Family quality of life among parents of children diagnosed with atopic dermatitis: a cross-sectional study at a tertiary hospital in Jeddah
Areen Y. Ibrahim1
, Abdullah W. Alfarwati1
, Zaina N. Alrawi1
, Ahmed K. Bahamim1
, Reem E. Alsomali1
, Saddiq B. Habiballah2,3
Contributions: (I) Conception and design: SB Habiballah, AY Ibrahim; (II) Administrative support: SB Habiballah; (III) Provision of study materials or patients: SB Habiballah, AY Ibrahim; (IV) Collection and assembly of data: AY Ibrahim, AW Alfarwati, ZN Alrawi, AK Bahamim, RE Alsomali; (V) Data analysis and interpretation: SB Habiballah, AY Ibrahim, AK Bahamim; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.
Background: Atopic dermatitis (AD) is an immune-mediated inflammatory process characterized by pruritus and skin dryness. It is considered one of the most common chronic conditions in pediatrics, affecting an estimated 20% of children worldwide. While previous studies showed AD has a clear and significant impact on caregivers of children with AD, our geographical area still needs similar evidence, given the scarcity of studies in this field. As far as our knowledge goes, this is the first study of its kind in Saudi Arabia. This study aimed to assess family quality of life among parents and legal guardians of children with AD attending a university hospital in Saudi Arabia, in order to support a more comprehensive family-centered approach to disease management.
Methods: Our study is a single-center, cross-sectional, caregiver survey-based study measuring the family quality of life of caregivers of AD patients using the Family Dermatology Life Quality Index (FDLQI). We hypothesized that caregivers in our population would have impaired quality of life, consistent with global data. We recruited caregivers of children (aged 0–14 years) diagnosed with AD at the pediatric allergy clinic of King Abdulaziz University Hospital, Jeddah, between July 2023 and August 2024 via telephone contact. Family quality of life was measured using the validated FDLQI, scored 0–30, with higher scores indicating greater impairment.
Results: Our results indicate that FDLQI scores, reflecting impaired family quality of life, were higher among mothers (mean 11.08±6.2) compared to fathers (mean 8.16±3.8), but the overall difference between caregivers was not statistically significant. The overall mean FDLQI score among all participants was 10.22±5.84. While no significant differences were identified by caregiver role, child age, disease duration or comorbidities, the overall FDLQI score (10.22±5.84) indicates moderate family quality of life impairment. These findings provide the first local evidence from Saudi Arabia; null results should be interpreted with caution given the limited sample size and the lack of data on disease severity.
Conclusions: Family quality of life is impaired among caregivers of children with AD in Jeddah, regardless of child age, disease duration, or parental role, underscoring the need for universal psychosocial support in pediatric dermatology practice. Our findings provide foundational local evidence and highlight the need for larger longitudinal studies in the region.
Keywords: Atopic dermatitis (AD); caregiver quality of life; Family Dermatology Life Quality Index (FDLQI); parental burden
Submitted Dec 14, 2025. Accepted for publication May 07, 2026. Published online Jun 26, 2026.
doi: 10.21037/tp-2025-1-902
Highlight box
Key findings
• Family quality of life, measured using the Family Dermatology Life Quality Index (FDLQI), was impaired among caregivers of children with atopic dermatitis (AD). However, no significant differences in FDLQI scores were observed according to child age, parental role, family history, disease duration, or coexisting atopic conditions. These findings suggest that impaired quality of life among caregivers highlight the importance of universal psychosocial support.
What is known and what is new?
• Parents and legal guardians of children with AD often experience stress and impaired quality of life due to the chronic and relapsing nature of the disease. Previous studies suggest disease severity, child age, family history, and caregiver role may influence caregiver burden, although findings remain inconsistent. Family quality of life impairment assessed using the FDLQI has been widely reported internationally, while regional evidence remains limited.
