Pediatric Atopic Dermatitis Disparities in the U.S.: A Deep Dive
Published: 2025-04-09
Unequal Burden: Pediatric Eczema Affects Minority and Low-Income Children Disproportionately
New research reveals important disparities in pediatric atopic dermatitis (AD), commonly known as eczema, across the United States. A extensive review published in April 2025 highlights that children from racial minority groups, lower-income families, and those residing in the South or rural areas face a greater risk of developing AD and experiencing more severe symptoms. This inequality extends too access to care,leading to increased hospitalizations and a poorer quality of life for these vulnerable populations.
Pediatric AD, a chronic inflammatory skin condition, affects up to 20% of children in the U.S., causing itchy, inflamed skin that can substantially impact a child’s well-being and progress.The study underscores that the burden of this condition is not evenly distributed.
Methodology: Scoping review Uncovers Systemic Issues
The systematic review, considered a “scoping review,” meticulously analyzed existing research published between January 2021 and May 2024. Databases like pubmed, Embase, wiley, and the Cochrane Database of Systematic Reviews were searched, yielding over 2,000 initial results. The final analysis included 53 studies that met stringent criteria. These studies were categorized to investigate disparities based on:
- Race and ethnicity
- Socioeconomic factors
- Regional and environmental factors
- Sex and gender
The review examined critical aspects of AD, including disease prevalence, co-occurring health conditions (comorbidities), access to medical care, and overall medical outcomes.
racial and Ethnic Disparities: A Stark Reality
The findings paint a concerning picture of racial and ethnic disparities in pediatric AD. The review found that:
American Indian/Alaskan Native, Hispanic, and Asian children had higher odds of AD, compared to White children. Children of color had between 2% and 10% absolute higher AD prevalence. There was also an 8% to 24% absolute increase in hospitalizations and ambulatory or urgent care visits.
Black children, in particular, face significant challenges:
Black children had higher odds of poor disease control and earlier, more persistent AD when compared to White children. Black and Hispanic children were less likely to receive treatments,be seen by a health care provider,and be represented in clinical trials and dermatology textbooks.
These disparities are not merely statistics; they represent real-world struggles for families. for example, a Black mother in Atlanta might struggle to find a dermatologist experienced in treating AD on darker skin tones, leading to delayed diagnosis and treatment. Similarly, a Hispanic family in Los Angeles might face language barriers and cultural differences that hinder their ability to navigate the healthcare system and access appropriate care.
The lack of representation in clinical trials and medical literature further exacerbates the problem. Without sufficient data on how AD manifests and responds to treatment in diverse populations, healthcare providers might potentially be less equipped to provide optimal care.
Socioeconomic Factors: The Poverty-Eczema Trap
The review also highlighted the profound impact of socioeconomic factors on pediatric AD:
Children with public insurance had a higher prevalence of AD compared to those with private insurance, by about 6%.Those without insurance were more prone to delayed and unfilled prescriptions. They also experienced more transport-delayed care, longer hospitalizations, more behavioral issues, increased food insecurity, and higher fatigue scores.
Families struggling with poverty often face multiple barriers to managing AD. These include:
- Limited access to healthcare: Lack of insurance or transportation can make it arduous to see a doctor or dermatologist regularly.
- Inability to afford medications: Even with insurance, the cost of prescription creams and other treatments can be prohibitive.
- Poor living conditions: Overcrowded housing, exposure to allergens, and stress can worsen AD symptoms.
- Food insecurity: Limited access to nutritious food can compromise the immune system and exacerbate skin problems.
A recent case study in rural Kentucky revealed that a family relied on over-the-counter remedies due to the high cost and travel distance associated with specialist care.This resulted in prolonged suffering for their child and avoidable complications.
The correlation between income, education, and AD management is clear:
Children who lived in households with higher income and education levels had lower odds of developing psychological comorbidities and/or discontinuing treatment. There was also an increase in care access as there were more AD and allergy diagnoses.
Geographical Disparities: The urban-Rural Divide
Where a child lives also plays a significant role in their risk of developing and managing AD. The review found that:
Disease prevalence was higher in the South, with 2% to 4% of pediatric patients in this region having AD Medicaid claims and lower treatment rates. It has also been reported that there is a lack of pediatric dermatologists in the rural regions of the US.
