Atopic dermatitis (AD) is a chronic inflammatory skin disorder affecting up to 3%–5% of adults and 20% of children worldwide. The pathophysiology of AD involves various factors including host genetics, altered skin barrier function, and immunological abnormalities.
Atopic dermatitis: Correlation of distinct risk factors with age of onset in adulthood compared to childhood
Atopic dermatitis (AD) has long been regarded as a primarily pediatric disease. However, there is growing evidence for a high rate of adult-onset AD. We aimed to characterize factors associated with adult-onset versus childhood-onset AD and controls.
An analysis of the CK-CARE-ProRaD cohort revealed adult-onset AD in nearly a quarter of patients. We identified active smoking to be associated with adult-onset AD versus controls. Food allergy, maternal food allergy, palmar hyper linearity, and academic background increased the odds of childhood-onset AD versus controls.
Shared AD-associated factors were maternal AD (4-34x), increased IgE (2-20x), atopic stigmata (2-3x) with varying effect sizes depending on AD onset and control group. Patients with adult-compared to childhood-onset had doubled odds of allergic rhinitis, but reduced odds to feature multiple (3-4) atopic comorbidities. Adult-onset AD, particularly onset ≥61 years, grouped mainly in clusters with low contributions of personal and familial atopy and high frequencies of physical inactivity, childhood-onset AD, particularly infant-onset, mainly in “high-atopic”-clusters.
The identified associated factors suggest partly varying endo- and exogeneous mechanisms underlying adult-onset versus childhood-onset AD. Our findings might contribute to better assessment of the individual risk to develop AD throughout life and encourage prevention by non-smoking and physical activity as modifiable lifestyle factors.