Correlation Revealed Between Pediatric Atopic Dermatitis and Uveitis

A recent retrospective cohort study from Taiwan indicated an increased risk of pediatric uveitis in children with early-onset atopic dermatitis (AD), independent of dupilumab use or autoimmune conditions.1

Uveitis risk as a byproduct of early-onset AD has been very infrequently researched; despite the severity of the simultaneous diseases, few cases report the relationship between AD and uveitis. Past research has suggested that uveitis is only a threat when AD occurs in conjunction with autoimmune conditions or the use of dupilumab.2

“Despite its potential severity, uveitis in the context of AD has been reported in only a few case studies, with some attributing its occurrence to the use of dupilumab,” wrote Yung-Yu Chu, MD, department of ophthalmology, Chi Mei Medical Center, and colleagues. “Furthermore, to our knowledge, only 1 single-center case-control study has investigated the association between atopy and uveitis, in a primarily adult population.”1

Investigators collected data from the TriNetX research network, specifically targeting the US Collaborative Network for patients with early-onset AD from 2004-2024. After filtering for cases of AD diagnosed at <2 years of age, the initial total was 456,432 participants. The team then excluded anyone with a history of uveitis and other diseases before the index date, which brought the total down to 114,889 participants in both the AD and control cohorts. Each patient with AD was then matched to a control participant without AD.1

Participants were then divided into disease severity cohorts based on medical treatments received, with 3004 patients considered “severe” and 126,482 considered “nonsevere”. Risk of pediatric uveitis was then compared between the groups with up to 16 years of follow-up from the date of index.

Upon analysis, Chu and colleagues indicated that the AD group had a higher risk of pediatric uveitis compared to control (94[0.08%] vs 58[0.05%]; HR, 1.92, 95% CI, 1.38-2.66, P <.001). Iridocyclitis risk was also elevated in the AD cohort (86[.08%] vs 49 [.04%]; HR 2.09, 95% CI, 1.47-2.98), which researchers explain is likely due to matching elevated levels of inflammatory cytokines and eosinophil-derived cytotoxic major basic protein. The severe AD cohort exhibited higher risk of pediatric uveitis (12 of 3004 [.40%] vs 97 of 126,482 [.08%]; HR 3.64, 95% CI, 2.00-6.66, P <.001).1

The team then conducted sensitivity analysis, which revealed that patients who did not use dupilumab (89 of 113,284 [.08%] vs 59 of 113,294 [.05%]; HR 1.77, 95% CI, 1.27-2.46) and without autoimmune conditions (80 of 114,425 [.07%] vs 61 of 114,425 [.05%]; HR 1.52, 95% CI, 1.09-2.12) also exhibited higher uveitis risk.1

This, Chu and colleagues point out, establishes not only a direct correlation between AD and uveitis, but also one between uveitis and AD severity. Additionally, the risk is proven independent of other factors such as dupilumab usage. The team believes this is cause for a significant amount of further research.

“These findings support the potential need to consider ophthalmologic monitoring in children with early-onset AD to try to detect and subsequently manage uveitis if it develops,” Chu and colleagues wrote. “These findings support an interdisciplinary approach, involving dermatology, ophthalmology, immunology, and pediatrics, that might contribute to optimized care for both AD and its associated ocular complications.”1

References

1. Chu Y, Sung C, Lin Y, et al. Risk of Developing Pediatric Uveitis Among Patients With Early-Onset Atopic Dermatitis. JAMA Ophthalmol. Published online April 03, 2025. doi:10.1001/jamaophthalmol.2025.0366

2. Achten R, van Luijk C, Thijs J, et al. Non-infectious uveitis secondary to dupilumab treatment in atopic dermatitis patients shows a pro-inflammatory molecular profile. Ocular Immunology and Inflammation. 2023;32(7):1150-1154. doi:10.1080/09273948.2023.2182325