Approximately 10% to 15% of kids in the United States will be diagnosed with atopic dermatitis (AD), usually before they turn two. AD is a form of eczema characterized by scaly red patches of skin that itch intensely. The condition is an autoimmune reaction to a usually unidentified trigger and is more likely to occur in children who suffer asthma and/or food, seasonal, or environmental allergies. Traditionally, doctors tell parents their baby will outgrow AD after a year or two but a recent study indicates it's more likely a life-long illness.

The study was led by Dr. David J. Margolis of the University of Pennsylvania Perelman School of Medicine's Departments of Biostatistics and Epidemiology and Dermatology. The Margolis research team recruited children with AD and their parents from the Pediatric Eczema Elective Registry (PEER).

To be eligible for the study, each of the 7,157 children was between 2 and 17 years old at enrollment, had been medically diagnosed with AD, and was using a specific medication (pimecrolimus cream) for a minimum of 42 of the 180 days prior to enrolling in the study. At six-month intervals throughout the study, the child or caregiver responded to mail-in or telephone surveys that asked several questions. Of particular concern was if the rash had cleared up completely at any point during the previous six months. Continued use of the pimecrolimus cream during the study was voluntary.

At least one study participant lived in each of 47 of the 48 contiguous US states. A two-year follow-up included 4,248 children and 2,416 were followed for 5 years.

During the 10-year course of study, the age range of the children was 2 to 26 years. Throughout the study:

• 80% exhibited AD symptoms and/or were using the prescribed medication at any given checkpoint.
• After reaching age 20, 50% had experienced at least one six-month period over the course of their lifetimes that was symptom- and medication-free.

Symptoms of AD were most persistent when certain demographics and exposure variables were present:

Demographics

• Female
• Low-income households (under $50,000)
• Eastern half of the United States

Environmental

• Cold, dry weather
• Exposure to soaps and detergents
• Dusty environment
• Wool clothing

These co-existing medical conditions also exacerbated symptoms:

• Asthma, wheezing, whistling in the chest
• Sneezing and runny nose not related to influenza
• Seasonal allergies
• Allergies to pets and other animals, food, and medication

A child is more likely to develop AD if a sibling has eczema or if the mother has asthma or eczema.

The research team suggests that a rethinking of AD care is in order. Even when symptoms are mild to moderate, the researchers urge physicians (pediatricians, dermatologists, allergists, etc.) to treat AD as a lifelong illness with periodic waxing and waning of symptoms.


Source: Margolis, David J, MD, PhD; et al. "Persistence of Mild to Moderate Atopic Dermatitis." JAMA Dermatology. The JAMA Network / American Medical Association. Apr 2, 2014. Web. Apr 12, 2014.