Prevalence and Risk Factors of atopic dermatitis in adult dermatology patients
DOI:
https://doi.org/10.5281/zenodo.22814368Keywords:
atopic dermatitis, prevalence, risk factors, adult dermatology, filaggrinAbstract
Background: Atopic dermatitis (AD) is increasingly recognized as a common condition in adult dermatology patients, not merely a childhood disease that resolves before adulthood, with population-based surveys estimating adult prevalence in the range of roughly 5% to 10% depending on region and case definition.
Objective: This review synthesizes the published evidence on the prevalence of AD among adult dermatology patients and the genetic, environmental, and lifestyle risk factors that shape its onset, persistence, and severity.
Methods: We synthesized population-based cross-sectional surveys, longitudinal cohort studies, systematic reviews and meta-analyses, and clinical guideline documents addressing adult AD epidemiology, risk factors, comorbidity, and diagnosis.
Findings: Adult prevalence estimates range from approximately 4.9% to 10.2% across regions, with a substantial minority of cases reflecting genuinely adult-onset disease rather than childhood persistence; filaggrin loss-of-function mutations and other skin-barrier abnormalities are the best-established genetic risk factors, while urban residence, air pollution, occupational irritant exposure, climate, and psychosocial stress modulate disease expression; comorbidity with allergic disease, depression, anxiety, and attention-deficit/hyperactivity disorder is well documented and correlates with disease severity.
Conclusions: Adult AD is common, heterogeneous in onset and course, and carries a comorbidity and quality-of-life burden that is frequently under-recognized; dermatology clinicians should maintain a high index of suspicion, apply standardized diagnostic criteria, and screen proactively for the comorbidities most strongly associated with long-term outcomes.
References
Bieber, T. (2008) Atopic dermatitis. New England Journal of Medicine, 358(14): 1483-1494. DOI: 10.1056/NEJMra074081
Weidinger, S., Novak, N. (2016) Atopic dermatitis. Lancet, 387(10023): 1109-1122. DOI: 10.1016/S0140-6736(15)00149-X
Silverberg, J.I. (2020) Atopic dermatitis in adults. Medical Clinics of North America, 104(1): 157-176. DOI: 10.1016/j.mcna.2019.08.009
Silverberg, J.I., Hanifin, J.M. (2013) Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. Journal of Allergy and Clinical Immunology, 132(5): 1132-1138. DOI: 10.1016/j.jaci.2013.08.031
Lee, H.H., Patel, K.R., Singam, V., Rastogi, S., Silverberg, J.I. (2019) A systematic review and meta-analysis of the prevalence and phenotype of adult-onset atopic dermatitis. Journal of the American Academy of Dermatology, 80(6): 1526-1532. DOI: 10.1016/j.jaad.2018.05.1241
Barrett, M., Luu, M. (2017) Differential diagnosis of atopic dermatitis. Immunology and Allergy Clinics of North America, 37(1): 11-34. DOI: 10.1016/j.iac.2016.08.009
Silverberg, J.I. (2019) Comorbidities and the impact of atopic dermatitis. Annals of Allergy, Asthma and Immunology, 123(2): 144-151. DOI: 10.1016/j.anai.2019.04.020
Langan, S.M., Irvine, A.D., Weidinger, S. (2020) Atopic dermatitis. Lancet, 396(10247): 345-360. DOI: 10.1016/S0140-6736(20)31286-1
Deckers, I.A.G., McLean, S., Linssen, S., Mommers, M., van Schayck, C.P., Sheikh, A. (2012) Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS ONE, 7(7): e39803. DOI:
1371/journal.pone.0039803 10. Chiesa Fuxench, Z.C., Block, J.K., Boguniewicz, M., Boyle, J., Fonacier, L., Gelfand, J.M., et al. (2019) Atopic Dermatitis in America Study: a cross-sectional study examining the prevalence and disease burden of atopic dermatitis in the US adult population. Journal of Investigative Dermatology, 139(3): 583-590. DOI: 10.1016/j.jid.2018.08.028
Barbarot, S., Auziere, S., Gadkari, A., Girolomoni, G., Puig, L., Simpson, E.L., et al. (2018) Epidemiology of atopic dermatitis in adults: results from an international survey. Allergy, 73(6): 1284-1293. DOI: 10.1111/all.13401
Williams, H., Stewart, A., von Mutius, E., Cookson, W., Anderson, H.R. (2008) Is eczema really on the increase worldwide? Journal of Allergy and Clinical Immunology, 121(4): 947-954.
