Eczema Rates Rise With Age Among Adults, Study Finds

Troy Brown, RN

December 04, 2018

Eczema, long thought to be a childhood disease, is also common among older adults, a population-based study has found.

"We have shown that rates of active atopic eczema (as defined by diagnosis and treatment codes applied by physicians) increase with age among adults in primary care, addressing a gap in evidence about the epidemiology of this condition after childhood," the researchers write.

The study by Katrina Abuabara, MD, MSCE, and Alexa Magyari, BA, both from University of California, San Francisco, and colleagues was published online December 3 in Annals of Internal Medicine.

The authors analyzed data from the Health Improvement Network, a primary care cohort that is representative of the United Kingdom population, from between 1994 and 2013. In the United Kingdom, primary care physicians manage 97% of patients with atopic eczema, also known as atopic dermatitis or eczema.

The study included 8,604,333 persons aged 0 to 99 years. The researchers first identified patients with physician-diagnosed eczema. "Because atopic eczema is an episodic disorder that may remit for years, we then calculated the prevalence of active disease requiring a physician visit or prescription during each year of follow-up," they explain.

The cumulative lifetime prevalence of the disorder was 9.9%. The highest rates occurred among children and older adults.

The mean prevalence was highest among those aged 0 to 17 years, at 12.3%. It then fell to 5.1% among those aged 18 to 74 years before rising again to 8.7% among those aged 75 years and older.

Across all ages, patients each year received a median of six prescriptions for the treatment of atopic eczema (interquartile range, two to 13 prescriptions). Therapies included topical steroids and systemic treatments.

The highest rates of comorbid atopic disease, including asthma and allergies/rhinitis, were seen among adults aged 18 to 74 years.

Although the study cohort is representative of the population in the United Kingdom, the researchers say the true prevalence of eczema may be higher than their estimates, because medical records do not capture over-the-counter treatments. In addition, providers may not document mild illness.

"Atopic eczema is known to substantially affect emotional and physical aspects of health-related quality of life but is often undertreated," the researchers write.

This may change with the availability of more therapies, they say. Two new agents were approved by the US Food and Drug Administration in 2016 and 2017, and "more than a dozen additional agents" are being tested, the authors note.

"As new targeted therapies become available, primary care providers will probably play a larger role in managing adults with atopic eczema. Attention should be paid to clinical testing in older adults, who may require special considerations for pharmacology, polypharmacy, and multimorbidity," the researchers conclude.

One coauthor has received grants from Valeant and personal fees from Sanofi/Regeneron and GSK, and another has received personal fees from TARGETPharma.

Ann Intern Med. Published online December 3, 2018. Abstract

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