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

Publication date: Available online 2 June 2018
Source:Journal of the American Academy of Dermatology
Author(s): Harrison H. Lee, Kevin R. Patel, Vivek Singam, Supriya Rastogi, Jonathan I. Silverberg
BackgroundPrevious studies found conflicting results about whether atopic dermatitis (AD) begins in adulthood.ObjectiveTo determine rates, predictors and phenotypical differences of adult-onset AD.MethodsA systematic review was performed of all published observational studies in MEDLINE, EMBASE, GREAT, LILACS, Cochrane Library, and Scopus that analyzed the age of AD onset beyond 10 years of age. Two reviewers performed study title/abstract review and data abstraction. Pooled meta-analysis of the proportion of adult-onset AD was performed using random-effects weighting (I²=99.3%).ResultsOverall, 25 studies met inclusion criteria. Seventeen studies reported age of AD-onset past 16 years and had sufficient data for meta-analysis. The pooled proportion (95% CI) of adult-onset AD was 26.1% (16.5-37.2%). Similar results were found in sensitivity analyses by diagnostic method for AD, study region, and gender. Phenotypical differences were observed across studies for adult vs. 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.LimitationsCharacteristics of adult- vs. child-onset AD were not commonly reported.ConclusionsAD is not only a disease of childhood. One in 4 adults with AD report adult-onset disease. Adult-onset AD was associated with distinct clinical characteristics.