Disease trajectories in childhood atopic dermatitis: an update and practitioner's guide

Summary

Background

Atopic dermatitis (AD) is a heterogeneous disease with a multifactorial aetiology and complex pathophysiology. This heterogeneity translates into different trajectories of disease progression with respect to severity, persistence, and risk of development of atopic comorbidities. Determining which possible disease trajectories or comorbidities any individual child might develop is challenging in clinical practice. Tools that help identify paediatric patients at higher risk of disease progression would greatly aid clinicians.

Methods

We reviewed recent cohort studies to synthesise and simplify the epidemiological data to try to identify shared clinically relevant characteristics that may help physicians estimate the risk of disease progression in paediatric patients with AD.

Results

Despite the variability in data collection and methods of analysis and their limitations, there are common patterns of early‐childhood AD which may aid in the estimation of risk for disease progression. Factors associated with risk of AD progression include younger age of onset, family history of atopy, greater AD severity, filaggrin mutations, urban environment and polysensitisation and/or allergic multimorbidity. Based on these factors, we provide a practitioner's guide for identifying, counselling and/or referring infants/children with AD at potentially higher risk of developing persistent AD and atopic comorbidities and clinical scenarios to illustrate how these data relate to real‐life situations.

Conclusions

Useful insights are provided for physicians and patients to better inform about risk of AD progression and to help guide care pathways for the AD paediatric population.

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