Global, regional, and national burdens of atopic dermatitis from 1990 to 2021: a trend analysis
Main Article Content
Keywords
Atopic dermatitis, Age-standardized rates of prevalence (ASPR), Age-standardized rates of incidence (ASIR), Disability-adjusted life years (DALYs)
Abstract
Background: Atopic dermatitis (AD) is a widespread dermatological condition, particularly affecting children globally. In spite of its high prevalence, comprehensive data on its burden and trends are limited.
Methods: Using the Global Burden of Disease Study 2021 (GBD 2021) data from 204 countries and 21 regions (1990–2021), we analyzed AD prevalence, incidence, and disability-adjusted life years (DALYs), calculating age-standardized rates (ASRs) and estimated annual percentage changes (EAPCs).
Objective: This study is designed to examine the temporal trends in the burden of AD across global, regional, and national levels.
Results: Globally, AD cases rose from 107.5 million (1990) to 129.0 million (2021). The high-income Asia Pacific region had instances of age-standardized prevalence (ASPR), age-standardized incidence rate (ASIR), and age-standardized DALYs, with Japan leading among 204 countries. High sociodemographic index (SDI) regions showed the highest ASPR, ASIR, and age-standardized DALYs, while medium and high SDI regions experienced the largest increases. Females exhibited higher ASRs than males. Age-specific prevalence and DALYs peaked in children aged 5–9 years, whereas incidence was the highest in those aged under 5 years. Projections based on 1990–2021 data suggest declining global trends in ASPR, ASIR, and age-standardized DALYs by 2050.
Conclusions: Global AD prevalence and DALYs continue to rise, whereas ASPR and age-standardized DALYs are declining. High SDI regions exhibit the highest prevalence, yet low-income countries show increasing age-standardized DALYs, underscoring profound regional heterogeneity. Thus, the absolute burden of AD is escalating worldwide, while individual-level risk appears to be improving.
References
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28 Aguilera AC, Dagher IA, Kloepfer KM. Role of the microbiome in allergic disease development. Curr. Allergy Asthma Rep. 2020;20(9):44. https://doi.org/10.1007/s11882-020-00944-2
29. Faraz K, Seely M, Marano AL. The role of the environment in allergic skin disease. Curr. Allergy Asthma Rep. 2024;24(6):323–330. https://doi.org/10.1007/s11882-024-01147-9
30. Afshari M, Kolackova M, Rosecka M, Čelakovská J, Krejsek J. Unraveling the skin; a comprehensive review of atopic dermatitis, current understanding, and approaches. Front. Immunol. 2024;15:1361005. https://doi.org/10.3389/fimmu.2024.1361005
31. Taguchi N, Hata T, Kamiya E, Kobayashi A, Aoki H, Kunisada T. Reduction in human hair graying by sterubin, an active flavonoid of Eriodictyon angustifolium. J. Dermatol. Sci. 2018;92(3):286–289. https://doi.org/10.1016/j.jdermsci.2018.11.002
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33. Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet Lond. Engl. 2010;376(9743):784–793. https://doi.org/10.1016/S0140-6736(10)61115-4
34. Li A, Fan L, Xie L, Ren Y, Li L. Associations between air pollution, climate factors and outpatient visits for eczema in West China Hospital, Chengdu, south-western China: a time series analysis. J. Eur. Acad. Dermatol. Venereol. 2018;32(3):486–494. https://doi.org/10.1111/jdv.14730
