venereol. 2016;151(4):403–11.
National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. Clinical Guideline [CG57]. 2007. Available at https://www.nice.org.uk/guidance/cg57. Accessed July 2018.
Nicotera P, Melino G. Caspase-14 and epidermis maturation. Nat Cell Biol. 2007;9(6):621–2.
Niebuhr M, Langnickel J, Draing C, Renz H, Kapp A, Werfel T. Dysregulation of toll-like receptor-2 (TLR-2)-induced effects in monocytes from patients with atopic dermatitis: impact of the TLR-2 R753Q polymorphism. Allergy. 2008;63(6):728–34.
Niebuhr M, Lutat C, Sigel S, Werfel T. Impaired TLR-2 expression and TLR-2-mediated cytokine secretion in macrophages from patients with atopic dermatitis. Allergy. 2009;64(11):1580–7.
Novak N. An update on the role of human dendritic cells in patients with atopic dermatitis. J Allergy Clin Immunol. 2012;129(4):879–86.
Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8–16.
Nyrén M, Lindberg M, Stenberg B, Svensson M, Svensson A, Meding B. Influence of childhood atopic dermatitis on future worklife. Scand J Work Environ Health. 2005;31(6):474–8.
O'Regan GM, Sandilands A, McLean WH, Irvine AD. Filaggrin in atopic dermatitis. J Allergy Clin Immunol. 2008;122(4):689–93.
Odhiambo JA, Williams HC, Clayton TO, Robertson CF, Asher MI; ISAAC Phase Three Study Group. Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. J Allergy Clin Immunol. 2009;124(6):1251–8.
Ong PY, Ohtake T, Brandt C, Strickland I, Boguniewicz M, Ganz T, et al. Endogenous antimicrobial peptides and skin infections in atopic dermatitis. N Engl J Med. 2002;347(15):1151–60.
Otsuka A, Kabashima K. Mast cells and basophils in cutaneous immune responses. Allergy. 2015;70(2):131–40.
Oyoshi MK, Larson RP, Ziegler SF, Geha RS. Mechanical injury polarizes skin dendritic cells to elicit a T(H)2 response by inducing cutaneous thymic stromal lymphopoietin expression. J Allergy Clin Immunol. 2010;126(5):976–84.
Paller AS, McAlister RO, Doyle JJ, Jackson A. Perceptions of physicians and pediatric patients about atopic dermatitis, its impact, and its treatment. Clin Pediatr (Phila). 2002;41(5):323–32.
Peng W, Novak N. Pathogenesis of atopic dermatitis. Clin Exp Allergy. 2015 Mar;45(3):566–74.
Rebane A, Zimmermann M, Aab A, Baurecht H, Koreck A, Karelson M, et al. Mechanisms of IFN-γ-induced apoptosis of human skin keratinocytes in patients with atopic dermatitis. J Allergy Clin Immunol. 2012;129(5):1297–306.
Reid P, Lewis-Jones MS. Sleep difficulties and their management in preschoolers with atopic eczema. Clin Exp Dermatol. 1995;20(1):38–41.
Romanos M, Gerlach M, Warnke A, Schmitt J. Association of attention-deficit/hyperactivity disorder and atopic eczema modified by sleep disturbance in a large population-based sample. J Epidemiol Community Health. 2010;64(3):269–73.
Schmitt J, Csötönyi F, Bauer A, Meurer M. Determinants of treatment goals and satisfaction of patients with atopic eczema. J Dtsch Dermatol Ges. 2008;6(6):458–65.
Schmitt J, Chen CM, Apfelbacher C, Romanos M, Lehmann I, Herbarth O, et al. Infant eczema, infant sleeping problems, and mental health at 10 years of age: the prospective birth cohort study LISAplus. Allergy. 2011;66(3):404–11.
Schmitt J, Schwarz K, Baurecht H, Hotze M, Fölster-Holst R, Rodríguez E, et al. Atopic dermatitis is associated with an increased risk for rheumatoid arthritis and inflammatory bowel disease, and a decreased risk for type 1 diabetes. J Allergy Clin Immunol. 2016;137(1):130–6.
