# Atopic dermatitis starting in childhood has a stronger impact on adults: results from the "Scars of Life" international project in 27 countries

Jonathan I Silverberg, Roni Dodiuk-Gad, Roberto Takaoka, Jerry Tan, Chaoying Gu, Thomas Luger, Bruno Halioua, Flavia Aslanian, Cita Rosita Sigit Prakoeswa, Ann'Laure Demessant Flavigny, et al.

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## ► To cite this version:

Jonathan I Silverberg, Roni Dodiuk-Gad, Roberto Takaoka, Jerry Tan, Chaoying Gu, et al. Atopic dermatitis starting in childhood has a stronger impact on adults: results from the "Scars of Life" international project in 27 countries. British Journal of Dermatology, inPress, 10.1093/bjd/ljf158. hal-05059743

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Submitted on 23 Jun 2025

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Atopic dermatitis starting in childhood has a
stronger impact on adults: results from the
'Scars of Life' international project in
27 countries

Dear Editor, The World Health Organization has urged gov-
ernments worldwide to take action in addressing stigma
associated with skin conditions.¹ Patients with atopic derma-
titis (AD) commonly experience stigmatization.²,³ Moreover,
children and adolescents are at a critical stage of social and
emotional development, and the visible symptoms or limi-
tations caused by chronic conditions often lead to teasing,
bullying or exclusion from peers. Despite this, the long-term
impact of stigmatization on individuals who had AD in child-
hood or adolescence has yet to be thoroughly examined.

In this context, we conducted a survey within the frame-
work of ‘Scars of Life’, a cross-sectional observational study
launched at the beginning of 2024, aiming to build a large
international database of patients with AD to assess the
psychosocial burden of their disease. The survey was con-
ducted in 27 countries across 5 continents. Our objective
was to compare the self-reported feelings of stigmatization
and psychosocial burden in individuals with AD that started
during adulthood with feelings of patients whose AD started
in childhood and persisted into adulthood.

A representative sample was selected using the quota
method. Participants reported whether they had a physi-
cian-confirmed diagnosis of AD and the age of onset. Two
groups were defined: (i) AD in both adulthood and childhood
(A+C) and (ii) AD only in adulthood (OA). Participants were
contacted by email to complete a structured digital ques-
tionnaire.

The questionnaire included sociodemographic character-
istics, age of onset of AD, standardized self-assessment
questions on clinical severity [Patient-Oriented Eczema
Measure (POEM) score], and effect of AD in five domains:
(i) avoidance and social isolation; (ii) relationships with fam-
ily and friends; (iii) perception and treatment by others;
(iv) discrimination, professional and administrative exclusion;
and (v) self-image and physical appearance. The severity of
perceived stigmatization due to AD was assessed using the
Patient Unique Stigmatization Holistic Tool in Dermatology
(PUSH-D) score.⁴ A multivariate linear regression was per-
formed to assess the relationship between PUSH-D and the
explanatory variables: gender, time of onset of AD, age, and
type of skin (fair or dark).

We included 2875 patients in the A+C group and 7383
in the OA group. In the A+C group, 1771 were women
(61.6%), and mean (SD) age was 37.3 (12.5) years. POEM

score was mild in 1146 (39.9%) and moderate-to-severe in
1729 (60.1%). In the OA group, 4160 were women (56.3%),
and mean age was 43.6 (15.1) years. POEM score was mild
in 3811 (51.6%) and moderate-to-severe in 3572 (48.4%).
The PUSH-D score in the A+C group was 23.04 (20.12) vs.
17.44 (17.17) in the OA group (P<0.001). Figure 1 shows
details of the impact in each group.

In multivariate analysis, male gender (β=1.23, 95% con-
fidence interval (CI) 0.2–2.25; P=0.0191), fair skin (β=1.37,
95% CI 0.04–2.7; P=0.043), and AD during A+C (β=3.11,
95% CI 1.95–4.28; P<0.001), were associated with higher
values of PUSH-D. Age (β=−0.35, 95% CI −0.39 to −0.32;
P<0.001) was associated with lower values of PUSH-D.

While many studies have explored AD's psychosocial impact,⁵⁻⁸ few address differences between A+C and OA groups. Our large-scale international study goes beyond a snapshot in time, revealing the long-term consequences of the disease, especially in the A+C group of patients.

