The prevalence of atopic dermatitis beyond childhood: A systematic review and meta‐analysis of longitudinal studies

Abuabara, Katrina; Yu, Ashley M.; Okhovat, Jean-Phillip; Allen, Isabel Elaine; Langan, Sinéad

doi:10.1111/all.13320

Cited by 183 publications

(162 citation statements)

References 32 publications

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“…Our observation is in line with recent longitudinal assessments of AD, one of more selected patients and one meta‐analysing prevalence data at different ages . Thus, the prospective US PEER cohort study, enrolling 2‐17‐year‐olds with mild‐to‐moderate AD and TCI use, found that it was not until age 20 years that 50% of these patients had at least 1 lifetime 6‐month symptom‐ and treatment‐free period .…”

Section: Discussionsupporting

confidence: 89%

“…Recent studies confirm that it is difficult to study AD persistence properly since the disease is heterogeneous and recurrent. Accordingly, another meta‐analysis showed that the prevalence of AD decreased by as little as 1% after 12 years of age . In continuation, there is an emerging paradigm of AD being a lifelong, genetic predisposition to episodic skin lesions.…”

Section: Introductionmentioning

confidence: 99%

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Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study

Thyssen

Corn

Wohlfahrt

et al. 2019

Clin Experimental Allergy

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Background Atopic dermatitis (AD) normally onsets in childhood and mostly resolves before adolescences. Disease persistence is known to be difficult to study properly, and current predictors are insufficient to identify more than a small fraction of patients at risk. Objective To study personal AD medicine history as a retrospective marker of persistent AD. Methods The study population included all Danish first hospital contacts with a diagnosis of AD (ICD‐10, L20) between 1995 and 2012. National register data following the diagnosis were used to define persistent AD activity until 2017 according to personal AD medicine history before diagnosis. Activity was defined as filled prescriptions for topical corticosteroids (TCS) or calcineurin inhibitors (TCI), dermatologist contacts or hospital re‐contacts for AD. Risk ratios (RR) for persistent activity (defined as activity >4 of the most recent 5 years) were estimated according to AD medicine history (prescriptions filled prior to diagnosis) adjusted for age at onset, parental AD and basic covariates. Results A total of 13 628 patients were diagnosed at ages 0‐16 years and had up to 21 years of follow‐up. 10 years after diagnosis, 67% showed activity (9.5% persistent). Among prior TCS users (69%), the RR10y of persistent activity increased 1‐ to 6‐fold with increasing strength of strongest TCS/TCI ever, and with number of TCS courses. Prior use of antibiotics (RR10y 1.32, 95% CI 1.09‐1.59) and antihistamines (RR10y 1.65, 95% CI 1.42‐1.91) increased the RR10y in a dose‐dependent manner. In >90% of patients, prior medication use occurred <4 years before diagnosis. Conclusions and clinical relevance The strength and type of AD medication used in the previous 4 years may predict 10‐year persistence of AD. Since children may be misjudged as having milder disease when seen between flares of skin lesions, this information may improve physicians' ability to determine the correct prognosis independently of current AD severity.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study

Thyssen

Corn

Wohlfahrt

et al. 2019

Clin Experimental Allergy

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“…The high rates of persistence in NHS2 are consistent with other recent studies. For example, a cohort study of children with mild‐to‐moderate AD found that 80% of participants still had periods of active disease into early adulthood and a systematic review found that there was no statistically significant drop year‐on‐year in the prevalence of AD within cohort studies …”

Section: Discussionmentioning

confidence: 99%

“…Atopic dermatitis (AD) is increasingly recognized to persist into adulthood . This has spurred epidemiologic studies of adults with AD, including investigations of risk factors for development of AD and non‐atopic comorbidities.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis validation and clinical characterization of atopic dermatitis in Nurses’ Health Study 2

Drucker

Cho

et al. 2019

Acad Dermatol Venereol

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Background Epidemiologic studies of atopic dermatitis (AD) are often limited by case definitions that have not been validated. Objective In this study, we assessed the accuracy of self‐report of AD in a large cohort of US female nurses, the Nurses’ Health Study 2 (NHS2). We also provide clinical characteristics of AD in the cohort. Methods We sent an electronic questionnaire to NHS2 participants who previously reported ever having a diagnosis of AD. This questionnaire was designed to confirm cases of AD using previously validated algorithms with >85% specificity. We assessed the association of AD with asthma, comparing the results when different definitions of AD were applied. We also inquired about various aspects of participants’ AD. Results Responses were received from 2509 of 5126 (49%) nurses who were sent the questionnaire, with an average age of 62. Most participants (1996/2509, 80%) reiterated their previously reported clinician diagnosis of AD. Application of the two diagnostic algorithms yielded confirmation of 1538 and 1293 prevalent cases, respectively. The association of AD with asthma was stronger when more stringent AD case definitions were applied. Participants generally reported mild disease (92% with ≤10% maximal body surface area involved) and a high proportion (57%) reported adult‐onset disease. Conclusions Self‐report of AD diagnosis has good reliability, and future analyses will be strengthened by our ability to conduct sensitivity analyses with refined confirmed AD subgroups.

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“…Atopic dermatitis (AD) is a common chronic pruritic skin condition in adults, characterized by skin barrier impairment, a T‐helper (Th) cell 2 skewed immune response and Staphylococcus aureus colonization . There is a little insight in the natural course of AD during pregnancy, and in particular the use of dermatologic therapy .…”

Section: Introductionmentioning

confidence: 99%

Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark

Hamann

Egeberg

Wollenberg

et al. 2018

Acad Dermatol Venereol

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Background The risk of prenatal, obstetric and birth complications in mothers with atopic dermatitis (AD), along with treatment use during pregnancy, is unknown. Objectives To examine the associations between prenatal, obstetric and birth complications in mothers with AD and describe the dermatologic care received during pregnancy. Methods Mother‐child pairs, in which the mother had a history of AD, were identified through the Danish Medical Birth Registry and matched 1 : 10 with non‐AD pairs. Data on dermatologic treatment and prenatal, obstetric and birth complications were obtained through linkage via nationwide registers. Multiple logistic regression was performed. Results We identified 10 668 births from 1997 through 2014 to women with AD. Women with a hospital/ambulatory contact for AD during pregnancy had increased topical corticosteroid and ultraviolet therapy use during pregnancy compared to prior. However, overall, women with AD received decreased dermatologic therapy during pregnancy compared to prior. In adjusted analysis, maternal AD was inversely associated with gestational diabetes [OR 0.79, 95% CI (0.68–0.92)], but positively associated with premature rupture of membranes [1.15 (1.05–1.27)] and staphylococcal neonatal septicemia [2.45 (1.33–4.49)]—albeit the latter was rare. These associations did not meet statistical significance in sub‐analysis where body mass index data were available. No associations were found with preeclampsia, prematurity or non‐staphylococcal neonatal septicaemia. Conclusions Women with AD during pregnancy mainly used topical corticosteroids and ultraviolet therapy to control their disease. While premature rupture of membranes and staphylococcal neonatal septicaemia were over‐represented in maternal AD, no associations were found with any other significant prenatal, obstetric or birth outcome.

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The prevalence of atopic dermatitis beyond childhood: A systematic review and meta‐analysis of longitudinal studies

Cited by 183 publications

References 32 publications

Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study

Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study

Diagnosis validation and clinical characterization of atopic dermatitis in Nurses’ Health Study 2

Pregnancy complications, treatment characteristics and birth outcomes in women with atopic dermatitis in Denmark

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