Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, affecting an estimated 240 million people and up to 11% of children worldwide.¹ While the physical manifestations of AD are well-characterized, less is known about the psychological burden of the disease and the factors associated with it, including potential differences between childhood-onset and adult-onset AD.¹ At the EADV Congress 2025, Dr. Delphine Kerob presented new findings from the “Scars of Life” international epidemiological study, which explored the psychological impact of AD and identified key risk factors for suicidal ideation (SI), especially when comparing individuals with childhood-onset and adult-onset disease.¹

“Scars of Life” was a cross-sectional, observational study that surveyed 30,801 adult participants from 27 countries.¹ The questionnaire incorporated patient-reported outcome (PRO) assessment tools such as the Patient Unique Stigmatization Holistic tool in Dermatology (PUSH-D), Atopic Dermatitis Burden Scale for Adults (ABS-A), a Dermatology Long-Term Life Impact Measure developed and validated for “Scars of Life” (DLLIM [SOL]), and Children’s Dermatology Life Quality Index (CDLQI).¹ Respondents were asked about any suicidal thoughts they may have had in the past 24 months and during their adolescence.¹

Participants were categorized into four groups depending on AD onset: no AD (control; n=7,968), adult-onset AD (n=7,383), childhood/teenage-onset AD without persistence into adulthood (n=7,610), and childhood/teenage-onset that persisted into adulthood (n=7,840; childhood onset: 2,875; teenage onset: 4,965).¹ The analytical focus was placed on groups with AD during adulthood vs. the group without AD (n=23,191).¹ A female predominance was observed across all AD groups (56%-62%), aligning with patterns described in prior epidemiological research.¹ The childhood-onset cohort was the youngest (mean: 37.3 years), whereas the no AD and adult-onset groups were older (mean: 43.7 and 43.6 years, respectively.¹ Mild and moderate cases accounted for the vast majority of participants in each AD group (around 90%), whereas severe disease was the most common in the childhood-onset group, affecting 15.4% of patients.¹

The study revealed a significant mental health burden among individuals with AD.¹ Overall, groups with AD during adulthood had a higher prevalence of SI (13.2% vs. 8.5%), and the difference was significant regardless of the age of onset (p<0.001 for all comparisons with those without AD).¹ Notably, participants with childhood-onset AD were three times more likely to report SI than those without AD (29.15% vs. 9.64%; p<0.001).¹Patients who reported SI were more likely to be younger than 30 years of age (31.0% vs. 21.9%), female (60.3% vs. 56.9%), and obese (20.6% vs. 16.7%).¹ They were also more likely to have moderate-to-severe AD (64.9% vs. 47.9%), and reported pruritus (70.4% vs. 64.6%), intense pruritus (52.1% vs. 43.2%) and skin pain (28.4% vs. 19.0%) (p<0.001 for all).¹

In the multivariate analysis, SI was strongly associated with moderate-to-severe AD (odds ratio [OR]=1.59; 95% CI: 1.43-1.76; p<0.0001), age <30 years (OR=1.55; 95% CI: 1.39-1.72; p<0.001), sleep-onset insomnia (OR=1.54; 95% CI: 1.37-1.72; p<0.0001), skin pain (OR=1.39; 95% CI: 1.25-1.56; p<0.0001), obesity (OR=1.32; 95% CI: 1.17-1.49; p<0.0001), sleep-maintenance insomnia (OR=1.26; 95% CI: 1.12-1.41; p<0.0001), and itching (OR=1.19; 95% CI: 1.07-1.33; p<0.0001).¹

In summary, the study highlights AD as a robust risk factor for SI irrespective of onset age, with severity, pruritus, and sleep disturbances as key drivers.¹ Across onset groups, younger individuals, females, and those with obesity also show heightened vulnerability.¹