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38. Zhang S, Zhang B, Liu Y, Li L. Adipokines in atopic dermatitis: the link between obesity and atopic dermatitis. Lipids Health Dis. 2024;23(1):26. https://doi.org/10.1186/s12944-024-02009-z
39. Shang D, Zhao S. Molecular mechanisms of obesity predisposes to atopic dermatitis. Front. Immunol. 2024;15:1473105. https://doi.org/10.3389/fimmu.2024.1473105
40. Al-Afif KAM, Buraik MA, Buddenkotte J, et al. Understanding the burden of atopic dermatitis in Africa and the Middle East. Dermatol. Ther. 2019;9(2):223–241. https://doi.org/10.1007/s13555-019-0285-2
41. Schmid-Grendelmeier P, Takaoka R, Ahogo KC, et al. Position statement on atopic dermatitis in sub-Saharan Africa: current status and roadmap. J. Eur. Acad. Dermatol. Venereol. 2019;33(11):2019–2028. https://doi.org/10.1111/jdv.15972
42. Pavli A, Maltezou H. Health problems of newly arrived migrants and refugees in Europe. J. Travel Med. 2017;24(4). https://doi.org/10.1093/jtm/tax016
43. Kanda N, Hoashi T, Saeki H. The roles of sex hormones in the course of atopic dermatitis. Int. J. Mol. Sci. 2019;20(19):4660. https://doi.org/10.3390/ijms20194660
44. Hong J, Koo B, Koo J. The psychosocial and occupational impact of chronic skin disease. Dermatol Ther. 2008;21(1):54–59. https://doi.org/10.1111/j.1529-8019.2008.00170.x
2. Chiesa Fuxench ZC, Block JK, Boguniewicz M, et al. Atopic dermatitis in America study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. J. Invest. Dermatol. 2019;139(3):583-590. https://doi.org/10.1016/j.jid.2018.08.028
3. Laughter MR, Maymone MBC, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990–2017*. Accessed August 18, 2025. https://dx.doi.org/10.1111/bjd.19580
4. Laughter MR, Maymone MBC, Mashayekhi S, et al. The global burden of atopic dermatitis: lessons from the Global Burden of Disease Study 1990–2017. Br. J. Dermatol. 2021;184(2):304–309. https://doi.org/10.1111/bjd.19580
5. Atopic dermatitis in older patients: particular points - PubMed. Accessed June 19, 2025. https://pubmed.ncbi.nlm.nih.gov/20569298/
6. Tanei R, Hasegawa Y. Atopic dermatitis in older adults: a viewpoint from geriatric dermatology. Geriatr. Gerontol. Int. 2016;16(Suppl 1):75–86. https://doi.org/10.1111/ggi.12771
7. Chiricozzi A, Maurelli M, Calabrese L, Peris K, Girolomoni G. Overview of atopic dermatitis in different ethnic groups. J. Clin. Med. 2023;12(7):2701. https://doi.org/10.3390/jcm12072701
8. Wollenberg A, Kinberger M, Arents B, et al. European guideline (EuroGuiDerm) on atopic eczema: part I - systemic therapy. J. Eur. Acad. Dermatol. Venereol. 2022;36(9):1409–1431. https://doi.org/10.1111/jdv.18345
9. Atopic dermatitis: economic burden and strategies for high‐quality care | Br. J. Dermatol. | Oxford Academic. Accessed August 18, 2025. https://academic.oup.com/bjd/article-abstract/182/5/1087/6603166?redirectedFrom=fulltext&login=false
10. Kahn D, Iturriaga C, Bertran K, et al. Sleep quality in children with atopic dermatitis during flares and after treatment. Sleep Sci. Sao Paulo Braz. 2020;13(2):172–175. https://doi.org/10.5935/1984-0063.20190139
11. Drucker AM, Wang AR, Li WQ, Sevetson E, Block JK, Qureshi AA. The burden of atopic dermatitis: summary of a report for the National Eczema Association. J Invest Dermatol. 2017;137(1):26–30. https://doi.org/10.1016/j.jid.2016.07.012
