Retrospective Assessment of Social Rejection Related to Atopic Dermatitis During Childhood and Adolescence: The Scars of Life—Eczema Study

Abstract

Atopic dermatitis (AD) is a chronic inflammatory skin disease that often begins early in life and is associated with a substantial psychosocial burden [1]. Previous studies have shown that AD negatively affects quality of life and social relationships during childhood and adolescence [2]. However, experiences of social rejection related to AD during these developmental periods remain insufficiently documented, particularly when assessed retrospectively. Participants were asked to recall experiences of social rejection that occurred during childhood and adolescence. The analyses, therefore, reflect perceived social experiences related to AD during earlier life stages as recalled in adulthood and do not represent prospectively collected pediatric data. This study is based on a retrospective assessment conducted within the Scars of Life—Eczema study, among adult respondents with a self-reported, physician-confirmed history of atopic dermatitis from 27 countries, recruited in 2024 through an online quota-based survey designed to obtain nationally representative samples of the general population. Adult respondents reporting a history of atopic dermatitis were included. Two subgroups were defined according to the age at which atopic dermatitis first appeared: childhood-onset AD before the age of 10 years (CHIL group, n = 6161) and adolescent-onset AD between 10 and 18 years (TEEN group, n = 9289). Social rejection was assessed as perceived social exclusion using items addressing exclusion, verbal aggression, physical aggression, perceived rejection, avoidance, shame, and loneliness. The items were developed by an expert patient group in collaboration with five patient associations involved in atopic dermatitis advocacy. Item wording reflected lived experiences reported by adults with AD and experiences described by parents who had witnessed social rejection directed toward their children. Each item has been translated and culturally adapted for each participating country. The associations involved in questionnaire development are co-signatories of this article. All items were completed by respondents within each subgroup. Descriptive analyses were performed, and comparisons between childhood and adolescent experiences were conducted using chi-square tests. Social rejection experiences were frequently reported in both subgroups, with higher proportions consistently observed for experiences recalled during childhood compared with adolescence. As shown in Table 1, overall social rejection was reported by 57.7% of respondents recalling childhood experiences, compared with 50.5% among those recalling adolescence (p < 0.001). All individual dimensions of social rejection—including exclusion, verbal aggression, physical aggression, perceived rejection, avoidance, shame, and loneliness—were significantly more frequent for childhood experiences than for adolescent experiences (all p < 0.001), indicating a greater burden of social rejection during childhood. To further explore factors independently associated with social rejection, a multivariate logistic regression analysis was performed (Figure 1). After adjustment for relevant covariates, several factors remained significantly associated with a higher likelihood of social rejection. Odds ratios (ORs) and 95% confidence intervals are presented in Figure 1, and diagnostic tests (Belsley–Kuh–Welsch, White, and Lilliefors) confirmed the robustness of the model. This retrospective assessment highlights the frequency of social rejection experiences related to atopic dermatitis during childhood and adolescence, as recalled in adulthood. The higher prevalence observed for childhood experiences may reflect greater vulnerability at younger ages and the lasting impact of early social experiences. Similar long-term psychosocial consequences have been described in other chronic childhood conditions [3, 4]. In addition, the use of patient-developed items supports the relevance of patient-reported outcomes in capturing lived experiences related to disease burden [5]. These findings underline the potential long-term social impact of atopic dermatitis during childhood and adolescence and emphasize the importance of addressing psychosocial aspects alongside clinical management. The study was designed by La Roche-Posay Laboratoire Dermatologique, France. 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 [South-East I Committee for the Protection of Persons, dated 11 March 2024]. Ann’Laure Demessant-Flavigny, Caroline Le Floc’h, Nabil Kerrouche, and Delphine Kerob are employees of La Roche-Posay Laboratoire Dermatologique, France. Charles Taieb received fees from La Roche-Posay Laboratoire Dermatologique, France, for setting up and overseeing this project. Julien Seneschal, Bruno Halioua, Jerry Tan, Chaoying Gu, Thomas Luger, Roni Dodiuk-Gad, Roberto Takaoka, Flavia Pretti Aslanian, Cita Rosita Sigit Prakoeswa, Delphine Kerob, Abraham Getachew Kelbore, Laurent Misery, Therdpong Tempark, Alexander Stratigos, Martin Steinhoff, and Jonathan I. Silverberg received fees for participating in the project’s scientific committee [methodology validation, questionnaire development, and manuscript writing]. Charbel Skayem, Stéphanie Merhand, Wendy Smith Begolka, África Luca de Tena Smith, and Shulamit Burstein didn’t receive any fees. The datasets generated during and/or analyzed during this study are available from the authors upon reasonable request.