Schneider L, Hanifin J, Boguniewicz M, Eichenfield LF, Spergel JM, Dakovic R, et al. Study of the atopic march: development of atopic comorbidities. Pediatr Dermatol. 2016 Jul;33(4):388–98.
Scott IR, Harding CR. Filaggrin breakdown to water binding compounds during development of the rat stratum corneum is controlled by the water activity of the environment. Dev Biol. 1996;115:84–92.
Shaw TE, Currie GP, Koudelka CW, Simpson EL. Eczema prevalence in the United States: data from the 2003 National Survey of Children's Health. J Invest Dermatol. 2011;131(1):67–73.
Silverberg J. Public health burden and epidemiology of atopic dermatitis. Dermatol Clin. 2017;35:283–9.
Silverberg JI. Health care utilization, patient costs, and access to care in us adults with eczema: a population-based study. JAMA Dermatol. 2015;151(7):743–52.
Silverberg JI and Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol. 2013;132(5):1132–8.
Silverberg JI and Simpson EL. Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatr Allergy Immunol. 2013;24(5):476–86.
Silverberg JI and Simpson EL. Associations of childhood eczema severity: a US population-based study. Dermatitis. 2014;25(3):107–14.
Silverberg JI and Simpson EL. Reply to: "Heterogeneity of data included in meta-analysis on persistence of atopic dermatitis alters interpretation". J Am Acad Dermatol. 2017;76(5):e183–e184.
Simpson EL, Chalmers JR, Hanifin JM, Thomas KS, Cork MJ, McLean WH, et al. Emollient enhancement of the skin barrier from birth offers effective atopic dermatitis prevention. J Allergy Clin Immunol. 2014;134(4):818–23.
Strom MA, Fishbein AB, Paller AS, Silverberg JI. Association between atopic dermatitis and attention deficit hyperactivity disorder in U.S. children and adults. Br J Dermatol. 2016;175(5):920–9.
Su JC, Kemp AS, Varigos GA, Nolan TM. Atopic eczema: its impact on the family and financial cost. Arch Dis Child. 1997;76(2):159–62.
Vakharia PP, Chopra R, Sacotte R, Patel KR, Singam V, Patel N, et al. Burden of skin pain in atopic dermatitis. Ann Allergy Asthma Immunol. 2017;119(6):548–52.
van der Hulst AE, Klip H, Brand PL. Risk of developing asthma in young children with atopic eczema: a systematic review. J Allergy Clin Immunol. 2007;120(3):565–9.
Ward S. The effective management of atopic dermatitis in school-age children. Nurs Times. 2004;100(32):55–6.
Williams HC et al. London-born black Caribbean children are at increased risk of atopic dermatitis. J Am Acad Dermatol. 1995;32(2 Pt 1):212–7.
Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR; International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008;121(4):947–54.
Wittkowski A, Richards HL, Griffiths CE, Main CJ. Illness perception in individuals with atopic dermatitis. Psychol Health Med. 2007;12(4):433–44.
Yaghmaie P, Koudelka CW, Simpson EL. Mental health comorbidity in patients with atopic dermatitis. J Allergy Clin Immunol. 2013;131(2):428–33.
Yokomaku A, Misao K, Omoto F, Yamagishi R, Tanaka K, Takada K, et al. A study of the association between sleep habits and problematic behaviors in preschool children. Chronobiol Int. 2008;25(4):549–64.
Yoo J, Omori M, Gyarmati D, Zhou B, Aye T, Brewer A, et al. Spontaneous atopic dermatitis in mice expressing an inducible thymic stromal lymphopoietin transgene specifically in the skin. J Exp Med. 2005;202(4):541–9.
Zimmermann M, Koreck A, Meyer N, Basinski T, Meiler F, Simone B, et al. TNF-like weak inducer of apoptosis (TWEAK) and TNF-α cooperate in the induction of keratinocyte apoptosis. J Allergy Clin Immunol. 2011;127(1):200–7.
Zuberbier T, Orlow SJ, Paller AS, Taïeb A, Allen R, Hernanz-Hermosa JM et al. Patient perspectives on the management of atopic dermatitis. J Allergy Clin Immunol. 2006;118:226–32.