Newly identified atopic eczema subtype may increase activity into adulthood

A novel subtype of atopic eczema marked by increasing disease activity into adulthood was recently observed in a large population-based study.

“Atopic eczema is characterized by a heterogenous waxing and waning course, with variable age of onset and persistence of symptoms,” Katrina Abuabara, MD, MA, MSCE, of the department of dermatology at the University of California San Francisco School of Medicine, and colleagues wrote. “Distinct patterns of disease activity such as early-onset/resolving and persistent disease have been identified throughout childhood; little is known about patterns into adulthood.”

The researchers assessed data for 15,939 individuals (51.4% male; 75.4% white) from the 1958 National Childhood Development Study and 14,966 individuals (51.6% male; 78.8% white) from the 1970 British Cohort Study. The study years that underwent analysis ranged from 1958 to 2016.

Patterns of disease activity through mid-adulthood were examined to determine the extent to which early life risk factors and participant characteristics could influence not only atopic eczema subtypes, but other atopic diseases and general health.

Results showed four types of atopic eczema, with prevalence probabilities as individuals increased in age. These groups were rare or no disease reported in 88% to 91% of the study population, a decreasing pattern in 4%, an increasing pattern in 2% to 6% and persistently high activity in 2% to 3%.

Results showed that only female sex at birth (OR = 1.99; 95% CI, 1.66-2.38) differentiated between risk for the high and decreasing probability subtypes.

However, a number of factors predicted the difference between the three atopic eczema subtypes and infrequent or no atopic eczema into adulthood. These included sex at birth, lower socioeconomic class, region of residence, tobacco smoke exposure and breastfeeding, according to the findings.

Individuals with persistently high disease activity were more likely to report asthma or rhinitis.

In addition, for patients experiencing the increasing disease activity subtype, self-reported data from their midlife ages showed risk for poor general health (OR = 1.29; 95% CI, 1.09-1.53) and mental health (OR = 1.45; 95% CI, 1.23-1.72).

“The findings of this cohort study suggest that extending the window of observation beyond childhood may reveal clear subtypes of atopic eczema based on patterns of disease activity,” the researchers wrote. “A newly identified subtype with increasing probability of activity in adulthood warrants additional attention given observed associations with poor self-reported health in midlife.”