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Childhood Atopic Dermatitis Often Persists into Adulthood

Summary and Comment |
April 10, 2014

Childhood Atopic Dermatitis Often Persists into Adulthood

  1. Mary Wu Chang, MD

Although symptoms may improve and inactive periods lengthen, AD is likely a lifelong disorder.

  1. Mary Wu Chang, MD

Little has been reported about the natural history of atopic dermatitis (AD). When topical calcineurin inhibitors were approved for AD treatment, the FDA required manufacturers to conduct post-marketing safety studies. One such effort is the Pediatric Eczema Elective Registry (PEER), which enrolled patients aged 2 to 17 years with mild-to-moderate AD who had used pimecrolimus cream for >42 days in the prior 6 months; they or their caretakers were mailed surveys every 6 months to log AD symptoms and treatment.

Investigators used survey responses to analyze AD persistence. At analysis, 7157 patients were enrolled; 4248 had at least 2 years of follow-up, and 2416 had at least 5 years' follow-up. Mean age at AD onset was 1.7 years; average age at enrollment was 7.4 years. Approximately 70% responded to any questionnaire. At every age (range, 2 to 26 years), more than 80% of respondents had AD symptoms, were using AD medication, or both. It was not until after age 20 years that 50% of patients had at least one 6-month symptom- and treatment-free period. The authors conclude that AD symptoms persist well into the second decade of life and that AD is likely a lifelong illness.

Comment

Many infants and young children “outgrow” most of their atopic dermatitis, but it does not completely resolve. AD and asthma have genetic origins, and patients will remain susceptible to flares if exposed to their “triggers.” A recent study found prevalence of AD in U.S. adults to be 10.2% — higher than traditional estimates and similar to childhood prevalence. Either adult AD is increasing (as childhood AD has done) or adult AD was previously under-recognized.

PEER participants received $25 for every completed questionnaire. This practice may have biased responders toward over- rather than under-reporting of AD symptoms. Nonetheless, this study shows that AD is probably a lifelong disorder.

  • Disclosures for Mary Wu Chang, MD at time of publication Consultant / Advisory board Valeant Speaker’s bureau Galderma

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