Atopic dermatitis (AD) is one of the most common childhood illnesses worldwide, affecting 15 to 30% of children in developed countries. It significantly impacts children’s and their families’ quality of life and daily activities. AD is linked with neurological conditions such as depression, anxiety, and stress which has been recognized as one of the seven psychosomatic disorders for over 15 years.
During that time, researchers detected an association between AD and stress. Several potential biological pathways or mechanisms have been found to describe this association. This association is well explained in a recent study published in the Journal of Investigative Dermatology. This longitudinal cohort study investigated the association between stressful childhood life events and the activity and severity of AD during childhood.
A total of 13,972 children’s (51.7% male) data were collected from the Avon Longitudinal Study of Parents and Children (ALSPAC) between 1990 and 2000. The age range of participants was 1 to 8.5 years. Of these, 4,454 children (31.9%) met the AD criteria. The primary outcome of this study was the measurement of AD period prevalence and stressful life events (SLE) scale at seven different time points: 18, 30, 42, 57, 69, 81, and 103 months. This outcome was determined by using standardized questionnaires related to flexural dermatitis.
This population-based study results showed that the median weighted SLE score at each age ranged from 1 to 3 (interquartile range [IQR] 2-5), while the median cumulative SLE score at 18 months was 1 and at 103 months was 15. The average prevalence of SLE included 91% for starting school, 75% for starting a new school, 54% for the death of a pet, 54% for moving homes, and 45% for having new siblings.
After adjusting for confounders such as age and sex of the child, maternal stress during pregnancy, and socioeconomic factors in multivariable analysis, it found that an increase in SLE was associated with a slight increase in AD risk (odds ratio (OR) of 1.04, 95% confidence interval [CI] 1.01-1.07). This risk was higher for moderate to severe AD (OR 1.13, 95% CI 1.03-1.23) and as well as for cumulative SLE (11% increase) throughout childhood (OR 1.11, 95% CI 1.07-1.16).
Moreover, while examining the association with specific SLE, a lower risk of AD activity was specifically linked to a more significant experience of starting school at the age range of 51 to 81 months, with OR of 0.93 (95% CI 0.88-0.98).
Additionally, severe adverse life events such as being taken into care, being physically harmed by someone, sexual abuse, or being separated from either parent were not associated with AD in cross-sectional analysis (OR 1.02, 95% 0.99-1.05). However, cumulative analysis indicated an increase in AD risk for these events (OR 1.05, 95% CI 1.01–1.09).
Study limitations include the potential measurement errors or bias in both the exposure and outcomes. Furthermore, missing data and selection bias were observed due to participant attrition over the follow-up period.
“We observed a significant association between childhood SLE and AD.  AD was also associated with the cumulative risks of common and severe SLE during childhood,” said Katrina Abuabara, MD, MA, MSCE, from the University of California, San Francisco Department of Dermatology, San Francisco, USA.
This study results suggest that moisturizing, stress-reducing therapies and screening instruments such as the family environment scale (FES) may help to prevent AD flares in children with SLE.
Reference: Abuabara K, Kidd SA, Ye M, et al. The impact of childhood stressful life events on atopic dermatitis disease activity and severity. J Invest Dermatol. 2025. doi:10.1016/j.jid.2025.01.014
