Atopic dermatitis presenting at a later age appears easier to control

Earlier-onset atopic dermatitis (AD) in children appears to correlate with stronger persistence over time and worse disease control, a recent study has found.

Researchers conducted a prospective observational study of 8,015 patients (median age at enrolment, 6.6 years; 53.3 percent female) with childhood-onset AD. Specific age of onset was determined according to caregiver interviews. The primary study outcome was AD disease control and persistence, assessed using guardian and patient interviews.

Over 41,934 person-years of follow-up, study participants accomplished a total of 70,841 surveys, corresponding to a mean of 8.8 surveys each. These revealed three distinct timing patterns of AD onset: early (<2 years; n=5,770), mid (3–7 years; n=1,492) and late (8–17 years; n=712) onset. The median age at AD onset was 0.75 years.

Sixteen percent of all surveys indicated complete control of the disease, while 5.2 percent showed uncontrolled AD. Good and limited control, on the other hand, was found on 50.2 percent and 28.6 percent of all surveys.

Patients whose AD presented at an older age enjoyed significantly better disease control and less AD persistence. For instance, each additional year of AD onset correlated with a 7-percent decline in the odds of worse control (adjusted odds ratio [OR], 0.93, 95 percent confidence intervals [CI], 0.91–0.94).

In absolute terms, 10-year-olds experiencing AD onset were 44-percent less likely to experience worse disease control than a counterpart whose disease onset occurred at 2 years.

Analysis according to patient subgroups showed that relative to the early-onset AD patients, the risk of poor control was lower in those with mid-onset (adjusted OR, 0.71, 0.64–0.80) and late-onset (adjusted OR, 0.51, 0.43–0.60) disease.