Survey on caregivers’ awareness of skin management for children with atopic dermatitis based on the PAEPAD study

Atopic dermatitis (AD) is a highly prevalent chronic inflammatory skin disorder that often begins in infancy and significantly impacts the quality of life for affected children and their families. Caregivers’ knowledge, attitudes, and practices (KAP) regarding infant skincare and AD management are critical factors influencing disease recognition, treatment adherence, and clinical outcomes. However, population-level data on caregiver knowledge remains limited. This study aimed to evaluate caregivers’ understanding of infant skincare and AD management using the validated Atopic Dermatitis and Infant Skincare Knowledge, Attitude, and Practice (ADISKAP) scale and to explore its association with the incidence of AD in infants. The study was embedded in the Preventive Antenatal Educational Program on Allergic Diseases (PAEPAD) birth cohort in Beijing, China. A total of 1857 pregnant women were enrolled between November 2020 and June 2023 and completed the ADISKAP questionnaire during pregnancy. Their infants were subsequently followed up at 3 and 12 months of age for AD diagnosis, which was conducted using the Hanifin and Rajka criteria by trained dermatologists. Findings revealed significant gaps in caregiver knowledge, particularly concerning daily emollient use, misconceptions about substituting touch oils for moisturizers, and widespread concerns regarding the safety of topical corticosteroids. Among 1517 infants evaluated at 3 months,13.1% were diagnosed with AD; at 12 months, the prevalence was 12.3% among 1203 infants assessed. Based on a median ADISKAP score of 36, caregivers were divided into high-knowledge (≥36) and low-knowledge (12 months(14.4%) compared to those in the higher-knowledge group (10.6%; P=0.05). Multivariate logistic regression analysis, adjusting for maternal age, parental allergy history, and education level, confirmed that higher caregiver knowledge was independently associated with a lower risk of infant AD (adjusted OR=0.34; P=0.02). These findings suggest that insufficient caregiver knowledge and misconceptions about infant skincare and AD treatment may contribute to suboptimal skincare practices, delayed intervention, and ultimately an increased risk of early-onset AD. The study emphasizes the urgent need for targeted caregiver education, ideally beginning during pregnancy or early postpartum, to address critical gaps in skincare knowledge and therapeutic attitudes. Strengthening caregiver education programs may serve as a cost-effective, scalable intervention to prevent AD onset, improve treatment adherence, and promote better long-term dermatologic health outcomes in the pediatric population.