• Our study found impaired family quality of life among caregivers of children with AD regardless of child age, parental role, family history, disease duration, or coexisting atopic conditions. No significant association was observed between FDLQI scores and child-related or parental factors, suggesting that caregiver burden may be universally experienced among affected families. In addition, this study provides regional data from Saudi Arabia, where evidence remains limited.
What is the implication, and what should change now?
• Routine screening and psychosocial support should be considered for all caregivers of children with AD. Integrating counseling and educational interventions into pediatric dermatology care may improve family well-being and disease management. Future studies should evaluate additional contributors to caregiver burden, given the limited regional evidence.
Introduction
Background
Atopic dermatitis (AD) is an immune-mediated inflammatory process characterized by pruritus and dryness of the skin (1). Literature estimates that around 20% of children are affected worldwide (2). AD has a significant impact on physical and mental health. It affects sleep, self-esteem, and social interactions, creating challenges for affected children and their families, especially their primary caregivers (3).
Caring for a child with moderate to severe AD could be exhausting. In many instances, the entire family’s lifestyle would be affected, given the social and financial burdens of this disease management. Caregivers of AD-affected children experience higher levels of stress and a lower quality of life compared to their counterparts with no AD children (3-5).
Rationale and knowledge gap
Previous findings have shown a high prevalence of anxiety and depression among parents of children with AD, with a 51.4% prevalence in China (4). Research has also indicated a positive correlation between the severity of the child’s AD and increased parental anxiety levels as parents cope with their child’s physical and social challenges (6). Additionally, a Korean study revealed that mothers of children diagnosed with AD experienced more stress and mental illness than fathers (7).
As global data is available on the relationship between caregiver burden and childhood eczema, there is a lack of similar data in Saudi Arabia. This gap is particularly meaningful given Saudi Arabia’s unique environmental and sociocultural context. The region’s extreme heat and arid climate are known triggers for AD flares, potentially increasing disease burden and caregiver stress beyond what is reported in temperate climates. This gap makes it challenging to fully understand the extent to which caregiver distress impacts adherence to treatment and overall disease control, ultimately making it difficult to ensure optimal and consistent management of pediatric AD cases.
Furthermore, the extended multigenerational family structure prevalent in Saudi culture may both distribute and concentrate caregiving responsibilities in distinct ways. These factors suggest that the impact of AD on family quality of life in Saudi Arabia may differ substantially from that documented in Western or East Asian populations, justifying a dedicated local investigation.
Objective
This study aims to assess family quality of life impairment among caregivers of pediatric patients with AD at a university hospital in Saudi Arabia, using the Family Dermatology Life Quality Index (FDLQI) questionnaire, among caregivers who visited the pediatric allergy clinic at King Abdulaziz University Hospital in Jeddah between July 2023 and August 2024, and to evaluate the utility of routine FDLQI use in pediatric immunology clinics. We present this article in accordance with the STROBE reporting checklist (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-1-902/rc).
Methods
The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. We conducted a cross-sectional study at King Abdulaziz University Hospital (KAUH), a tertiary teaching hospital in Saudi Arabia, and the study was approved by the Research Ethics Committee of King Abdulaziz University, Jeddah, Saudi Arabia (Ref: 166-24). Verbal consent was obtained from the patients’ caregivers prior to participation, in accordance with ethical guidelines for survey-based research. The caregivers of 87 pediatric patients with AD who visited the pediatric allergy clinic from July 2023 to August 2024 were contacted to participate in the study. We used the cutoff age of 14 years to define pediatric patients following the Ministry of Health definition. Patients with a history of psychiatric illnesses before diagnosis, those with language barriers, and those who refused to participate in the study were all excluded. The calculated sample size was 67 using the Raosoft website, with a margin of error of 5% and a 90% confidence interval. Due to refusal and non-responses, the final sample was 50 participants with a 25.4% shortfall. This underpowered sample means null results should not be interpreted as true equivalence.
