Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting up to 20% of children, significantly impacting their quality of life (1). While the burden on children is well documented, the emotional toll on parents, particularly feelings of guilt, remains underexplored (2, 3). Guilt is a recognized response among caregivers of children with chronic illnesses, often assessed as a component of parental stress (4), but its prevalence and determinants in atopic dermatitis (AD) remain poorly explored.
This study assesses parental guilt in a representative US sample of parents of children with AD.
MATERIALS AND METHODS
The survey was conducted within the framework of “Scars of Life”. “Scars of Life” is a cross-sectional observational study, launched at the beginning of 2024, to assess the psychosocial burden of patients’ disease. A representative sample of 500 US parents of children with physician-diagnosed AD was recruited via stratified quota sampling from the Megabase database (Kantar Health, NY, USA), based on age, sex, environment, and income (5). Participants completed a digital questionnaire.
The questionnaire was developed in collaboration with the National Eczema Association (NEA). It included sociodemographic characteristics, personal history of AD, Caregiver-reported Patient Oriented Eczema Measure (POEM) score, familial history of AD, gender of the child, age of onset of the child’s AD, birth order of child, impact of AD on child’s daily life, impact on child’s social or emotional behaviour, ways of support during AD flare-ups (strictly medical, finding natural or alternative remedies, providing emotional support, leave your child to cope on their own), cooperation with other parents (close, difficult, or limited by disagreements), and presence of a feeling of guilt regarding their child’s AD.
Statistical analysis
Qualitative variables were analysed by frequency, quantitative variables by mean and standard deviation. Comparisons used chi-square and t-tests (α = 0.05). Multivariate logistic regression assessed predictors of guilt. Analyses were performed using EasyMedStat software (https://www.easymedstat.com/).
Results
Overall, 500 parents of children with AD were included in the study, including 311 females (62.2%) and 189 males (37.8%). The mean ± standard deviation (SD) age of females was 37.89 ± 7.46 and that of males was 38.85 ± 6.57 (p-value: 0.087).
A total of 404 parents (80.8%) reported feelings of guilt, with similar proportions of guilt expressed by parents of boys (82.7%, n = 239/289) compared with parents of girls (78.5%, n = 164/209; p = 0.285). Feelings of guilt were reported more commonly in parents of children with moderate (83.2%, n = 238/286) and severe (88.5%, n = 77/87) AD (based on the POEM score) than mild AD (70%, n = 89/170).
Interestingly, parental guilt was reported more commonly among those with children whose AD began at age 2–6 years (82.6%, n = 214/259) and above age 6 years (86.4%, n = 121/140) compared with before the age of 2 years (68.3%, n = 69/101; p = 0.01). A personal history of AD in parents was not significantly associated with guilt (83% of cases, compared with 77.5% of those without such a history, p = 0.15). Similarly, 82.8% of parents with a family history of AD reported guilt vs 76.4% without a family history (p = 0.12).
Parents whose eldest or only child was affected expressed guilt at rates of 88.7% (n = 94/106) and 88.3% (n = 98/111) respectively. The rates were only 78.6% (p = 0.02) and 78.7% (p = 0.03) respectively for those who were not eldest.
Additionally, 93.3% of parents whose child experienced daily life impacts from AD felt guilty, compared with 58.6% among those whose child’s life was unaffected (p < 0.001). Similarly, guilt was reported by 90.3% of parents whose child faced social or emotional challenges related to AD, compared with 56.4% of those without such challenges (p < 0.001).
More parents (n = 126/138: 91.3%) expressed guilt when cooperation with their partner was difficult or limited compared with those who had close cooperation from their partner (n = 216/274: 78.8%; p = 0.001).
Additionally, 93.3% of parents whose child experienced daily life impacts from AD felt guilty, compared with 58.6% among those whose child’s life was unaffected (p < 0.001). Similarly, guilt was reported by 90.3% of parents whose child faced social or emotional challenges related to AD, compared with 56.4% of those without such challenges (p < 0.001).
More parents (n = 126/138: 91.3%) expressed guilt when cooperation with their partner was difficult or limited compared with those who had close cooperation from their partner (n = 216/274: 78.8%; p = 0.001) (Table I).
Table I.
