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Adult-onset eczema: a common and poorly understood problem

Published online: June 28, 2019

Atopic eczema (also known as atopic dermatitis) is one of the most common and burdensome childhood skin conditions, and recent research suggests rates among adults are higher than previously thought. Whether these trends are due to persistent disease from childhood or new-onset disease in adults is unclear, and the frequency and characteristics of adult-onset disease remain controversial.

In an article recently published in The Journal of Allergy & Clinical Immunology (JACI), Abuabara and colleagues investigated the proportion of individuals who reported atopic eczema symptoms between birth and mid adulthood, and examined characteristics associated with when symptoms started. This longitudinal study used data from two nationally representative community-based birth cohorts from the United Kingdom: the British Cohort Studies from 1958 and 1970. Over 17,000 individuals from each cohort were followed from birth through age 42-50.

The authors found that among adults who reported active atopic eczema during a given year, only 38% reported symptom onset in childhood. The analysis showed that when compared to individuals with childhood-onset eczema, those with adult-onset disease were more likely to be women, from Scotland or Northern England, of lower childhood socio-economic group, smokers in adulthood, and less likely to have a history of asthma. A sub-analysis also found that genetic mutations previously associated with atopic eczema, including filaggrin null mutations (encoding the skin barrier), and allergy were more common among those with childhood-onset disease. These results suggest that adult-onset eczema is common and may have a different characteristics and risk factors than childhood-onset eczema. The authors emphasize the need for better characterization of adult-onset disease and confirmation of the best way to diagnose atopic eczema in this population.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

Graphical Abstract