Children with atopic dermatitis, also known as eczema, will most likely experience symptoms off and on into their 20s and throughout their lifetime, according to a new study published online in JAMA Dermatology.
Atopic dermatitis (AD) is characterized by itchy, inflamed skin, an increased number of skin creases on the palms, raised bumps, or changes in skin texture due to itching and rubbing, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
While AD can occur at any age, it usually begins before the second year of a child’s life, according to study authors and the NIAMS. It “affects between 8.7 and 18.1 percent of all infants and children” in the U.S., according to the National Eczema Association. The exact cause of eczema is unknown, but many researchers believe it is linked to inherited genes and certain environmental factors.
While recent studies have begun to chip away at the myth that eczema is a childhood disease, few studies have been able to observe the nature of AD in patients over such an extended period of time with the opportunity for frequent follow-ups, said study author Dr. David Margolis in an interview with Healthline.
“It’s important for people to realize [AD] is not a disease that just goes away,” Margolis said. “It has a more serious effect on an individual’s life than we originally anticipated.”
Few Remissions Reported in Childhood
Researchers used self-reported data from 7,157 people (a total of 22,550 person-years) enrolled in the Pediatric Eczema Elective Registry (PEER), a study conducted a decade ago by the U.S. Food and Drug Administration (FDA) and the European Medicines Agency to test the safety of a topical medicine for treatment of eczema. Enrollment in the study began in 2004, and researchers followed its participants—ages 2 to 17—for a period of 10 years. The average age of eczema onset in the study participants was 1.7 years.
Once enrolled, participants (or the parents of participants, if the children were too young) took an initial survey and then completed follow-up questionnaires every six months for two to five years.
According to the survey responses, more than 80 percent of patients— at every age, ranging from 2 to 26—experienced eczema symptoms and/or were using medication to treat their condition. To follow the natural course of the disease in these patients, researchers identified times throughout the study in which participants reported periods of remission.
“Our definition of remission meant that [the patient] wasn’t itching, didn’t have a rash, and wasn’t using any medications to treat the disease,” Margolis said.
During the five years of follow-up, “64 percent of participants never reported a six-month period when their skin was symptom-free while they were not using topical medications,” the study authors said. “It was not until patients reached age 20 that 50 percent of participants had at least one six-month symptom- and treatment-free period.”
“Most children and young adults still reported symptoms of AD that required the use of medication,” the authors concluded. “But, as children got older, they were more likely to have experienced at least one symptom-free and medication-free period.”
Debunking the Myths of Childhood Eczema
Contrary to previous research, most participants in this study “reported symptoms and used medications well into the second and even the third decade of life,” the authors said, demonstrating that eczema can last far beyond the childhood years.
“In our PEER cohort, during the second decade of life, most enrollees were very likely to have had at least one period where their skin was clear while not requiring medications,” the study authors wrote. “However, this finding did not persist and should not be confused with a ‘permanent’ remission in that at most ages, the majority of enrollees had symptoms and were using medications.”
According to the study authors, previous research also found that 50 to 70 percent of children with AD had resolved their symptoms by age 12, which was not the case in this study. Researchers said the difference in these findings might be attributed to several factors. For example, PEER participants may have had more-severe eczema, resulting in more-persistent symptoms.
Past studies may also have failed to follow patients long enough to accurately estimate persistence of AD, the researchers said. Yet another explanation is that AD patients used to coping with the disease may not be as bothered by it in their adult years and may therefore stop seeking care for their symptoms, leading doctors to believe their symptoms had resolved, Margolis said.
Living with Eczema
While symptoms of AD may not resolve as a child grows older, eczema can be managed, and people with the disease can lead a healthy life.
Current medications for eczema include corticosteroid creams and ointments, antibiotics, and antihistamines. Suggestions from NIAMS for treating AD in infants and children include giving the child lukewarm baths, applying lubricant right after a bath, keeping the child’s fingernails short, and identifying and removing any skin irritants. Common irritants include wool or synthetic fibers, soaps and detergents, perfumes and cosmetics, cigarette smoke, dust and sand.
According to the NIAMS, along with practicing proper skincare and making lifestyle changes, it’s important to work closely with your physician to find the most effective treatment for your child.
Doctors should also take the time to discuss the possible longevity of the disease with their patients, the study authors said.
“Physicians who treat children with mild to moderate AD should tell children and their caregivers that AD is a lifelong illness with periods of waxing and waning skin problems,” wrote the authors.