The participants were contacted via telephone calls. The FDLQI, a three-sectioned questionnaire, was translated from English to Arabic. The FDLQI is a valid and reliable instrument for measuring the secondary impact of skin disease on family quality of life, comprising ten questions (numbered 1–10). The scoring of each question is as follows: not at all/not relevant = 0; a little = 1; quite a lot = 2; very much = 3; and question unanswered = 0. The total score is calculated by summing the scores of each question, resulting in a maximum of 30 and a minimum of 0. The higher the score, the more family quality of life is impaired. The questionnaire can also be expressed as a percentage of the maximum possible score 30 (8). Google Sheets (Google Inc., Mountain View, CA, USA) were used for data entry.
The first section aimed to describe the purpose of the research and consent for participants, while the second section collected demographic data such as the child’s age, nationality, relation of the participant to the patient, age at the time of AD diagnosis, and family history of AD. The third section assessed family quality of life among caregivers using the FDLQI.
Statistical analysis
Collected data were then analyzed using SPSS program version 26 (IBM Corp., Armonk, NY, USA). Qualitative data were expressed as numbers and percentages. Quantitative data was presented as mean and standard deviation (mean ± SD), where Mann-Whitney and Kruskal-Wallis tests were applied for non-parametric variables. A P value of <0.05 was considered statistically significant. All statistical tests were two-sided. Multivariable analysis to adjust for potential confounders was not performed due to the limited sample size; this represents a methodological limitation that should be addressed in future larger-scale studies.
Results
A total of 50 participants were enrolled in the study. Table 1 demonstrated the demographic characteristics of participants: 74% were mothers, 24% were fathers, and only 2% were siblings. Among the children diagnosed with AD, the mean age was 6.7 years, and the mean duration since the diagnosis was 3.21 years. Furthermore, the most prominent nationality was Saudi (90%), while 10% were other nationalities. Additionally, 68% of children were documented to have other atopies, including medication allergies, food allergies, asthma, allergic rhinitis and urticaria. On the other hand, 32% were diagnosed exclusively with AD. The most prevalent reported atopy is food allergy, with 24 participants (48%) confirming their diagnosis through skin prick or specific serum IgE testing. Asthma and allergic rhinitis were observed in 17 participants (34%) and 16 participants (32%), respectively. In most cases, asthma was either a parental diagnosis or a physician’s diagnosis. Concerning family history, 54% of children had a family history of AD, 44% reported no family history, and 2% didn’t know.
Table 1
| Variable | Female | Male | t | P value |
|---|---|---|---|---|
| Relationship with patient | 0.94 | 0.62 | ||
| Father | 6 (25) | 6 (23.1) | ||
| Mother | 18 (75) | 19 (73.1) | ||
| Sibling | 0 (0.0) | 1 (3.8) | ||
| Nationality | 0.14 | 0.71 | ||
| Non-Saudi | 2 (8.3) | 3 (11.5) | ||
| Saudi | 22 (91.7) | 23 (88.5) | ||
| Family history of eczema | 3.48 | 0.18 | ||
| Unknown | 0 (0.0) | 1 (3.8) | ||
| No | 8 (33.3) | 14 (53.8) | ||
| Yes | 16 (66.7) | 11 (42.3) | ||
| Other atopies | 0.17 | 0.68 | ||
| No | 7 (29.2) | 9 (34.6) | ||
| Yes | 17 (70.8) | 17 (65.4) | ||
| Medication allergies | 0.94 | 0.33 | ||
| No | 24 (100) | 25 (96.2) | ||
| Yes | 0 (0.0) | 1 (3.8) | ||
| Food allergies | 0.07 | 0.79 | ||
| No | 12 (50) | 14 (53.8) | ||
| Yes | 12 (50) | 12 (46.2) | ||
| Asthma | 0.09 | 0.92 | ||
| No | 16 (66.7) | 17 (65.4) | ||
| Yes | 8 (33.3) | 9 (34.6) | ||
| Allergic rhinitis | 0.03 | 0.85 | ||
| No | 16 (66.7) | 18 (69.2) | ||
| Yes | 8 (33.3) | 8 (30.8) | ||
| Urticaria other than food allergies | 1.1 | 0.29 | ||
| No | 23 (95.8) | 26 (100) | ||
| Yes | 1 (4.2) | 0 (0.0) |
Mean child age was 6.7±4.37 years; mean duration since diagnosis was 3.21±3.57 year.
