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Journal of the American Academy of Dermatology
Volume 80, n° 6
page 1526 (juin 2019)
Doi : 10.1016/j.jaad.2018.05.1241
accepted : 28 May 2018
From the Dermatology Foundation

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

Harrison H. Lee, BS a, Kevin R. Patel, BS a, Vivek Singam, BLA a, Supriya Rastogi, BA a, Jonathan I. Silverberg, MD, PhD, MPH a, b, c, d,
a Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
b Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
c Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois 
d Northwestern Medicine Multidisciplinary Eczema Center, Chicago, Illinois 

Correspondence to: Jonathan I. Silverberg, MD, PhD, MPH, 676 N St. Clair St, Ste 1600, Dermatology, Chicago, IL 60611.676 N St. Clair St, Ste 1600, DermatologyChicagoIL60611
Abstract
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.

The full text of this article is available in PDF format.

Key words : atopic dermatitis, adult-onset, eczema, epidemiology, meta-analysis, phenotype, prevalence, systematic review

Abbreviations used : AD, CI, SPT



 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.

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