Bottom Line: Children diagnosed with atopic dermatitis (AD or eczema) may have symptoms persist into their 20s, and the condition is likely to be a lifelong illness marked by waxing and waning skin problems.
Author: David J. Margolis, M.D., Ph.D., of the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.
Background: AD or eczema is a common skin disease that often begins in childhood, but little has been reported about the natural history of the condition.
How the Study Was Conducted: The authors examined the natural history of eczema using self-reported data from a group of 7,157 children enrolled in the Pediatric Eczema Elective Registry (PEER) study to evaluate the prevalence of symptoms over time. The average age of AD onset was 1.7 years.
Results: At every age (i.e. 2 to 26 years) more than 80 percent of the study participants had eczema symptoms or were using medication to treat the condition. During five years of follow-up, 64 percent of patients never reported a six-month period when their skin was symptom free while they were not using topical medications. It was not until age 20 that 50 percent of patients had at least one six-month period free of symptoms and treatment. The authors acknowledge that study participants may have had more severe disease and therefore more persistent eczema.
Discussion: "In conclusion, symptoms associated with AD seem to persist well into the second decade of a child's life and likely longer. … Based on our findings, it is probable that AD does not fully resolve in most children with mild to moderate symptoms. Physicians who treat children with mild to moderate AD should tell children and their caregivers that AD is a lifelong illness with periods of waxing and waning skin problems."
(JAMA Dermatology. Published online April 2, 2014. doi:10.1001/jamadermatol.2013.10271. Available pre-embargo to the media at http://media.jamanetwork.com.)
Editor's Note: The PEER study is funded by a grant from Valeant Pharmaceuticals, a company that makes pimecrolimus, a drug used to treat AD. The PEER study is an FDA-mandated study as part of the FDA approval process. This study was support in part by the National Institute of Arthritis Musculoskeletal and Skin Diseases. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Media Advisory: To contact author David J. Margolis, M.D., Ph.D., call Kim Menard 215-662-6183 or email Kim.Menard@uphs.upenn.edu. Please visit our For the Media website http://bit.ly/QbIRTK for a related editorial.
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