Proportion of parents with or without feelings of guilt regarding each of the studied variables
| Item | Guilt (n = 404) n (%) | No guilt (n = 96) n (%) | p-value |
|---|---|---|---|
| Gender of parent | |||
| Female parent | 238 (58.91) | 73 (76.04) | 0.004 |
| Male parent | 163 (40.35) | 22 (22.92) | |
| Severity ( POEM) | |||
| Mild | 89 (22.0) | 38 (39.58) | 0.001 |
| Moderate | 238 (58.9) | 48 (50.00) | |
| Severe | 77 (19.1) | 10 (10.42) | |
| Gender of child | |||
| Boy | 239 (59.2) | 50 (52.08) | 0.285 |
| Girl | 164 (40.6) | 45 (46.88) | |
| Age of eczema onset | |||
| < 2 years | 69 (17.1) | 32 (33.33) | 0.001 |
| 2–6 years | 214 (53.0) | 45 (46.88) | |
| > 6 years | 121 (30.0) | 19 (19.79) | |
| History of atopic dermatitis in parent | |||
| Yes | 249 (61.6) | 51 (53.13) | 0.15 |
| No | 155 (38.4) | 45 (46.88) | |
| History of atopic dermatitis in family | |||
| Yes | 284 (70.3) | 59 (61.46) | 0.12 |
| No | 120 (29.7) | 37 (38.54) | |
| Affected child | |||
| Eldest | |||
| Yes | 94 (23.3) | 12 (12.5) | 0.029 |
| No | 310 (76.7) | 84 (87.5) | |
| Only child | |||
| Yes | 98 (24.3) | 13 (13.5) | 0.033 |
| No | 306 (75.7) | 83 (86.5) | |
| Impact of AD on child’s daily life as perceived by parents | |||
| Yes | 346 (85.6) | 55 (57.3) | < 0.001 |
| No | 58 (14.4) | 41 (42.7) | |
| Social or emotional behaviour impacted as perceived by parent | |||
| Yes | 325 (80.4) | 35 (36.5) | < 0.001 |
| No | 79 (19.6) | 61 (63.5) | |
| Ways of support eczema flares | 147 | 30 | |
| Strictly medical | 257 (63.6) | 66 (68.8) | 0.4 |
| Finding natural or alternative remedies | 201 (49.8) | 51 (53.1) | 0.6 |
| Providing emotional support | 264 (65.3) | 66 (68.8) | 0.6 |
| Leave your child to cope on their own | 45 (11.1) | 7 (7.3) | 0.4 |
| Work with other parent | |||
| Closely together | |||
| Yes | 216 (53.5) | 58 (60.4) | 0.21 |
| No | 188 (46.5) | 38 (39.6) | |
| Cooperation difficult or limited with disagreements | |||
| Yes | 126 (31.2) | 12 (12.5) | < 0.001 |
| No | 278 (68.8) | 84 (87.5) | |
Among parents expressing guilt, there are few differences between fathers and mothers. The details of the comparison between mothers with guilt and fathers with guilt are presented in Table II.
Table II.
Comparison of mothers and fathers with feelings of guilt
| Item | Mothers with feelings of guilt | Fathers with feelings of guilt | p-value |
|---|---|---|---|
| Gender of parent | |||
| Female parent | 238 | ||
| Male parent | 163 | ||
| Severity (POEM) | |||
| Mild | 52 (21.8) | 36 (22.1) | 0.0849 |
| Moderate | 137 (57.6) | 99 (60.7) | |
| Severe | 49 (20.6) | 28 (17.2) | |
| Gender of child | |||
| Boy | 109 (45.8) | 129 (79.1) | < 0.001 |
| Girl | 128 (53.8) | 34 (20.9) | |
| Age of eczema onset | |||
| < 2 years | 60 (25.2) | 9 (5.5) | < 0.001 |
| 2–6 years | 122 (51.3) | 89 (54.6) | |
| > 6 years | 56 (23.5) | 65 (39.9) | |
| History of atopic dermatitis in parent | |||
| Yes | 146 (61.3) | 100 (61.3) | 0.999 |
| No | 92 (38.7) | 63 (38.7) | |
| History of atopic dermatitis in family | |||
| Yes | 168 (70.6) | 113 (69.3) | 0.88 |
| No | 70 (29.4) | 50 (30.7) | |
| Affected child | |||
| Eldest | |||
| Yes | 50 (21.0) | 44 (27.0) | 0.204 |
| No | 188 (79.0) | 119 (73.0) | |
| Only child | |||
| Yes | 53 (22.3) | 45 (27.6) | 0.27 |
| No | 185 (77.7) | 118 (72.4) | |
| Impact of AD on child’s daily life as perceived by parents | |||
| Yes | 205 (86.1) | 139 (85.3) | 0.923 |
| No | 33 (13.9) | 24 (14.7) | |
| Social or emotional behaviour impacted as perceived by parent | |||
| Yes | 182 (76.5) | 141 (86.5) | 0.018 |
| No | 56 (23.5) | 22 (13.5) | |
| Ways of support eczema flares | |||
| Strictly medical | 169 (71.01) | 85 (52.1) | < 0.001 |
| Finding natural or alternative remedies | 121 (50.84) | 80 (49.1) | 0.807 |
| Providing emotional support | 163 (68.49) | 99 (60.7) | 0.135 |
| Leave your child to cope on their own | 18 (7.56) | 26 (16.0) | 0.013 |
| Work with other parent | |||
