title: Persistence of atopic dermatitis (AD): A systematic review and meta-analysis.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Jooho P
authors.initials: JP
authors.lastname: Kim
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
authors.forename: Lucy X
authors.initials: LX
authors.lastname: Chao
authors.affiliation: Department of Dermatology, Oregon Health and Science University, Portland, Oregon.
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
authors.affiliation: Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois. Electronic address: JonathanISilverberg@Gmail.com.
authors.forename: Jonathan I
authors.initials: JI
authors.lastname: Silverberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D017668:Age of Onset; D000485:Allergens / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D010328:Patch Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000485:Allergens
keywords: atopic dermatitis; eczema; epidemiology; persistence; prognosis