Persistence of atopic dermatitis (AD): A systematic review and meta-analysis

J Am Acad Dermatol. 2016 Oct;75(4):681-687.e11. doi: 10.1016/j.jaad.2016.05.028. Epub 2016 Aug 17.

Abstract

Background: Previous studies found conflicting results about whether childhood atopic dermatitis (AD) persists into adulthood.

Objective: We sought to determine persistence rates and clinical factors associated with prolonged AD.

Methods: A systematic review was performed in MEDLINE, EMBASE, Scopus, GREAT, LILACS, Web of Science, Academic Search Complete, and Cochrane Library. Meta-analysis was performed using Kaplan-Meier plots and random-effects proportional hazards regression.

Results: In total, 45 studies including 110,651 subjects spanning 434,992 patient-years from 15 countries were included. In pooled analysis, 80% of childhood AD did not persist by 8 years and less than 5% persisted by 20 years after diagnosis (mean ± SE: 6.1 ± 0.02 years). Children with AD that persisted already for more than 10 years (8.3 ± 0.08 years) had longer persistence than those with 3 (3.2 ± 0.02 years) or 5 (6.8 ± 0.06 years) years of persistence. Children who developed AD by age 2 years had less persistent disease (P < .0001). Persistence was greater in studies using patient-/caregiver-assessed versus physician-assessed outcomes, female versus male patients (P ≤ .0006), but not in those with sensitivity to allergens (P = .90). Three studies found prolonged persistence with more severe AD.

Limitations: Some studies did not capture recurrences later in life.

Conclusions: Most childhood AD remitted by adulthood. However, children with already persistent disease, later onset, and/or more severe disease have increased persistence.

Keywords: atopic dermatitis; eczema; epidemiology; persistence; prognosis.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Age of Onset
  • Allergens / immunology
  • Child
  • Child, Preschool
  • Dermatitis, Atopic / diagnosis*
  • Dermatitis, Atopic / epidemiology*
  • Dermatitis, Atopic / therapy
  • Female
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Patch Tests
  • Prognosis
  • Proportional Hazards Models
  • Recurrence
  • Risk Assessment
  • Severity of Illness Index
  • Sex Factors
  • Young Adult

Substances

  • Allergens