Persistence of atopic dermatitis (AD): A systematic review and meta-analysis

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.