Persistence of atopic dermatitis (AD): A systematic review and meta-analysis.
J Am Acad Dermatol 2016;
75:681-687.e11. [PMID:
27544489 DOI:
10.1016/j.jaad.2016.05.028]
[Citation(s) in RCA: 151] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/18/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022]
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.
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