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Original Investigation |

Persistence of Mild to Moderate Atopic Dermatitis

Jacob S. Margolis1; Katrina Abuabara, MD1,2; Warren Bilker, PhD1; Ole Hoffstad, MS1; David J. Margolis, MD, PhD1,2
[+] Author Affiliations
1Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia
2Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia
JAMA Dermatol. 2014;150(6):593-600. doi:10.1001/jamadermatol.2013.10271.
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Published online

Importance  Atopic dermatitis (AD) is a common illness of childhood.

Objective  To evaluate the natural history of AD and determine the persistence of symptoms over time.

Design, Setting, and Participants  A cross-sectional and cohort study of a nation-wide long-term registry of children with AD enrolled in the Pediatric Eczema Elective Registry (PEER).

Main Outcomes and Measures  Self-reported outcome of whether a child’s skin was AD symptom–free for 6 months at 6-month intervals.

Results  A total of 7157 patients were enrolled in the PEER study for a total of 22 550 person-years. At least 2 years of follow-up were observed for 4248 children and at least 5 years of follow-up were observed for 2416 children. Multiple demographic and exposure variables were associated with more persistent AD. At every age (ie, 2-26 years), more than 80% of PEER participants had symptoms of AD and/or were using medication to treat their AD. It was not until age 20 years that 50% of patients had at least 1 lifetime 6-month symptom- and treatment-free period.

Conclusions and Relevance  Based on this large longitudinal cohort study, symptoms associated with AD seem to persist well into the second decade of a child’s life and likely longer. Atopic dermatitis is probably a life-long illness.

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Figure 1.
Pediatric Eczema Elective Registry (PEER) Locations

Locations of zip codes inhabited by at least 1 PEER study enrollee.

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Figure 2.
Persistence of Atopic Dermatitis (AD) by Age

A Kaplan-Meier curve demonstrating the proportion of individuals with at least 5 years of follow-up at a given age who ever reported a 6-month symptom-free and medication-free period (A) and the proportion of enrollees at a given age who reported no symptoms of AD and medication use in the previous 6 months (B).

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