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

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

Author information

1
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
2
Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
3
Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois. Electronic address: JonathanISilverberg@Gmail.com.

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

PMID:
27544489
PMCID:
PMC5216177
DOI:
10.1016/j.jaad.2016.05.028
[Indexed for MEDLINE]
Free PMC Article

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