, Volume 21, Issue 2, pp 105–113 | Cite as

Cost of Illness of Atopic Dermatitis in Children

A Societal Perspective
  • Andrew S. Kemp
Review Article


Childhood atopic dermatitis is a disorder with considerable social and financial costs. Consideration of these costs is increasingly important in view of the growing prevalence of atopic dermatitis, particularly in developed countries over recent decades. The family stress related to the care of children with moderate or severe atopic dermatitis is significantly greater than that of the care of children with type 1 diabetes mellitus. The factors contributing to family stress include sleep deprivation, loss of employment, time taken for care of atopic dermatitis and financial costs. The financial costs for the family and community include medical and hospital direct costs of treatments and indirect costs from loss of employment. There are many interventions utilised in the treatment of childhood atopic dermatitis which involve not only medical practitioners but nurses, pharmacists, dieticians, psychologists and purveyors of so-called alternative therapies such as naturopathy, aromatherapy and bioresonance, all of which contribute to the financial burdens on the parents and the community. It is possible that appropriate interventions directed to reducing trigger factors might produce worthwhile savings, although the cost benefit of these measures has not been demonstrated. In conclusion, atopic dermatitis should not be regarded as a minor skin disorder but as a condition which has the potential to be a major handicap with considerable personal, social and financial consequences both to the family and the community.


Atopic Dermatitis Pimecrolimus Gross National Product Severe Atopic Dermatitis Betamethasone Valerate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The author has acted as a consultant to CSL, manufacturers of intravenous immunoglobulin, and Novartis Pharmaceuticals, manufacturers of pimecrolimus.


