Not so long ago, the received wisdom was that atopic dermatitis (also known as infant or childhood eczema) was a disease that would disappear (or resolve) before adulthood. Eczema sufferers the world over knew that this wasn’t actually the case for every eczema sufferer and recent studies have confirmed that while eczema can and often does resolve in later childhood, sometimes it will persist throughout life.
What we’ve learnt:
- Around 80% of children grow out of eczema by the time they are 8 years old and only 5% of cases last into adulthood.
- There’s no way to predict which children will grow out of their eczema. However, there are some trends linked to family history, gender, age at onset and severity. The biggest risk factors for persistent eczema are a family history of atopic disease (eczema, asthma or hay fever) and darker skin tones.
- While eczema is typically associated with children, there is a second peak in occurrence at around 50 and a trend increasing occurrence in old age.
How many children grow out of their eczema?
A large meta-study, which incorporated the information about over 110,000 children with eczema, found that 80% of children grew out of their eczema by the time they were 8 years old, and only 5% cases persisted beyond 18 years 1.
Many cases of childhood eczema appear to resolve around the time children start school, only for the eczema to reappear at times of stress or hormonal changes. The combination of teenage hormones and exam stress is a common trigger and made my senior school years miserable at times. Eczema can also suddenly appear for the first time in later life with a second peak in occurrence at around 50 years, often following a period of stress or associated with the onset of the menopause. There is also a trend of increasing eczema in the elderly.
What factors influence the chances of growing out of eczema?
Eczema is driven by a complex interplay of genetic and environmental factors. There is no one single factor that will perfectly predict eczema persistence. However, there are some common trends.
- Genetics and family history. Family history of atopic disease (eczema, asthma and allergies) is one of the strongest predictors of persistent eczema. Investigations into the genes causing this relationship are ongoing. Around half of adults with eczema are known to have a difference in a skin protein called filaggrin. This deficiency can lead to drier, itchier skin and is strongly linked to the development of early onset, persistent eczema2. Researchers are also looking at variation in other genes, such as those involved in the immune system, including thymic stromal lymphopoietin (TSLP). Differences in this gene have been associated with differences in the persistence of childhood eczema3. There is currently no routine screening for these genetic variations and other biomarkers that could potentially be used to predict eczema persistency. The research surrounding them is still ongoing and they are still a long way from being clinically useful.
- Eczema severity. A number of studies have found that children with more severe eczema are less likely to outgrow it, although many of them do and the vast majority of cases will become less severe with time1.
- Time of onset. Studies have also found that early onset eczema (diagnosed before 2 years) was more likely to resolve than later onset eczema. One study found that an the average duration of symptoms was 3 years for children diagnosed before 1 year of age compared to 8 years for children diagnosed with eczema between 2 and 5 years1.
- Gender. Persistent eczema is more likely to occur in girls than boys. In the under 2s, eczema is more common in boys than girls. In the over 2s, it becomes progressively more common in girls than boys are the children get older4. One study found that 17.3% of young women had eczema compared to 16.4% of young men5.
- Ethnicity. There are limited studies into the impact of ethnicity on the persistence of eczema, however it appears that coloured skin is prone to more persistent eczema6. There are a number of possible reasons for this correlation, including the lower levels of vitamin D produced by coloured skin and higher occurrence of filaggrin variations in some populations4. As these studies are typically carried out in the USA, it is also possible that this correlation could also be related to socioeconomic factors.
- Socioeconomic factors. Eczema has been found to be more prevalent in babies from well off families, but in older children this pattern switches to one where eczema is more prevalent in children from less well off families4. In particular, increased eczema persistence has been linked to reduced access to timely healthcare; quality of housing and smoking levels, both of which reduce air quality within the home; and parental education levels7,8.
So will my child grow out of their eczema?
In all likelihood, your child will grow out of their eczema – 95% of children do. Eczema that appears early typically resolves and boys are less likely to have persistent eczema than girls. However, it isn’t guaranteed. The biggest risk factors for persistent eczema is a family history of atopic disease (eczema, asthma or hay fever) and darker skin tones.
Regardless of whether or not your child does grow out of their eczema, managing it will get easier with time as you discover their eczema triggers and which treatments work (and don’t work) for them.
Our sources
- Kim, J P, et al. “Persistence of Atopic Dermatitis (AD): A Systematic Review and Meta-Analysis.” Journal of the American Academy of Dermatology. Oct. 2016. www.ncbi.nlm.nih.gov/pmc/articles/PMC5216177/.
- Barker, ZN, et al. “Null Mutations in the FILAGGRIN Gene (FLG) Determine Major Susceptibility to Early-Onset Atopic Dermatitis That Persists into Adulthood.” The Journal of Investigative Dermatology. Mar. 2007. pubmed.ncbi.nlm.nih.gov/16990802/.
- Margolis, DJ, et al. “Thymic Stromal Lymphopoietin Variation, Filaggrin Loss of Function, and the Persistence of Atopic Dermatitis.” JAMA Dermatology. Mar. 2014, pubmed.ncbi.nlm.nih.gov/24401911/.
- de Lusignan, S, et al. “The Epidemiology of Eczema in Children and Adults in England: A Population-Based Study Using Primary Care Data.” Clinical and Experimental Allergy : Journal of the British Society for Allergy and Clinical Immunology. Mar. 2021, www.ncbi.nlm.nih.gov/pmc/articles/PMC7984097/.
- Johansson, EK, et al. “Prevalence and Characteristics of Atopic Dermatitis among Young Adult Females and Males-Report from the Swedish Population-Based Study Bamse.” Journal of the European Academy of Dermatology and Venereology : JEADV. May 2022, pubmed.ncbi.nlm.nih.gov/35032357/.
- Kim, Y, et al. “Racial/Ethnic Differences in Incidence and Persistence of Childhood Atopic Dermatitis.” The Journal of Investigative Dermatology. Apr. 2019, www.ncbi.nlm.nih.gov/pmc/articles/PMC6431568/.
- Chung, J, and EL Simpson. “The Socioeconomics of Atopic Dermatitis.” Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology, U.S. National Library of Medicine, Apr. 2019, pubmed.ncbi.nlm.nih.gov/30597208/.
- Hiranput, S. et al “Socioeconomic factors influence severity rather than incidence of dermatoses”. British Journal of Dermatology. July 2021. https://academic.oup.com/bjd/article/185/S1/49/6599433.
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