Children living in rural areas often face challenges accessing specialized care due to the limited number of dermatologists and other healthcare providers. This can lead to delays in diagnosis and treatment, and also increased reliance on primary care physicians who may not have specialized knowledge of AD.
Environmental factors also contribute to geographical disparities. Urban areas, with their higher levels of pollution and traffic, may exacerbate AD symptoms. The review noted:
Over 91% of AD-related visits occurred in urban settings, due to increased access to care and greater exposure to traffic and air pollutants.
Though those who lived farther from a major road showed lower odds of AD. This points toward the impact of air quality on the prevalence of the disease.
Sex and Gender Differences: A Complex Picture
The review also explored sex and gender differences in pediatric AD, revealing a complex picture:
Girls had approximately 2% to 4% absolute higher disease prevalence than boys, which could be due to increased female hormones like estrogen. though, boys had a higher risk of early and more persistent AD with more comorbidities compared to girls. Thus, boys were also more likely to receive systemic corticosteroids.
While girls may be more likely to develop AD, boys tend to experience more severe and persistent symptoms, requiring more aggressive treatment. This highlights the need for a nuanced approach to managing AD in children of different sexes.
Addressing Potential Counterarguments
While this review highlights significant disparities, some argue that these differences may be due to genetic factors or lifestyle choices rather than systemic inequalities. However, the overwhelming evidence suggests that social determinants of health, such as poverty, lack of access to healthcare, and environmental factors, play a crucial role in shaping AD outcomes.
Moreover, attributing disparities to individual choices ignores the systemic barriers that prevent many families from making healthy choices. For example, a family living in a food desert may have limited access to fresh fruits and vegetables, making it difficult to follow a healthy diet that could help manage AD symptoms.
Practical Applications and Recent Developments
The findings of this review have crucial implications for healthcare providers, policymakers, and community organizations. Some practical applications include:
- Increased awareness and education: Healthcare providers need to be aware of the disparities in pediatric AD and culturally sensitive in their approach to diagnosis and treatment.
- Improved access to care: Efforts should be made to expand access to dermatology services in underserved communities, including increasing the number of dermatologists and providing telehealth options.
- Targeted interventions: Programs should be developed to address the specific needs of vulnerable populations, such as providing financial assistance for medications, offering transportation to medical appointments, and addressing food insecurity.
- Further research: more research is needed to understand the underlying causes of AD disparities and to develop effective interventions to address them.
Recent developments in AD treatment offer hope for improved outcomes. These include new topical and systemic medications that target specific immune pathways involved in the development of AD. However, it is crucial to ensure that these new treatments are accessible to all children, regardless of their race, ethnicity, or socioeconomic status.
call to Action: Towards Equitable Care
The disparities in pediatric AD are a symptom of deeper systemic inequalities. Addressing these disparities requires a multi-faceted approach that includes:
- Investing in early childhood education and healthcare.
- Expanding access to affordable housing and nutritious food.
- Promoting diversity and inclusion in healthcare professions.
- Addressing environmental injustices that disproportionately affect vulnerable communities.
By working together, we can create a more equitable healthcare system where all children have the possibility to thrive, regardless of their background or zip code.
Looking Ahead
the authors of the review emphasize the need for future research to address gaps in knowledge related to patients who are in the LGBTQ+ community, those who are unhoused, or those who have disabilities. These populations often face unique challenges in accessing healthcare and managing chronic conditions like AD.
The “Revolutionizing Atopic Dermatitis Conference” this June in Nashville, TN, is an opportunity for healthcare professionals to learn more about the latest advances in AD research and treatment, as well as to discuss strategies for addressing disparities in care.By fostering collaboration and innovation, we can move closer to a future where all children with AD receive the care they need to live healthy, happy lives.
Want to hear more pearls and expert insights on AD? Join us at the annual Revolutionizing Atopic Dermatitis Conference this June in Nashville, TN!
What steps can healthcare providers and policymakers take to address the disparities in pediatric AD discussed in the interview?
Interview with Dr. Evelyn Reed,Pediatric Dermatologist
Welcome,Dr. Reed, and thank you for joining us today to discuss the concerning disparities in pediatric AD.
