Atopic dermatitis may be more persistent than previously understood

Image: PD

1. Patients who were diagnosed with mild to moderate atopic dermatitis (AD) within the first few years of life were likely to have persistent disease into their second decade. 

2. Factors including history of atopic illness, household income<$50,000, seasonal allergies, household pet allergies and allergies to common foods and medications were associated with more persistent disease. 

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Atopic Dermatitis (AD) is a common disease in early childhood, and may cause a high morbidity.  This study analyzed the Pediatric Eczema Elective Registry (PEER) in an attempt to better understand the natural history of patients with AD.  Whereas previous studies have proven 50-70% of patients will achieve remission of their AD by age 12, this study showed high likelihood of persistence of disease into the second decade of life. This study’s strengths are the unprecedented very large cohort and the design to re-evaluate patients longitudinally through many years of follow-up. The study is limited by the inclusion criteria, which incorporated only patients that already required topical treatment, which selects for a pool of patients that have more severe disease at baseline. Additionally, it’s possible that patients with greater burden of disease were more likely to fill out and return surveys.

Click to read the study in JAMA Dermatology

Relevant Reading: Atopic Dermatitis and the Atopic March

In-Depth [prospective cohort]: From the 7157 patients in the PEER registry, surveys assessed whether during the past 6-months, their rash from AD had ever cleared completely, and whether they had used topical treatment. Between ages 2-26, at every age group, 80% of patients with mild to moderate atopic dermatitis (AD) had symptoms of AD. Additionally, 64% of patients who had followed-up for 5-years never reported a 6-month period without disease. Authors also analyzed risk factors for any 6-month symptom and treatment-free period using and Χ2 testing and random-intercept logistic regression. Multiple demographic and environmental exposures were associated with more persistent disease including seasonal allergies, medication allergies and food allergies (Adjusted OR: 0.81, 1.18, and 0.63, respectively). Kaplan Meier plots illustrated the proportion of the study population that was symptom-free for 6 months. Using this analysis and area under the receiver operating curve, prognostic models were developed to depict persistent symptoms of AD past the first decade of life.

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