Odhiambo, J.A., Williams, H.C., Clayton, T.O., Robertson, C.F., Asher, M.I. (2009) Global variations in prevalence of eczema symptoms in children from ISAAC Phase Three. Journal of Allergy and Clinical Immunology, 124(6): 1251-1258. DOI: 10.1016/j.jaci.2009.10.009
Flohr, C., Mann, J. (2014) New insights into the epidemiology of childhood atopic dermatitis. Allergy, 69(1): 3-16. DOI: 10.1111/all.12270
Nutten, S. (2015) Atopic dermatitis: global epidemiology and risk factors. Annals of Nutrition and Metabolism, 66(Suppl 1): 8-16. DOI: 10.1159/000370220
Silverberg, J.I. (2017) Public health burden and epidemiology of atopic dermatitis. Dermatologic Clinics, 35(3): 283-289.
Yew, Y.W., Thyssen, J.P., Silverberg, J.I. (2019) A systematic review and meta-analysis of the regional and age-related differences in atopic dermatitis clinical characteristics. Journal of the American Academy of Dermatology, 80(2): 390-401. DOI: 10.1016/j.jaad.2018.09.035
Abuabara, K., Yu, A.M., Okhovat, J.P., Allen, I.E., Langan, S.M. (2018) The prevalence of atopic dermatitis beyond childhood: a systematic review and meta-analysis of longitudinal studies. Allergy, 73(3): 696-704. DOI: 10.1111/all.13320
Garmhausen, D., Hagemann, T., Bieber, T., Dimitriou, I., Fimmers, R., Diepgen, T., et al. (2013) Characterization of different courses of atopic dermatitis in adolescent and adult patients. Allergy, 68(4): 498-506.
Margolis, J.S., Abuabara, K., Bilker, W., Hoffstad, O., Margolis, D.J. (2014) Persistence of mild to moderate atopic dermatitis. JAMA Dermatology, 150(6): 593-600. DOI: 10.1001/jamadermatol.2013.10271
Kantor, R., Thyssen, J.P., Paller, A.S., Silverberg, J.I. (2016) Atopic dermatitis, atopic eczema, or eczema? A systematic review, meta-analysis, and recommendation for uniform use of "atopic dermatitis". Allergy, 71(10): 1480-1485. DOI: 10.1111/all.12982
Palmer, C.N.A., Irvine, A.D., Terron-Kwiatkowski, A., Zhao, Y., Liao, H., Lee, S.P., et al. (2006) Common loss-of-function variants of the epidermal barrier protein filaggrin are a major predisposing factor for atopic dermatitis. Nature Genetics, 38(4): 441-446. DOI: 10.1038/ng1767
Kim, J.P., Chao, L.X., Simpson, E.L., Silverberg, J.I. (2016) Loss-of-function mutations in the filaggrin gene and their associations with atopic dermatitis and allergic disease: a systematic review and meta-analysis. Journal of the American Academy of Dermatology, 75(6): 1215-1223. DOI: 10.1016/j.jaad.2016.07.014
Thyssen, J.P., Kezic, S. (2014) Causes of epidermal filaggrin reduction and their role in the pathogenesis of atopic dermatitis. Journal of Allergy and Clinical Immunology, 134(4): 792-799. DOI: 10.1016/j.jaci.2014.06.014
Brown, S.J., McLean, W.H.I. (2012) One remarkable molecule: filaggrin. Journal of Investigative Dermatology, 132(3 Pt 2): 751-762.