Understanding the Scope of the Problem
archyde News: Dr. Reed, could you start by outlining the key racial and ethnic disparities the review uncovered, and what these disparities mean for children and thier families?
Dr. Evelyn Reed: Certainly. the review clearly shows that children of color, particularly American Indian/Alaskan Native, Hispanic, and Asian children, have a higher likelihood of developing AD compared to white children. Black children face a particularly challenging situation with poorer disease control and earlier onset and persistence of AD. This translates to real-world struggles; imagine a mother in Atlanta struggling to find a dermatologist who can effectively treat AD on darker skin tones. It’s a problem in access to care for many families.
The Impact of Socioeconomic Factors
Archyde News: The review highlights the significant impact of socioeconomic status. Can you elaborate on how poverty and lack of insurance exacerbate the challenges of managing AD?
Dr.Evelyn Reed: Absolutely. Children with public insurance or no insurance face significant barriers. This includes increased prevalence rates, frequently enough delayed or missed prescriptions, and difficulties with transportation to appointments. Think about a rural Kentucky family who might resort to over-the-counter remedies due to the costs of specialist care and travel. It’s the poverty-eczema trap – the cycle of poverty that worsens the condition and restricts access to quality care.
Geographical Disparities and Access to Care
archyde News: The review also addresses geographical disparities. In your experience, how does where a child lives impact their ability to access and manage AD treatment?
Dr. Evelyn Reed: The research shows that the South and rural areas face many challenges in treating AD. There’s a real shortage of pediatric dermatology specialists, leading to delays in diagnosis. In these instances, primary care physicians, who may not have specialist knowledge, are the only source of treatment. Further, environmental issues like air pollution in urban areas make AD symptoms worse. These disparities in healthcare access and environmental conditions require substantial efforts.
Sex and Gender Considerations
Archyde News: The report provides insight into the role that various hormones might play in disparities.What are some of the sex and gender-based differences?
Dr. Evelyn Reed: The findings point out, while girls may be more likely to have AD, studies show that boys could, in general, have more severe and persistent symptoms, often requiring more aggressive courses of treatment. To be more specific, it provides some details on the need for a specialized approach that factors in the differences between sexes.
Addressing Potential Counterarguments
Archyde News: Some might argue that differences are due to genetics or lifestyle choices. How do you address those counterarguments?
Dr. Evelyn Reed: While genetics and lifestyle play a role, the overwhelming evidence supports that social determinants of health are strongly related to AD outcomes. Attributing disparities to individual choices ignores systemic barriers. Access to food deserts with a lack of fresh fruits and vegetables or limited access to healthy food can often lead to increased eczema.
Practical applications and Recent Developments
Archyde News: What steps can healthcare providers and policymakers take to address these disparities?
Dr. Evelyn Reed: We need to increase awareness, improve access to dermatology services, offer financial support for medications, and expand telehealth options. Moreover, healthcare providers have to be extremely learned about the disparities in pediatric AD. The latest advancements in treatment provide hope. Ensuring that new treatments are accessible to all children, despite their background, is crucial.
Call to Action and Future Directions
Archyde News: What is your call to action considering these findings?
Dr.Evelyn Reed: We must tackle these disparities with a multi-faceted approach. Invest in early education and healthcare, expand access to affordable housing and nutritious food, promote diversity in healthcare professions, and recognize the effects of environmental factors.We also need future research to address gaps in knowledge related to the patients who are in the LGBTQ+ community, those who are unhoused, or those who have disabilities.
The “Revolutionizing Atopic Dermatitis Conference” in Nashville provides a great opportunity for more learning and also discussions on strategies of dealing with healthcare disparities. I encourage everyone to get involved and start moving towards a more just and fair environment.
Final Thoughts
Archyde news: Dr. reed, this has been incredibly informative. Thank you for shedding light on this critical issue.
Dr. Evelyn Reed: thank you for the invitation and the opportunity to discuss this important topic. I hope this conversation raises awareness, and prompts action.
Call to Action
Archyde News: What do you believe is the single most significant step that can be taken now to alleviate these disparities? Let us no in the comments.
