"Will your child outgrow their eczema?" A dermatologist’s perspective on the development of atopic dermatitis

By Fatima Lakhani, BS and Peter A. Lio, MD (see bio below)

Eczema or atopic dermatitis (AD) is often thought of as a skin problem mainly affecting infants and young children, most of whom will outgrow the condition [Abuabara]. However, relatively few studies have been conducted to validate these beliefs, and the concept of “outgrowing eczema” remains somewhat mysterious. The relative similarity between childhood and adult eczema prevalence rates suggests that the condition may be more common in adults than generally thought. There are several possible explanations for this, including that many children do not outgrow their eczema or that childhood eczema is replaced by adult eczema, which may actually be different. Additionally, the proportion of children who outgrow eczema may be falsely elevated due to lack of follow-up during later years in life—perhaps some just grow weary of doctor appointments [Abuabara]!

Will Your Child Outgrow Their Eczema?

Studies have demonstrated that patients who develop eczema during infancy tend to experience a greater severity during adolescence [Hon]. Additionally, the use of immune-modulating therapies, traditional Chinese herbs, and wet wraps were also associated with a increased disease severity in adolescence. However, it is unclear if this is due to those eczema treatments—they are the cause—or if it simply means that more severe cases required these treatments and it is just a correlation.

One study found that 48% of patients experienced a relatively constant severity between childhood and adolescence, while 39% improved and 13% actually experienced a worsening of their symptoms [Hon]. Further studies found that in a population of 121 infants, 63% will continue to suffer from atopic dermatitis. Studies have also demonstrated that 50% of patients with mild eczema during childhood experienced a worsening of their condition and had their eczema classification elevated to moderate-to-severe during adolescence while only 14% improved from mild-to moderate to mild in adolescence.

However, one study also demonstrated that patients who do not experience complete remission of their atopic dermatitis tend to at least experience a decrease in severity compared to infancy as they grow older [Hon]. Finally, a study conducted roughly 50 years ago reported that only 40% of patients with mild eczema and 30% of patients with severe eczema experienced clearance of the condition after 20 years [Roth]. In general, however, the age of disease clearance correlates with the severity of the condition: patients with more severe cases outgrow eczema at a later age [Ricci].

Taken together, these findings seem to indicate that the process of “outgrowing eczema” is not as common as we would like to believe, and that many children will continue to suffer from symptoms well into adulthood. Despite the progress we have made in learning about atopic dermatitis and its prognostic factors, we are still unable to confidently predict if a child or infant will clear the disease later in life. Eczema continues to keep us humble: much remains to be discovered about this condition and hopefully, in time, we will able to predict with greater accuracy the persistence of a child’s eczema. 

Bio: Dr. Peter Lio is a Clinical Assistant Professor in the Department of Dermatology and Pediatrics at Northwestern University, Feinberg School of Medicine. He is the co-founder and co-director of the Chicago Integrative Eczema Center and very passionate about finding safe treatments that work for eczema. Dr. Lio received his medical degree from Harvard Medical School, completed his internship at Boston Children’s Hospital and his dermatology training at Harvard. He has had formal training in acupuncture under Kiiko Matsumoto and David Euler, and has held a long interest in alternative medicines. He currently serves on the Scientific Advisory Board for the National Eczema Association. His clinical office is located at Medical Dermatology Associates of Chicago.

References:

Abuabara K., & Margolis, D. J. (2013). Do children really outgrow their eczema, or is there more than one eczema. Journal of Allergy and Clinical Immunology.132(5), 1139-1140. https://dx.doi.org/10.1016/j.jaci.2013.08.028

Hon K. L., Tsang Y. K., Poon T. C. W., Pong, N. H., Kwan, M…& Leung T. (2016). Predicting eczema severity beyond childhood. World Journal of Pediatrics. 12(1), 44-48. doi: 10.1007/s12519-015-0064-9

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

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