  1. 1.
    Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet 1998; 351: 1225–32Google Scholar
  2. 2.
    Castles I. 1989–90 National health survey summary of results. Canberra: Australian Bureau of Statistics, 1991Google Scholar
  3. 3.
    Asher MI, Barry D, Clayton T, et al. The burden of symptoms of asthma, allergic rhinoconjunctivitis and atopic eczema in children and adolescents in six New Zealand centres: ISAAC Phase One. N Z Med J 2001; 114: 114–20PubMedGoogle Scholar
  4. 4.
    Schultz Larsen F, Diepgen T, Svensson A. The occurrence of atopic dermatitis in north Europe: an international questionnaire study. J Am Acad Dermatol 1996; 34: 760–4PubMedCrossRefGoogle Scholar
  5. 5.
    Tay YK, Kong KH, Khoo L, et al. The prevalence and descriptive epidemiology of atopic dermatitis in Singapore school children. Br J Dermatol 2002; 146: 101–6PubMedCrossRefGoogle Scholar
  6. 6.
    Schultz Larsen F. Atopic dermatitis: a genetic-epidemiologic study in a population-based twin sample. J Am Acad Dermatol 1993; 28: 719–23PubMedCrossRefGoogle Scholar
  7. 7.
    Butland BK, Strachan DP, Lewis S, et al. Investigation into the increase in hay fever and eczema at age 16 observed between the 1958 and 1970 British birth cohorts. BMJ 1997; 315: 717–21PubMedCrossRefGoogle Scholar
  8. 8.
    Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999; 103: 125–38PubMedCrossRefGoogle Scholar
  9. 9.
    Su JC, Kemp AS, Varigos GA, et al. Atopic eczema: its impact on the family and financial cost. Arch Dis Child 1997; 76: 159–62PubMedCrossRefGoogle Scholar
  10. 10.
    Rajka G, Langeland T. Grading of the severity of atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1989; 144: 13–4Google Scholar
  11. 11.
    Daud LR, Garralda ME, David TJ. Psychosocial adjustment in preschool children with atopic eczema. Arch Dis Child 1993; 69: 670–6PubMedCrossRefGoogle Scholar
  12. 12.
    Lawson V, Lewis-Jones MS, Finlay AY, et al. The family impact of childhood atopic dermatitis: the Dermatitis Family Impact Questionnaire. Br J Dermatol 1998; 138: 107–13PubMedCrossRefGoogle Scholar
  13. 13.
    Reid P, Lewis-Jones MS. Sleep difficulties and their management in preschoolers with atopic eczema. Clin Exp Dermatol 1995; 20: 38–41PubMedCrossRefGoogle Scholar
  14. 14.
    Dahl RE, Bernhisel-Broadbent J, Scanlon-Holdford S, et al. Sleep disturbances in children with atopic dermatitis. Arch Pediatr Adolesc Med 1995; 149: 856–60PubMedCrossRefGoogle Scholar
  15. 15.
    Lewis-Jones MS, Finlay AY, Dykes PJ. The infants’ dermatitis quality of life index. Br J Dermatol 2001; 144: 104–10PubMedCrossRefGoogle Scholar
  16. 16.
    Lapidus CS, Kerr PE. Social impact of atopic dermatitis. Med Health R I 2001; 84: 294–5PubMedGoogle Scholar
  17. 17.
    Fennessy M, Coupland S, Popay J, et al. The epidemiology and experience of atopic eczema during childhood: a discussion paper on the implications of current knowledge for health care, public health policy and research. J Epidemiol Community Health 2000; 54: 581–9PubMedCrossRefGoogle Scholar
  18. 18.
    Stewart AW, Mitchell EA, Pearce N, et al. The relationship of per capita gross national product to the prevalence of symptoms of asthma and other atopic diseases in children (ISAAC). Int J Epidemiol 2001; 30: 173–9PubMedCrossRefGoogle Scholar
  19. 19.
    Lamb SR, Rademaker M. Pharmacoeconomics of drug therapy for atopic dermatitis. Exp Opin Pharmacother 2002; 3: 249–55CrossRefGoogle Scholar
  20. 20.
    Kernick D, Cox A, Powell R, et al. A cost consequence study of the impact of a dermatology-trained practice nurse on the quality of life of primary care patients with eczema and psoriasis. Br J Gen Pract 2000; 50: 555–8PubMedGoogle Scholar
  21. 21.
    Kemp AS. Atopic eczema: its social and financial costs. J Paediatr Child Health 1999; 35: 229–31PubMedCrossRefGoogle Scholar
  22. 22.
    Resnick SD, Hornung R, Konrad TR. A comparison of dermatologists and generalists: management of childhood atopic dermatitis. Arch Dermatol 1996; 132: 1047–52PubMedCrossRefGoogle Scholar
  23. 23.
    Lapidus CS, Schwarz DF, Honig PJ. Atopic dermatitis in children: who cares? who pays? J Am Acad Dermatol 1993; 28: 699–703PubMedCrossRefGoogle Scholar
  24. 24.
    Ellis CN, Drake LA, Prendergast MM, et al. Cost of atopic dermatitis and eczema in the United States. J Am Acad Dermatol 2002; 46: 361–70PubMedCrossRefGoogle Scholar
  25. 25.
    Herd RM, Tidman MJ, Prescott RJ, et al. The cost of atopic eczema. Br J Dermatol 1996; 135: 20–3PubMedCrossRefGoogle Scholar
  26. 26.
    Hoare C, Li Wan Po A, Williams H. Systematic review of treatments for atopic eczema. Health Technol Assess 2000; 4: 1–191PubMedGoogle Scholar
  27. 27.
    Khan SN, Slavin RG. Pediatricians’ attitudes towards allergy: past and present attitudes of pediatricians towards allergy. Ann Allergy Asthma Immunol 2000; 85: 189–93PubMedCrossRefGoogle Scholar
  28. 28.
    Williams HC. Epidemiology of atopic dermatitis. Clin Exp Dermatol 2000; 25: 522–9PubMedCrossRefGoogle Scholar
  29. 29.
    Marks R. The public health approach to the burden of common skin diseases in the community. J Dermatol 2001; 28: 602–5PubMedGoogle Scholar
  30. 30.
    Hammarstrom B, Wessling A, Nilsson JL. Pharmaceutical care for patients with skin diseases: a campaign year at Swedish pharmacies. J Clin Pharm Ther 1995; 20: 327–34PubMedCrossRefGoogle Scholar
  31. 31.
