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

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.

Fig 1

PRISMA flow diagram of literature search and study selection for meta-analysis of atopic dermatitis persistence.

Fig 2

Predictors of persistence of atopic dermatitis (AD). Kaplan-Meier survival plots and 95% log-log confidence intervals of AD persistence are presented overall (A) and stratified by age of AD onset (0–1, 2–5, 6–11 years) (B), already persistent AD (3, 5, 10 years) (C), assessment of AD (self-report, physician assessment) (D), sex (male, female) (E), and sensitization to 1 or more allergens (no, yes) (F).