| Closely together | |||
| Yes | 128 (53.8) | 87 (53.4) | 0.9 |
| No | 110 (46.2) | 76 (46.6) | |
| Cooperation difficult or limited with disagreements | |||
| Yes | 61 (25.6) | 63 (38.7) | < 0.01 |
| No | 177 (74.4) | 100 (61.3) | |
In the multivariate analysis, we analysed the factors associated with parents’ guilt regarding their child’s atopic dermatitis (AD). The results show that fathers do not show a significant difference in guilt compared with mothers (OR = 1.58; 95% CI (0.817; 3.05); p = 0.175). However, a personal history of atopic dermatitis in the parents is significantly associated with increased guilt (OR = 1.79; 95% CI (1; 3.2); p = 0.049). Regarding the age of onset of AD, parents of children aged 2 to 6 years reported higher levels of guilt than those whose children were younger than 2 years (OR = 2.16; 95% CI (1.09; 4.27); p = 0.027). Having an only child was also associated with higher levels of parental guilt (OR = 2.41; 95% CI (1.08; 5.36); p = 0.031). However, no significant association was found between the sex of the child and parental guilt, with parents of girls having an odds ratio of 0.798 (95% CI (0.446; 1.43); p = 0.448) compared with parents of boys. Limited parental cooperation, compared with close cooperation, appeared to be associated with marginally significantly increased guilt (OR = 2.08; 95% CI (0.991; 4.36); p = 0.052). The other results are presented in Table III.
Table III.
Multivariate analysis
| Item | Odds ratio | p-value |
|---|---|---|
| Intercept | 2.37 [0.776; 7.25] | 0.13 |
| Parent | ||
| Reference: mother | ||
| Father | 1.58 [0.817; 3.05] | 0.175 |
| Personal history of A D | 1.79 [1;3.2] | 0.049 |
| Age of onset | ||
| Reference < 2 years | ||
| 2–6 years | 2.16 [1.09; 4.27] | 0.0274 |
| > 6 years | 1.81 [0.823; 3.97] | 0.14 |
| Only child | 2.41 [1.0 8; 5.36] | 0.0315 |
| Sex of child | ||
| Reference: boy | ||
| Girl | 0.798 [0.446; 1.43] | 0.448 |
| Ways of support during AD flare-ups | ||
| Strictly medical | 0.725 [0.353; 1.49] | 0.381 |
| Finding natural or alternative remedies | 0.611 [0.34; 1.1] | 0.0988 |
| Providing emotional support | 0.815 [0.438; 1.52] | 0.519 |
| Leave your child to cope on their own | 1.52 [0.418; 5.52] | 0.526 |
| Cooperation with other parent | ||
| Reference: close cooperation | ||
| Limited cooperation | 2.08 [0.991; 4.3 6] | 0.0528 |
DISCUSSION
This study shows that 80.8% of parents of children with atopic dermatitis (AD) experience feelings of guilt, a prevalence likely higher than that reported in other chronic paediatric conditions, where guilt is often assessed indirectly as a component of parenting stress (4). This emotional burden is particularly pronounced among parents of children with moderate to severe AD, reflecting the significant toll of observing a child’s struggle with daily life disruptions and social/emotional challenges (2, 8). The caregiving responsibilities associated with managing AD profoundly alter parents’ daily routines, as they undertake complex tasks to support their child’s condition, transitioning from routine caregiving to a more intensive role as care providers (9).
Guilt is strongly associated with specific factors, including later AD onset (ages 2–6), having an only child, and limited co-parenting cooperation. Parents with a personal history of AD report heightened guilt, likely due to perceived genetic responsibility for their child’s condition (6, 7). These findings are consistent with prior research indicating that familial and genetic factors amplify parental emotional responses (6). Limited co-parenting cooperation further exacerbates guilt, possibly due to increased stress and feelings of isolation, underscoring the critical role of family dynamics in shaping emotional outcomes (10).
These results highlight the necessity of a family-centred approach to AD management, one that addresses both the clinical symptoms of the child and the emotional well-being of parents (3, 11).
