From the dermatology foundation
A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis

https://doi.org/10.1016/j.jaad.2018.05.1241Get rights and content

Background

Previous studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood.

Objective

To determine rates, predictors, and phenotypic differences of adult-onset AD.

Methods

A systematic review was performed with all published observational studies in Medline, Embase, GREAT (Global Resource of EczemA Trials), LILACS (Latin American and Caribbean Health Sciences Literature), Cochrane Library, and Scopus that analyzed the age of AD onset beyond 10 years of age. At least two reviewers performed study title, abstract review, and data extraction. Pooled meta-analysis of the proportion of adult-onset AD was performed by using random-effects weighting (I2 = 99.3%).

Results

Overall, 25 studies met inclusion criteria. Seventeen studies reported age of AD onset as after 16 years of age and had sufficient data for meta-analysis. The pooled proportion (95% confidence interval) of adult-onset AD was 26.1% (16.5%-37.2%). Similar results were found in sensitivity analyses by AD diagnostic method, study region, and sex. Phenotypic differences were observed across studies for adult-onset and child-onset AD, including higher rates of foot dermatitis and personal history of atopy but lower rates of flexural lesions and other signs and symptoms.

Limitations

Characteristics of adult-onset versus child-onset AD were not commonly reported.

Conclusion

AD is not only a disease of childhood; 1 in 4 adults with AD report adult-onset disease, which has distinct clinical characteristics as compared to child-onset AD.

Section snippets

Literature search

The following databases were searched for articles up to December 1, 2017: Cochrane Library, Medline (PubMed and Ovid), Embase, GREAT (Global Resource of EczemA Trials), LILACS (Latin American and Caribbean Health Sciences Literature) and Scopus. The search strategy was modified from a previous Cochrane review of AD10 to also include a number of search terms related to age of disease onset (Supplemental Table I; available at http://www.jaad.org).11, 12, 13

Any cross-sectional or cohort study was

Literature search

Overall, 4074 nonduplicate citations were identified in the database search; 3690 were excluded during title and abstract review and 359 during full-text review. In total, 25 observational studies met inclusion and exclusion criteria and were included in this systematic review (Fig 1).14

Study characteristics

The 25 observational studies were published during 1956-2017.5, 11, 12, 13, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35 Six (24%) studies had prospective cohorts, 4 (16%)

Discussion

The results of this systematic review and meta-analysis of observational studies suggest that ∼1 in 4 adults with AD report adult-onset disease, with relatively consistent proportions of adult-onset disease for both sexes across different regions. There were several important characteristics that seemed to differ between adult-onset and child-onset AD, including higher proportions of foot dermatitis and lower proportions of flexural eczema and multiple other signs and symptoms.

Some have

References (36)

  • S. Nutten

    Atopic dermatitis: global epidemiology and risk factors

    Ann Nutr Metab

    (2015)
  • J.M. Hanifin et al.

    Eczema Prevalence and, Impact Working Group. A population-based survey of eczema prevalence in the United States

    Dermatitis

    (2007)
  • H. Nankervis et al.

    House dust mite reduction and avoidance measures for treating eczema

    Cochrane Database Syst Rev

    (2015)
  • V. Ingordo et al.

    Adult-onset atopic dermatitis in a patch test population

    Dermatology

    (2003)
  • R.B. Jaafar et al.

    Atopic eczema in a multiracial country (Malaysia)

    Clin Exp Dermatol

    (1993)
  • A. Liberati et al.

    The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration

    PLoS Med

    (2009)
  • N. Aberg et al.

    Natural history of allergic diseases in children

    Acta Paediatr Scand

    (1990)
  • M. Amri et al.

    Atopic dermatitis in Tunisia: a multicentre retrospective study

    Exogenous Dermatol

    (2003)
  • Cited by (125)

    • Exogenous drugs-induced mouse models of atopic dermatitis

      2024, Cytokine and Growth Factor Reviews
    • Comorbidities of atopic dermatitis—what does the evidence say?

      2023, Journal of Allergy and Clinical Immunology
    View all citing articles on Scopus

    Funding sources: Supported by the Agency for Healthcare Research and Quality (grant no. K12 HS023011) and the Dermatology Foundation.

    Conflicts of interest: None disclosed.

    Reprints not available from the authors.

    View full text