Research on Eczema and Emotional Issues in Children

The National Eczema Association (NEA) is the largest private nonprofit funder of research for adult and pediatric eczema, investing more than $4 million to date. Ever wonder what exactly our research grant recipients are working on? Under the Microscope is where we provide an inside look at research from one of our latest grant recipients, including what they are studying and its potential impact on the eczema community.

What causes emotional and behavioral issues in children with eczema?

Though doctors who treat children with atopic dermatitis (the most common type of eczema) have long observed that many develop emotional and behavioral problems, the connection between the two remains poorly understood.

Is it the atopic dermatitis, which can cause problems like disrupted sleep and discomfort from itching, that causes the emotional and behavioral problems in children? Can emotional problems trigger outbreaks of eczema, as stress is known to do? Or is it possible that children who are predisposed to atopic dermatitis are also predisposed to certain mental health conditions?

None of these questions have been clearly answered, according to Dr. Joy Wan, assistant professor of dermatology at the Johns Hopkins University School of Medicine.

“We need to better understand the mechanisms underlying the connection between atopic dermatitis and mental health issues, so we can then select appropriate interventions that directly act upon those mechanisms,” said Dr. Wan, who was awarded a Catalyst Grant from NEA in 2022 to research this topic.

Using a Catalyst Grant funded by NEA, Dr. Wan recently completed a two-part research project aimed at filling the gap in understanding the connection between poor mental health outcomes and atopic dermatitis.

Trying to understand behavioral issues in kids with eczema

Dr. Wan noted that there has been previous research on the subject, but that it has not been studied with enough scientific rigor for physicians to understand the exact types of mental health issues that these children may face as a result of their atopic dermatitis. Nor is it well understood if the disease severity influences the types of behavioral and emotional problems these children may face.

For the first part of her research, Dr. Wan used data from a study that followed 1,000 children in the United States from birth to age 15. The children in the study were examined for atopic dermatitis and also for behavioral problems at different points in the study. This research revealed that the 116 children with atopic dermatitis were at higher risk for developing both internal problems and external problems than children without atopic dermatitis. Internal problems include anxiety and depression, and external problems include aggression and interpersonal conflict. This part of her research also revealed that children who had atopic dermatitis before first grade were more likely to have concerning behavioral and emotional problems over their early- to mid-childhood compared to children without atopic dermatitis.

In the second part of her research, Dr. Wan enrolled 47 children between the ages of 2 and 17 with mild, moderate or severe atopic dermatitis in a study to evaluate whether the severity of the disease relates to behavioral and emotional outcomes. She used two established research systems for evaluating the childrens’ behavior and collected data on sleep and itch to explore whether these factors are connected.

Though Dr. Wan is still working on the analysis of this study, she noted that one surprising result seems to be that behavioral and emotional problems are common in all children with atopic dermatitis, including those with mild cases.

“We initially hypothesized that there would be a greater difference between children with mild eczema and those with more severe cases, but the difference is not as great as we expected and it is quite common even in children with mild eczema,” said Dr. Wan.

Research is ongoing

Dr. Wan noted that both aspects of her research are ongoing, she is collecting more data from which she hopes to draw more precise conclusions. She is also working on projects to further characterize the role of sleep in the connection between atopic dermatitis and mental health.

“I would definitely like to have the opportunity to extend this research and try to make some more meaningful connections that can be used to come up with effective and targeted treatment plans for children with eczema and mental health burdens,” said Dr. Wan.

Though her research is ongoing, Dr. Wan noted that her work so far points to the fact that doctors who treat children with atopic dermatitis should be aware of this risk and screen all children with atopic dermatitis for emotional and behavioral problems.

“Unfortunately, we need to do more research on the underlying mechanisms before we will be able to make solid recommendations on how best to screen children and what tools are going to be most helpful,” said Dr. Wan.

NEA grants and their impact

NEA is dedicated to increasing the number of scientists, research projects and research dollars devoted to eczema, in pursuit of better therapies, better care, better outcomes — and one day, potentially, a cure. Learn more about our eczema research grants, their impact and how you can get involved.