Two registry studies point to connections between atopic dermatitis (AD) and learning problems and possible lower educational attainment in young people. Both studies were published in JAMA Dermatology. In the first study, Dr. Joy Wan of the University of Pennsylvania Perelman School of Medicine in Philadelphia and colleagues analyzed data on more than 2,000 teens with AD (median age, 16; 54% female at the 10-year follow-up). Among them, 8.2% were diagnosed with a learning disability. Children with a learning disability versus those without were more likely to have worse AD severity, as measured by the median Patient-Oriented Eczema Measure (POEM) score (5 vs. 2); POEM severity category (moderate AD: 29.8% vs. 17%; severe to very severe: 8.9% vs. 4.5%); and self-report (moderate: 29.2% vs. 20.7%; severe: 6.5% vs.3.4%). After adjustment for sex, age, race/ethnicity, annual household income, AD age of onset, family history of AD, and comorbid conditions, participants with mild AD (odds ratio, 1.72), moderate AD (OR, 2.09), and severe to very severe AD (OR, 3.10) on the POEM were all significantly more likely to have reported a learning disability than those with clear or almost clear skin. Dr. Wan told Reuters Health by email, "Our observation that children with increasingly worse AD have increasingly greater odds of learning disability suggests that AD may be causally related to learning problems. However, additional studies are critically needed to understand the timing and types of learning disability occurring in children with AD and importantly, to test potential interventions for reducing the risk of learning problems." "It is possible that symptoms of AD, such as chronic itch, and other effects of the skin disease, such as poor sleep and inattention, impact one's ability to learn," she noted. "It is also possible that shared inflammatory pathways link AD and learning." "For now," she said, "I would recommend that dermatologists and primary care physicians ask patients and their parents about how they are functioning in school and whether they have any concerns for learning difficulties. If so, then referral for formal learning evaluations would be warranted." In the second study, Dr. Sinead Langan of the London School of Hygiene and Tropical Medicine and colleagues analyzed data on close to 6,000 children with AD and more than 55,000 age- and sex- matched children from the general population. Children with AD were at increased risk of not attaining lower secondary education (2.5% vs. 1.7%); adjusted risk ratio, 1.50) and upper secondary education (19.8% vs. 16.4%; RR, 1.16), but not higher education (51.9% vs. 53.1%; RR, 0.95). The absolute differences in probability were less than 3.5%, and differences were less pronounced in a secondary analysis comparing patients with their siblings. The authors conclude, "The clinical importance was uncertain owing to small absolute differences and possible confounding by familial factors." Nonetheless, Dr. Langan told Reuters Health by email, "it is important for clinicians to be aware of these findings." "Previous studies have shown that having atopic eczema is not associated with impaired educational attainment," she noted. "However, there are many reasons why it might be — sleeplessness from itch, presenteeism due to itch when children are at school, or use of medications such as antihistamines that might make (them) feel very sleepy the next day." Commenting on both studies in an email to Reuters Health, Dr. Katrina Abuabara of the University of California, San Francisco, author of a related editorial, said, "It is important for clinicians to be aware of a growing body of literature linking AD to learning and education, but we don't yet have enough evidence to support clear clinical practice guidelines on this topic." "Both of these studies establish this as an important area for additional research with more detailed understanding of the causes for lower graduation rates and the types, timing, and mechanism for the link with learning disabilities." "From an individual perspective, this work is important for children with AD who may be struggling in school. From a public health perspective, this work is important because AD is so common, and it could be a good way to identify children who would benefit from additional educational resources." —Marilynn Larkin Source
