J Korean Med Sci.  2012 Jul;27(7):723-728. 10.3346/jkms.2012.27.7.723.

Retrospective Analysis of the Natural History of Atopic Dermatitis Occurring in the First Year of Life in Korean Children

• Chung Y
• Kwon JH
• Kim J
• Han Y
• Lee SI
• Ahn K

• KMID: 2157914
• DOI: http://doi.org/10.3346/jkms.2012.27.7.723

Abstract

The aim of this study was to analyze the natural history of atopic dermatitis (AD) and the risk factors associated with the remission of AD in Korean children. We enrolled 597 children with AD that occurred in the first year of life. A variety of factors influencing the prognosis were assessed by medical records and telephone interviews. Their outcome was classified into complete remission, intermittent, and persistent AD. AD had completely disappeared in 422 cases (70.6%), while 149 (25%) and 26 cases (4.4%) showed intermittent and persistent skin symptoms, respectively. The average healing time was 29.6 months in complete remission group and expected healing time of the AD was 60 months. None of risk factors were significant by multivariate analysis. But, in moderate-to-severe AD group, maternal diet restriction during lactation (P = 0.046) and no sensitization to cow's milk (P = 0.017) were significantly associated with remission of AD in the multivariate analysis. In conclusion, AD occurring in the first year of life disappears in a significant proportion of patients. In addition, in Korean children with moderate-to-severe AD, maternal diet restriction of allergenic food during lactation and sensitization to cow's milk seem to predict the prognosis of AD.

Keyword

Dermatitis, Atopic; Natural History; Risk Factors

MeSH Terms

Adult
Child, Preschool
Dermatitis, Atopic/*diagnosis/etiology
Female
Food Hypersensitivity/complications
Humans
Infant
Interviews as Topic
Lactation
Male
Milk Hypersensitivity/complications
Predictive Value of Tests
Prognosis
Remission Induction
Republic of Korea
Retrospective Studies
Risk Factors

Figure

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  Fig. 1 Patient enrollment.

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  Fig. 2 Natural history of atopic dermatitis in 597 children with age of onset within 1 yr after birth.

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  Fig. 3 Kaplan-Meier survival analysis of persistence of atopic dermatitis with age of onset within 1 yr.

Reference

1. Clark RA, Kristal L. Sams WM, Lynch PJ, editors. Atopic dermatitis. Principles and practice of dermatology. 1996. New York: Churchill Livingston;403–418.

2. Oh JW, Pyun BY, Choung JT, Ahn KM, Kim CH, Song SW, Son JA, Lee SY, Lee SI. Epidemiological change of atopic dermatitis and food allergy in school-aged children in Korea between 1995 and 2000. J Korean Med Sci. 2004. 19:716–723.

3. Williams H, Stewart A, von Mutius E, Cookson W, Anderson HR. International Study of Asthma and Allergies in Childhood (ISAAC) Phase One and Three Study Groups. Is eczema really on the increase worldwide? J Allergy Clin Immunol. 2008. 121:947–954.

4. Palmer CN, Irvine AD, Terron-Kwiatkowski A, Zhao Y, Liao H, Lee SP, Goudie DR, Sandilands A, Campbell LE, Smith FJ, et al. Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nat Genet. 2006. 38:441–446.

5. Nomura T, Sandilands A, Akiyama M, Liao H, Evans AT, Sakai K, Ota M, Sugiura H, Yamamoto K, Sato H, et al. Unique mutations in the filaggrin gene in Japanese patients with ichthyosis vulgaris and atopic dermatitis. J Allergy Clin Immunol. 2007. 119:434–440.

6. Kang TW, Lee JS, Oh SW, Kim SC. Filaggrin mutation c.3321delA in a Korean patient with ichthyosis vulgaris and atopic dermatitis. Dermatology. 2009. 218:186–187.

7. Barker JN, Palmer CN, Zhao Y, Liao H, Hull PR, Lee SP, Allen MH, Meggitt SJ, Reynolds NJ, Trembath RC, et al. Null mutations in the filaggrin gene (FLG) determine major susceptibility to early-onset atopic dermatitis that persists into adulthood. J Invest Dermatol. 2007. 127:564–567.

8. Sandilands A, Smith FJ, Irvine AD, McLean WH. Filaggrin's fuller figure: a glimpse into the genetic architecture of atopic dermatitis. J Invest Dermatol. 2007. 127:1282–1284.

9. Wüthrich B. Clinical aspects, epidemiology, and prognosis of atopic dermatitis. Ann Allergy Asthma Immunol. 1999. 83:464–470.

10. Gustafsson D, Sjöberg O, Foucard T. Development of allergies and asthma in infants and young children with atopic dermatitis: a prospective follow-up to 7 years of age. Allergy. 2000. 55:240–245.

11. Illi S, von Mutius E, Lau S, Nickel R, Grüber C, Niggemann B, Wahn U. Multicenter Allergy Study Group. The natural course of atopic dermatitis from birth to age 7 years and the association with asthma. J Allergy Clin Immunol. 2004. 113:925–931.

12. Ricci G, Patrizi A, Baldi E, Menna G, Tabanelli M, Masi M. Long-term follow-up of atopic dermatitis: retrospective analysis of related risk factors and association with concomitant allergic diseases. J Am Acad Dermatol. 2006. 55:765–771.

13. Ohshima Y, Yamada A, Hiraoka M, Katamura K, Ito S, Hirao T, Akutagawa H, Kondo N, Morikawa A, Mayumi M. Early sensitization to house dust mite is a major risk factor for subsequent development of bronchial asthma in Japanese infants with atopic dermatitis: results of a 4-year followup study. Ann Allergy Asthma Immunol. 2002. 89:265–270.

14. Kissling S, Wüthrich B. Follow-up of atopic dermatitis after early childhood. Hautarzt. 1993. 44:569–573.

15. Musgrove K, Morgan JK. Infantile eczema: a long-term follow-up study. Br J Dermatol. 1976. 95:365–372.

16. Roth HL, Kierland RR. The natural history of atopic dermatitis. A 20-year follow-up study. Arch Dermatol. 1964. 89:209–214.

17. Hanifin JM, Rajka G. Diagnostic feature of atopic dermatitis. Acta Derm Venereol (Stockholm). 1980. 92:44–47.

18. Berth-Jones J. Six area, six sign atopic dermatitis (SASSAD) severity score: a simple system for monitoring disease activity in atopic dermatitis. Br J Dermatol. 1996. 135:25–30.

19. Henderson J, Northstone K, Lee SP, Liao H, Zhao Y, Pembrey M, Mukhopadhyay S, Smith GD, Palmer CN, McLean WH, et al. The burden of disease associated with filaggrin mutations: a population-based, longitudinal birth cohort study. J Allergy Clin Immunol. 2008. 121:872–877.

20. Rodríguez E, Baurecht H, Herberich E, Wagenpfeil S, Brown SJ, Cordell HJ, Irvine AD, Weidinger S. Meta-analysis of filaggrin polymorphisms in eczema and asthma: robust risk factors in atopic disease. J Allergy Clin Immunol. 2009. 123:1361–1370.e7.

21. Peters AS, Kellberger J, Vogelberg C, Dressel H, Windstetter D, Weinmayr G, Genuneit J, Nowak D, von Mutius E, Radon K. Prediction of the incidence, recurrence, and persistence of atopic dermatitis in adolescence: a prospective cohort study. J Allergy Clin Immunol. 2010. 126:590–595.