Several notable patterns were observed in analyzing the mean FDLQI scores reflecting family quality of life impairment among a sample of 50 participants. Mothers reported a mean FDLQI score of 11.08±6.2 compared to fathers’ mean score of 8.16±3.8; however, this difference was not statistically significant (P=0.16). The overall mean FDLQI score among all participants was 10.22±5.84, indicating moderate impairment of family quality of life.
Furthermore, a non-significant relationship was found between the mean FDLQI total score and having other atopies and their types (P>0.05). And no remarkable differences were found regarding the child’s history of AD or certain types of allergies, such as medications or environmental allergies (P>0.05). Additionally, atopic rhinitis did not result in significant differences in FDLQI scores (P>0.05) (Table 2).
Table 2
| Variable | FDLQI total score, mean ± SD | t | P value |
|---|---|---|---|
| Gender of the caregiver | 1.23 | 0.22 | |
| Female | 9.75±6.91 | ||
| Male | 10.63±4.75 | ||
| Relationship with patient | 3.61* | 0.16 | |
| Father | 8.16±3.8 | ||
| Mother | 11.08±6.2 | ||
| Sibling† | 3 | ||
| Nationality | 0.7** | 0.19 | |
| Non-Saudi | 14.8±8.2 | ||
| Saudi | 9.71±5.4 | ||
| Family history of eczema | 3.53* | 0.17 | |
| Unknown† | 10 | ||
| No | 8.22±4.33 | ||
| Yes | 11.85±6.56 | ||
| Other atopies | 0.55 | 0.58 | |
| No | 10.81±6.29 | ||
| Yes | 9.94±5.69 | ||
| Medication allergies | 0.7 | 0.80 | |
| No | 10.2±5.9 | ||
| Yes† | 11 | ||
| Food allergies | 0.23 | 0.82 | |
| No | 10.03±6.07 | ||
| Yes | 10.41±5.7 | ||
| Asthma | 0.65 | 0.51 | |
| No | 10.48±5.95 | ||
| Yes | 9.7±5.7 | ||
| Allergic rhinitis | 0.15 | 0.88 | |
| No | 10.08±5.83 | ||
| Yes | 10.5±6.04 | ||
| Urticaria other than food allergies | 0.17 | 0.09 | |
| No | 9.91±5.49 | ||
| Yes | 10.42±0.001 |
*, Kruskal Wallis test; **, Mann-Whitney test. †, these subgroups consisted of one participant (n=1); SD could not be calculated. FDLQI, Family Dermatology Life Quality Index; SD, standard deviation.
The results of Spearman’s correlation analysis examine the relationship between the total FDLQI score and two variables: child age and duration since diagnosis. It found that the child’s age had no significant relationship to FDLQI scores (r=−0.013, P=0.36). Similarly, the duration since diagnosis also showed no significant correlation with family quality of life impairment (r=0.04, P=0.77).
Discussion
Key findings
The findings of this study offer meaningful insights into the family quality of life and demographic characteristics of caregivers of children diagnosed with AD and comorbid allergic conditions. The demographic data exhibit a predominance of mothers as the primary caregivers (74%) and no statistically significant difference in FDLQI scores between mothers and fathers. This lack of a significant gender difference is inconsistent with findings from previous studies, which found that mothers managing chronic conditions in their children experience greater emotional and psychological distress than fathers (7,9,10).
Explanations of findings
This might be due to recent changes in parental traditional roles, where now both parents carry the responsibility for healthcare and nutrition. Additionally, the vast majority of the study participants were Saudi (90%), which emphasizes the local context of this study and reflects that the results primarily reflect experiences within this population.