Paller, A.S., Spergel, J.M., Mina-Osorio, P., Irvine, A.D. (2019) The atopic march and atopic multimorbidity: many trajectories, many pathways. Journal of Allergy and Clinical Immunology, 143(1): 46-55. DOI: 10.1016/j.jaci.2018.11.006
Hendricks, A.J., Eichenfield, L.F., Shi, V.Y. (2020) The impact of airborne pollution on atopic dermatitis: a literature review. British Journal of Dermatology, 183(1): 16-23. DOI: 10.1111/bjd.18781
Kantor, R., Silverberg, J.I. (2017) Environmental risk factors and their role in the management of atopic dermatitis. Expert Review of Clinical Immunology, 13(1): 15-26. DOI: 10.1080/1744666X.2016.1212660
Zink, A.G.S., Arents, B., Fink-Wagner, A., Seitz, I.A., Mensing, U., Wettemann, N., et al. (2019) Out-of-pocket costs for individuals with atopic eczema: a cross-sectional study in nine European countries. Acta Dermato-Venereologica, 99(3): 263-267. DOI: 10.2340/00015555-3102
Eckert, L., Gupta, S., Amand, C., Gadkari, A., Mahajan, P., Gelfand, J.M. (2017) The burden of atopic dermatitis in US adults: health care resource utilization data from the 2013 National Health and Wellness Survey. Journal of the American Academy of Dermatology, 77(2): 274-279. DOI: 10.1016/j.jaad.2017.04.019
Tsakok, T., Marrs, T., Mohsin, M., Baron, S., du Toit, G., Till, S., et al. (2016) Does atopic dermatitis cause food allergy? A systematic review. Journal of Allergy and Clinical Immunology, 137(4): 1071-1078. 10.1016/j.jaci.2015.10.049
Silverberg, J.I., Simpson, E.L. (2013) Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization. Pediatric Allergy and Immunology, 24(5): 476-486. 10.1111/pai.12095
Ronnstad, A.T.M., Halling-Overgaard, A.S., Hamann, C.R., Skov, L., Egeberg, A., Thyssen, J.P. (2018) Association of atopic dermatitis with depression, anxiety, and suicidal ideation in children and adults: a systematic review and meta-analysis. Journal of the American Academy of Dermatology, 79(3): 448-456. DOI: 10.1016/j.jaad.2018.03.017
Strom, M.A., Fishbein, A.B., Paller, A.S., Silverberg, J.I. (2016) Association between atopic dermatitis and attention deficit hyperactivity disorder in US children and adults. British Journal of Dermatology, 175(5): 920-929. 10.1111/bjd.14697
Silverberg, J.I., Gelfand, J.M., Margolis, D.J., Boguniewicz, M., Fonacier, L., Grayson, M.H., et al. (2018) Patient burden and quality of life in atopic dermatitis in US adults: a population-based cross-sectional study. Annals of Allergy, Asthma and Immunology, 121(3): 340-347. 10.1016/j.anai.2018.07.006
Drucker, A.M., Wang, A.R., Li, W.Q., Sevetson, E., Block, J.K., Qureshi, A.A. (2017) The burden of atopic dermatitis: summary of a report for the National Eczema Association. Journal of Investigative Dermatology, 137(1): 26-30. DOI: 10.1016/j.jid.2016.07.012
Eichenfield, L.F., Tom, W.L., Chamlin, S.L., Feldman, S.R., Hanifin, J.M., Simpson, E.L., et al. (2014) Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. Journal of the American Academy of Dermatology, 70(2): 338-351. DOI: 10.1016/j.jaad.2013.10.010
Simpson, E.L., Bieber, T., Guttman-Yassky, E., Beck, L.A., DOI: Blauvelt, A., Cork, M.J., et al. (2016) Two phase 3 trials of dupilumab versus placebo in atopic dermatitis. New England Journal of Medicine, 375(24): 2335-2348. DOI: 10.1056/NEJMoa1610020 DOI: DOI: DOI:
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