12. Maurelli M, Chiricozzi A, Peris K, Gisondi P, Girolomoni G. Atopic dermatitis in the elderly population. Acta. Derm. Venereol. 2023;103:adv13363. https://doi.org/10.2340/actadv.v103.13363
13. DaVeiga SP. Epidemiology of atopic dermatitis: a review. Allergy Asthma Proc. 2012;33(3):227–234. https://doi.org/10.2500/aap.2012.33.3569
14. Kim JP, Chao LX, Simpson EL, Silverberg JI. Persistence of atopic dermatitis (AD): a systematic review and meta-analysis. J. Am. Acad. Dermatol. 2016;75(4):681–687.e11. https://doi.org/10.1016/j.jaad.2016.05.028
15. Financial Burden of Atopic Dermatitis Out-of-Pocket Health Care Expenses in the United States—PubMed. Accessed June 19, 2025. https://pubmed.ncbi.nlm.nih.gov/33323748/
16. Elezbawy B, Kaló Z, Fasseeh A, Inotai A, Nemeth B, Ágh T. The hidden burden of atopic dermatitis in central and Eastern European countries. Expert Rev. Pharmacoecon. Outcomes Res. 2025;25(2):257–264. https://doi.org/10.1080/14737167.2024.2416249
17. Mohr N, Naatz M, Zeervi L, et al. Cost-of-illness of atopic dermatitis in Germany: data from dermatology routine care. J. Eur. Acad. Dermatol. Venereol. 2021;35(6):1346–1356. https://doi.org/10.1111/jdv.17203
18. GBD 2019 diseases and injuries collaborators. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the global burden of disease study 2019. Lancet. Lond. Engl. 2020;396(10258):1204–1222. https://doi.org/10.1016/S0140-6736(20)30925-9
19. Stevens GA, Alkema L, Black RE, et al. Correction: guidelines for accurate and transparent health estimates reporting: the GATHER statement. PLoS Med. 2016;13(8):e1002116. https://doi.org/10.1371/journal.pmed.1002116
20. GBD 2019 demographics collaborators. Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the global burden of disease study 2019. Lancet Lond. Engl. 2020;396(10258):1160–1203. https://doi.org/10.1016/S0140-6736(20)30977-6
21. Knoll M, Furkel J, Debus J, Abdollahi A, Karch A, Stock C. An R package for an integrated evaluation of statistical approaches to cancer incidence projection. BMC Med. Res. Methodol. 2020;20(1):257. https://doi.org/10.1186/s12874-020-01133-5
22. GBD 2021 causes of death collaborators. Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the global burden of disease study 2021. Lancet Lond. Engl. 2024;403(10440):2100–2132. https://doi.org/10.1016/S0140-6736(24)00367-2
23. Weidinger S, Simpson EL, Silverberg JI, et al. Burden of atopic dermatitis in paediatric patients: an international cross-sectional study. Br. J. Dermatol. 2024;190(6):846–857. https://doi.org/10.1093/bjd/ljad449
24. Tight junctions/adherens junctions: basic structure and function—PubMed. Accessed June 20, 2025. https://pubmed.ncbi.nlm.nih.gov/17934504/
25. Innate immunity and inflammation in ageing: a key for understanding age-related diseases—PubMed. Accessed June 20, 2025. https://pubmed.ncbi.nlm.nih.gov/15904534/
26. Williamson S, Merritt J, De Benedetto A. Atopic dermatitis in the elderly: a review of clinical and pathophysiological hallmarks. Br. J. Dermatol. 2020;182(1):47–54. https://doi.org/10.1111/bjd.17896
27. Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev. Clin. Immunol. 2017;13(1):15–26. https://doi.org/10.1080/1744666X.2016.1212660
28 Aguilera AC, Dagher IA, Kloepfer KM. Role of the microbiome in allergic disease development. Curr. Allergy Asthma Rep. 2020;20(9):44. https://doi.org/10.1007/s11882-020-00944-2