In 2015, Pustišek et al. (12) mentioned that clinicians should incorporate emotional and educational support into the management of AD to improve the well-being of families. It is understandable that this type of support may be difficult to implement in a community practice. In such practices, addressing parents’ feelings of guilt during consultations could encourage open discussions and thus alleviate parents’ emotional distress and promote better well-being for the whole family. Such an approach may enhance treatment adherence and strengthen family resilience, ultimately improving outcomes for children with AD.
In conclusion, parental guilt in AD is influenced by several factors, including the parent’s history of AD, the onset of the child’s symptoms between ages 2 and 6, and whether the child is an only child. Guilt is more common when AD significantly impacts the child’s daily life or emotional well-being, with fathers particularly affected by perceived social challenges. Additionally, the quality of parental cooperation within the family plays a role, as higher guilt is reported when cooperation is limited.
ACKNOWLEDGEMENT
The authors sincerely thank the 500 parents and their 500 children who took the time to complete the questionnaire.
Funding Statement
Funding sources The study was designed by La Roche Posay Laboratoire Dermatologique, France.
IRB approval status
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 (Committee for the Protection of Individuals South-East I dated 11 March 2024).
Conflict of interest disclosures
WSB, CS, JIS, and CT have no conflicts of interest to declare in this study. ALD-F, CLF, and DK, are employed by the La Roche Posay Laboratory.
REFERENCES
- 1.Langan SM, Mulick AR, Rutter CE, Silverwood R, Asher I, García-Marcos L, et al. Trends in eczema prevalence in children and adolescents: a Global Asthma Network Phase I Study. Clin Exp Allergy 2023; 53: 337–352. 10.1111/cea.14276 [DOI] [Google Scholar]
- 2.Marciniak J, Reich A, Szepietowski JC. Quality of life of parents of children with atopic dermatitis. Acta Derm Venereol 2017; 97: 711–714. 10.2340/00015555-2633 [DOI] [PubMed] [Google Scholar]
- 3.Chamlin SL, Frieden IJ, Williams ML, Chren MM. Effects of atopic dermatitis on young American children and their families. Pediatrics 2004; 114: 607–611. 10.1542/peds.2004-0374 [DOI] [PubMed] [Google Scholar]
- 4.Cousino MK, Hazen RA. Parenting stress among caregivers of children with chronic illness: a systematic review. J Pediatr Psychol 2013; 38: 809–828. 10.1093/jpepsy/jst049 [DOI] [PubMed] [Google Scholar]
- 5.Richard MA, Paul C, Nijsten T, Gisondi P, Salavastru C, Taieb C, et al. Prevalence of most common skin diseases in Europe: a population-based study. J Eur Acad Dermatol Venereol 2022; 36: 1088–1096. 10.1111/jdv.18050 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Bursztejn AC, Shourick J, Bodemer C, Lasek A, Mahé E, Merhand S, et al. Feelings of guilt in parents of children with atopic dermatitis. J Eur Acad Dermatol Venereol 2022; 36: e155–e157. 10.1111/jdv.17712 [DOI] [PubMed] [Google Scholar]
- 7.Wang IJ, Wen HJ, Chiang TL, Lin SJ, Guo YL. Maternal psychologic problems increased the risk of childhood atopic dermatitis. Pediatr Allergy Immunol 2016; 27: 169–176. 10.1111/pai.12518 [DOI] [PubMed] [Google Scholar]
- 8.Kilic N, Kilic M. Investigation of quality of life of patients with atopic dermatitis and quality of life, psychiatric symptomatology, and caregiver burden of their mothers. Children (Basel) 2023; 10: 1487. 10.3390/children10091487 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Knafl K, Deatrick JA, Gallo AM. The interplay of concepts, data, and methods in the development of the Family Management Style Framework. J Fam Nurs 2008; 14: 412–428. 10.1177/1074840708327138 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Lee HJ, Lee GN, Lee JH, Han JH, Han K, Park YM. Psychological stress in parents of children with atopic dermatitis: a cross-sectional study. Acta Derm Venereol 2023; 103: adv00844. 10.2340/actadv.v103.2242 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Beattie PE, Lewis-Jones MS. An audit of the impact of a consultation with a paediatric dermatology team on quality of life in infants with atopic eczema and their families. Br J Dermatol 2006; 155: 1249–1255. 10.1111/j.1365-2133.2006.07525.x [DOI] [PubMed] [Google Scholar]
- 12.Pustišek N, Vurnek Živković M, Šitum M. Quality of life in families with children with atopic dermatitis. Pediatr Dermatol 2016; 33: 28–32. 10.1111/pde.12698 [DOI] [PubMed] [Google Scholar]