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Risk factors may predict persistent atopic dermatitis in children
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Childhood atopic dermatitis subsides by adulthood in most cases; however, clinical factors such as already persistent disease, later onset, and/or more severe disease increases the risk for persistence, according to recent study results.
“Atopic dermatitis (AD)/eczema is a chronic inflammatory skin disease with a clinical course that varies widely between patients,” Jonathan I. Silverberg, MD, PhD, MPH, of the department of dermatology at Northwestern University Feinberg School of Medicine in Chicago, and colleagues wrote. “Some children have disease activity that persists well into adolescence and adulthood, although most children are thought to ‘grow out of it.’ Much of the data to support this notion originate from smaller studies and did not account for a number of clinical factors that might modify disease persistence.”
Kim and colleagues conducted a systematic review of 45 studies within multiple existing databases and a meta-analysis using Kaplan-Meier plots and random-effects proportional hazards regression to determine the overall persistence rates of the disease and clinical factors associated with disease persistence.
The 45 studies reviewed consisted of 110,651 patients spanning 434,992 patient-years from 15 different countries.
Overall, 80% of childhood AD did not persist after 8 years, whereas, 20 years after diagnosis, less than 5% persisted (mean ± SE: 6.1 ± 0.02 years).
Results showed that more severe AD at the time of diagnosis and prolonged disease persistence increased the risk for persistent AD. Children who had AD for more than 10 years (8.3 ± 0.08 years) had higher persistent rates than those who had AD for only 3 years (3.2 ± 0.02 years) or 5 years (6.8 ± 0.06 years). Furthermore, less persistent disease was observed in patients who developed AD in the first 2 years of life (P < .0001).
Studies using patient-/caregiver-assessed versus physician-assessed outcomes and female versus male patients showed greater disease persistence (P ≤ .0006). However, persistence was not greater in patients with sensitivity to allergens.
The researchers noted that not all studies included recurrences later in life.
“Only one in five children with AD had disease persistence beyond 8 years,” Kim and colleagues wrote. “However, children with already persistent disease, later onset, and more severe disease were more likely to have disease persistence into adolescence and adulthood. These risk factors may be useful to predict which children will have persistent AD. Future investigation into risk factors for disease persistence is warranted.” – by Alaina Tedesco
Disclosure: The researchers report no relevant financial disclosures.