29. Faraz K, Seely M, Marano AL. The role of the environment in allergic skin disease. Curr. Allergy Asthma Rep. 2024;24(6):323–330. https://doi.org/10.1007/s11882-024-01147-9
30. Afshari M, Kolackova M, Rosecka M, Čelakovská J, Krejsek J. Unraveling the skin; a comprehensive review of atopic dermatitis, current understanding, and approaches. Front. Immunol. 2024;15:1361005. https://doi.org/10.3389/fimmu.2024.1361005
31. Taguchi N, Hata T, Kamiya E, Kobayashi A, Aoki H, Kunisada T. Reduction in human hair graying by sterubin, an active flavonoid of Eriodictyon angustifolium. J. Dermatol. Sci. 2018;92(3):286–289. https://doi.org/10.1016/j.jdermsci.2018.11.002
32. Furue M, Chiba T, Tsuji G, et al. Atopic dermatitis: immune deviation, barrier dysfunction, IgE autoreactivity and new therapies. Allergol. Int. Off. J. Jpn. Soc. Allergol. 2017;66(3):398-403. https://doi.org/10.1016/j.alit.2016.12.002
33. Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet Lond. Engl. 2010;376(9743):784–793. https://doi.org/10.1016/S0140-6736(10)61115-4
34. Li A, Fan L, Xie L, Ren Y, Li L. Associations between air pollution, climate factors and outpatient visits for eczema in West China Hospital, Chengdu, south-western China: a time series analysis. J. Eur. Acad. Dermatol. Venereol. 2018;32(3):486–494. https://doi.org/10.1111/jdv.14730
35. Belugina IN, Yagovdik NZ, Belugina OS, Belugin SN. Outdoor environment, ozone, radionuclide-associated aerosols and incidences of infantile eczema in Minsk, Belarus. J. Eur. Acad. Dermatol. Venereol. 2018;32(11):1977–1985. https://doi.org/10.1111/jdv.15063
36. Kim YM, Kim J, Jung K, Eo S, Ahn K. The effects of particulate matter on atopic dermatitis symptoms are influenced by weather type: application of spatial synoptic classification (SSC). Int. J. Hyg. Environ. Health. 2018;221(5):823–829. https://doi.org/10.1016/j.ijheh.2018.05.006
37. Yang S, Zhu T, Wakefield JS, Mauro TM, Elias PM, Man MQ. Link between obesity and atopic dermatitis: does obesity predispose to atopic dermatitis, or vice versa? Exp. Dermatol. 2023;32(7):975–985. https://doi.org/10.1111/exd.14801
38. Zhang S, Zhang B, Liu Y, Li L. Adipokines in atopic dermatitis: the link between obesity and atopic dermatitis. Lipids Health Dis. 2024;23(1):26. https://doi.org/10.1186/s12944-024-02009-z
39. Shang D, Zhao S. Molecular mechanisms of obesity predisposes to atopic dermatitis. Front. Immunol. 2024;15:1473105. https://doi.org/10.3389/fimmu.2024.1473105
40. Al-Afif KAM, Buraik MA, Buddenkotte J, et al. Understanding the burden of atopic dermatitis in Africa and the Middle East. Dermatol. Ther. 2019;9(2):223–241. https://doi.org/10.1007/s13555-019-0285-2
41. Schmid-Grendelmeier P, Takaoka R, Ahogo KC, et al. Position statement on atopic dermatitis in sub-Saharan Africa: current status and roadmap. J. Eur. Acad. Dermatol. Venereol. 2019;33(11):2019–2028. https://doi.org/10.1111/jdv.15972
42. Pavli A, Maltezou H. Health problems of newly arrived migrants and refugees in Europe. J. Travel Med. 2017;24(4). https://doi.org/10.1093/jtm/tax016
43. Kanda N, Hoashi T, Saeki H. The roles of sex hormones in the course of atopic dermatitis. Int. J. Mol. Sci. 2019;20(19):4660. https://doi.org/10.3390/ijms20194660
44. Hong J, Koo B, Koo J. The psychosocial and occupational impact of chronic skin disease. Dermatol Ther. 2008;21(1):54–59. https://doi.org/10.1111/j.1529-8019.2008.00170.x