Atopic Dermatitis Symptoms in Children Are Persistent

Steven Fox

April 03, 2014

Children with symptoms of atopic dermatitis (AD) are likely to have persistent symptoms into their teens, and often well beyond, according to findings from a long-term longitudinal study of more than 7000 children, published online April 2 in JAMA Dermatology.

"Little has been reported about the natural history of AD and how genetic and environmental factors are associated with its waxing and waning nature," write Jacob S. Margolis, MD, PhD, from the Departments of Biostatistics and Epidemiology and Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.

Looking to bridge that gap in knowledge, these researchers analyzed data from the Pediatric Eczema Elective Registry (PEER), an ongoing prospective observational registry of children with AD.

Enrolled patients were 2 to 17 years of age, had been diagnosed with AD, and had used pimecrolimus cream at least 42 of the previous 180 days.

A total of 7157 patients were enrolled in the study. On the basis of the mailed self-reports generated every 6 months, the researchers tracked the clinical status of the patients for a total of 22,550 person-years.

"We investigated the self-reported outcome of whether a child's skin, without requiring the use of topical medication (eg, steroids or calcineurin inhibitors to treat their AD), was AD symptom-free during the previous 6 months," the investigators write.

About two thirds of the patients were followed-up for at least 2 years (4248/7157); the remainder was followed-up for at least 5 years (2416/7157).

At every age, from 2 to 26 years, more than 80% of participants reported having continued symptoms of AD and/or were using topical medications in an effort to control symptoms. By 20 years of age, about half of patients had experienced at least a single 6-month period free of symptoms and use of medications.

A variety of environmental and demographic factors were linked to problems: residency in southern states, having a relative with an atopic illness, and exposure to pollen, pets, cigarettes, wool clothing, fumes, certain foods or drinks, and soaps/detergents.

"Based on our findings, it is probable that AD does not fully resolve in most children with mild to moderate symptoms," the researchers conclude. They say physicians who treat children with such symptoms should advise parents accordingly.

In an accompanying editorial, Jonathan L. Silverberg, MD, PhD, MPH, from the Departments of Dermatology, Preventive Medicine, and Medical Social Sciences, Northwestern University, Chicago, Illinois, notes that one of the challenges of identifying environmental risk factors by questionnaire is the potential for recall bias. "Nonetheless, these findings are 'hypothesis generating,' and I am hopeful that Margolis et al and others will continue to explore the environmental risk factors for eczema persistence."

The PEER study is funded by a grant from Valeant Pharmaceuticals. This study was supported by the National Institute of Arthritis Musculoskeletal and Skin Diseases. The authors and Dr. Silverberg have disclosed no relevant financial relationships.

JAMA Dermatol. Published online April 2, 2014. Article full text, Editorial extract

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