The prevalence of comorbid atopic conditions, including food allergies (48%) and asthma (34%), was an important observation in this study, with almost 68% of the children found to have other atopies in addition to AD, supporting the well-established association between AD and other atopic diseases. This overlap of comorbid atopic conditions aligns with research suggesting that AD is part of the atopic march, where one atopic condition predisposes the child to develop others over time. The presence of allergic rhinitis (32%) in this population confirms this pattern of atopy clustering.
Comparison with similar research
Previous literature has suggested an association between increased caregiver burden and comorbid conditions, with parents of children with more complex medical profiles facing more significant challenges that may accentuate their levels of stress and impaired quality of life (11). Our study did not find a significant difference in FDLQI scores between caregivers of children with AD alone and those with additional atopic comorbidities. While managing multiple conditions may contribute to an increased caregiving burden, our findings indicate that this factor alone may not be a primary determinant of family quality of life impairment in our population.
Remarkably, our findings showed that there is no significant relationship between the child’s age or the time elapsed since the diagnosis and family quality of life impairment; hence, it may be said that the chronicity of AD, in and of itself, does not exacerbate caregiver burden (Figures 1,2). This contrasts with earlier studies, which argued that a longer duration of the diagnosis was a protective factor for caregiver distress (4).
While this might be the case, other factors related to disease severity or the presence of comorbid conditions may well be more significant predictors of family quality of life impairment than the mere passage of time or the child’s age (12).
Another key finding in this study is the lack of significant difference in FDLQI scores observed between the different types of allergies, such as food or environmental allergies. This agrees well with studies showing that while allergies may exacerbate caregiver burden, the type of allergy may not be a significant determinant of family quality of life impairment (11). Similarly, our findings also showed that allergic rhinitis was not significantly associated with higher FDLQI scores, a result mirroring previous findings in the literature, where allergic rhinitis has often been perceived as less severe and light to live with, as opposed to other atopic conditions such as asthma or food allergies (13).
Strengths and limitations
While this study provided insights into the relationship between AD and family quality of life, using the validated FDLQI questionnaire administered in the clinics, several limitations must be considered. A key limitation is the small sample size: only 50 caregivers participated, fewer than the calculated minimum of 67 (based on a 90% confidence interval and a 5% margin of error). In addition, variable severity of eczema not precisely examined for each patient, there was also no control group in the research which might limit the accuracy of quality of life estimation.
Implications and actions needed
Although the results were not statistically significant, healthcare professionals should continue to support caregivers of children with AD through resource sharing and explanation of preventive measures to help improve family quality of life.
Conclusions
Caregivers of children with AD experience impaired family quality of life, as measured by the FDLQI, independent of child age, disease factors, or parental role. This highlights the need for routine psychosocial support for all parents, rather than targeting only those perceived as high-risk. Providing counselling, education, and resources within pediatric dermatology care can enhance family well-being and support effective disease management. These findings also contribute valuable local evidence from a tertiary hospital in Jeddah, offering a foundation for further research on caregiver mental health in the region.
Acknowledgments
The authors affirm that they employed an artificial intelligence-based linguistic model to improve clarity in English and enhance writing, ensuring that all ideas, data, results, and discussions are original, with no involvement from AI in their generation.
Footnote
Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-1-902/rc
Data Sharing Statement: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-1-902/dss
Peer Review File: Available at https://tp.amegroups.com/article/view/10.21037/tp-2025-1-902/prf
Funding: None.
Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tp.amegroups.com/article/view/10.21037/tp-2025-1-902/coif). The authors have no conflicts of interest to declare.
Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The study was conducted in accordance with the Declaration of Helsinki and its subsequent amendments. The study was approved by the Research Ethics Committee of King Abdulaziz University, Jeddah, Saudi Arabia (Ref: 166-24). Verbal consent was obtained from the patients’ caregivers prior to participation, in accordance with ethical guidelines for survey-based research.
Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.
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