Patients in the A+C group often avoid public interactions,
family photos, and situations where their appearance is high-
lighted. With social media amplifying personal visibility, indi-
viduals with AD feel exposed, triggering anxiety, shame and
fear of judgment. This intensifies the psychosocial toll of AD,
deepening the strain on family bonds and friendships. Many
patients in the A+C group report feeling unloved, bringing
shame to their families and experiencing partner rejection.
They also notice being avoided in public, such as people
refusing to shake hands or sit near them. In professional
settings, those in the A+C group report higher rates of dis-
crimination, isolation and unfair treatment. They are more
likely to avoid personal care services, such as hairdressing
or manicures, and conceal affected areas of their body,
eroding self-worth over time. These experiences highlight a
consistent pattern of stigmatization among the A+C group
of patients, differentiating them from those in the OA group.
However, no significant differences were found regarding
avoidance of being in the spotlight. Among all factors, A+C
is the strongest predictor of stigma, followed by male gen-
der and fair skin.

Our findings suggest that A + C and OA may represent
distinct phenotypes with unique psychosocial and clinical
patterns. These distinctions merit further investigation to
see whether these phenotypes correlate with specific
clinical signs and, ultimately, should influence treatment
strategies. Given the long-term emotional burden associ-
ated with A + C, it may be necessary to reconsider how
we approach the treatment of AD. The assumption that
treatment of less severe cases can be deferred may
underestimate the psychosocial impacts that accumulate
over time.
<figure><img src="image_3.png" /><figcaption>**Figure 1** Results of different items of each studied domain. The 27 studied countries, by continent, were: North America: Canada and the USA; Europe: France, Germany, Greece, Israel, Poland, Spain, Sweden and the UK; Africa: Cameroon, Kenya and South Africa; Latin America: Brazil and Mexico; the Middle East and North Africa: Egypt, Morocco and Saudi Arabia; Asia: China, Japan, South Korea, India, Indonesia, Malaysia, Singapore and Thailand; and Australia.</figcaption></figure>

Jonathan I Silverberg<sup>1</sup>,<sup>2,3,4</sup> Roni Dodiuk-Gad,

Roberto Takaoka,<sup>5</sup> Jerry Tan,<sup>6</sup> Chaoying Gu,<sup>7</sup>

Thomas Luger,<sup>8</sup> Bruno Halioua<sup>9,10</sup>

Flavia Aslanian,<sup>11</sup> Cita Rosita Sigit Prakoeswa,<sup>12</sup>

Ann'Laure Demessant Flavigny,<sup>13</sup>

Caroline Le Floc'h,<sup>13</sup> Nabil Kerrouche,<sup>13</sup>

Stéphanie Merhand,<sup>14</sup> Wendy Smith Begolka,<sup>15</sup>

África Luca de Tena Smith,<sup>16</sup> Shulamit Burstein,<sup>17</sup>

Delphine Kerob,<sup>13</sup> Charles Taieb<sup>10,18</sup>

Charbel Skayem<sup>19</sup> Therdpong Tempark<sup>20</sup>

Abraham Getachew Kelbore,<sup>21</sup> Alexander Stratigos,<sup>22</sup>

Martin Steinhoff,<sup>23,24,25</sup> Julien Seneschal<sup>26,27</sup> and

Laurent Misery<sup>28,29</sup>

The complete list of author affiliations can be found in Appendix S1 (see Supporting Information).

Correspondence: Charles Taieb. Email: charles.taieb@emma.clinic

**Funding sources:** This study was granted and designed by the Scars of Life Unit of La Roche-Posay Laboratoire Dermatologique.

**Conflicts of interest:** A.D.-F., C. Le F., N.K. and D.K. are employed by La Roche-Posay. C.T. received fees from La Roche-Posay for setting up and overseeing this project. The remaining authors received fees for participating in the project's scientific committee (methodology validation, questionnaire development and manuscript writing).

**Data availability:** The data underlying this article will be shared on reasonable request to the corresponding author.

**Ethics statement:** The project was reviewed by a French ethics committee and was found to be in accordance with the ethical standards set forth by that committee (IDRCB 2023-A02722-43).

**Patient consent:** All patients gave written, informed consent for participation.

## Supporting Information

Additional Supporting Information may be found in the online version of this article at the publisher's website: **Appendix S1 Complete list of author affiliations.**

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