    Shum KW, Lawton S, Williams HC, et al. The British Association of Dermatologists audit of atopic eczema management in secondary care. Phase 1: audit of service structure. Br J Dermatol 1999; 141: 430–7PubMedCrossRefGoogle Scholar
  32. 32.
    Chinn DJ, Poyner T, Sibley G. Randomized controlled trial of a single dermatology nurse consultation in primary care on the quality of life of children with atopic eczema. Br J Dermatol 2002; 146: 432–9PubMedCrossRefGoogle Scholar
  33. 33.
    Thomas KS, Armstrong S, Avery A, et al. Randomised controlled trial of short bursts of a potent topical corticosteroid versus prolonged use of a mild preparation for children with mild or moderate atopic eczema [abstract]. BMJ 2002; 324: 768–71PubMedCrossRefGoogle Scholar
  34. 34.
    Cheer SM, Plosker GL. Tacrolimus ointment: a review of its therapeutic potential as a topical therapy in atopic dermatitis. Am J Clin Dermatol 2001; 2: 389–406PubMedCrossRefGoogle Scholar
  35. 35.
    Wellington K, Jarvis B. Topical pimecrolimus: a review of its clinical potential in the management of atopic dermatitis. Drugs 2002; 62: 817–40PubMedCrossRefGoogle Scholar
  36. 36.
    Reitamo S, Van Leent EJ, Ho V, et al. Efficacy and safety of tacrolimus ointment compared with that of hydrocortisone acetate ointment in children with atopic dermatitis. J Allergy Clin Immunol 2002; 109: 539–46PubMedCrossRefGoogle Scholar
  37. 37.
    Nghiem P, Pearson G, Langley RG. Tacrolimus and pimecrolimus: from clever prokaryotes to inhibiting calcineurin and treating atopic dermatitis. J Am Acad Dermatol 2002; 46: 228–41PubMedCrossRefGoogle Scholar
  38. 38.
    Wahn U, Bos JD, Goodfield M, et al. Efficacy and safety of pimecrolimus cream in the long-term management of atopic dermatitis in children [online]. Pediatrics 2002; 110: e2PubMedCrossRefGoogle Scholar
  39. 39.
    Salek MS, Finlay AY, Luscombe DK, et al. Cyclosporin greatly improves the quality of life of adults with severe atopic dermatitis: a randomized, double-blind, placebo-controlled trial. Br J Dermatol 1993; 129: 422–30PubMedCrossRefGoogle Scholar
  40. 40.
    Jang IG, Yang JK, Lee HJ, et al. Clinical improvement and immunohistochemical findings in severe atopic dermatitis treated with interferon gamma. J Am Acad Dermatol 2000; 42: 1033–40PubMedCrossRefGoogle Scholar
  41. 41.
    Jolles S, Hughes J, Rustin M. The treatment of atopic dermatitis with adjunctive high-dose intravenous immunoglobulin: a report of three patients and review of the literature. Br J Dermatol 2000; 142: 551–4PubMedCrossRefGoogle Scholar
  42. 42.
    Fischer G. Compliance problems in paediatric atopic eczema. Australas J Dermatol 1996; 37: S10–3PubMedCrossRefGoogle Scholar
  43. 43.
    Jensen P. Use of alternative medicine by patients with atopic dermatitis and psoriasis. Acta Derm Venereol 1990; 70: 421–4PubMedGoogle Scholar
  44. 44.
    Ashcroft DM, Po AL. Herbal remedies: issues in licensing and economic evaluation. Pharmacoeconomics 1999; 16 (4): 321–8PubMedCrossRefGoogle Scholar
  45. 45.
    Fung AY, Look PC, Chong LY, et al. A controlled trial of traditional Chinese herbal medicine in Chinese patients with recalcitrant atopic dermatitis. Int J Dermatol 1999; 38: 387–92PubMedCrossRefGoogle Scholar
  46. 46.
    Worm M, Henz BM. Novel unconventional therapeutic approaches to atopic eczema. Dermatology 2000; 201: 191–5PubMedCrossRefGoogle Scholar
  47. 47.
    Ohya Y, Williams H, Steptoe A, et al. Psychosocial factors and adherence to treatment advice in childhood atopic dermatitis. J Invest Dermatol 2001; 117: 852–7PubMedCrossRefGoogle Scholar
  48. 48.
    Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol 2000; 142: 931–6PubMedCrossRefGoogle Scholar
  49. 49.
    Poysa L, Remes K, Korppi M, et al. Compliance with a dietary manipulation programme in families with infants prone to atopy. Acta Paediatr Scand 1988; 77: 563–8PubMedCrossRefGoogle Scholar
  50. 50.
    Chandra RK. Five-year follow-up of high-risk infants with family history of allergy who were exclusively breast-fed or fed partial whey hydrolysate, soy, and conventional cow’s milk formulas. J Pediatr Gastroenterol Nutr 1997; 24: 380–8PubMedCrossRefGoogle Scholar
  51. 51.
    Halken S, Hansen KS, Jacobsen HP, et al. Comparison of a partially hydrolyzed infant formula with two extensively hydrolyzed formulas for allergy prevention: a prospective, randomized study. Pediatr Allergy Immunol 2000; 11: 149–61PubMedCrossRefGoogle Scholar
  52. 52.
    Pike MG, Carter CM, Boulton P, et al. Few food diets in the treatment of atopic eczema. Arch Dis Child 1989; 64: 1691–8PubMedCrossRefGoogle Scholar
  53. 53.
    Tan BB, Weald D, Strickland I, et al. Double-blind controlled trial of effect of housedust-mite allergen avoidance on atopic dermatitis. Lancet 1996; 347: 15–8PubMedCrossRefGoogle Scholar
  54. 54.
    Schiffner R, Schiffner-Rohe J, Gerstenhauer M, et al. Differences in efficacy between intention-to-treat and per-protocol analyses for patients with psoriasis vulgaris and atopic dermatitis: clinical and pharmacoeconomic implications. Br J Dermatol 2001; 144: 1154–60PubMedCrossRefGoogle Scholar

Copyright information

© Adis International Limited 2003

Authors and Affiliations

  1. 1.Departments of Immunology and General PaediatricsRoyal Children’s HospitalParkville, MelbourneAustralia

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