Disease trajectories in childhood atopic dermatitis

Eczema (also known as atopic dermatitis or AD) is a complex skin condition that generally develops in early childhood, affecting 15 to 20% of children worldwide. Although it clears by itself in some children, it persists into adulthood in many children, contrary to popular belief. Many children develop related allergic diseases such as asthma, allergic rhinitis and eosinophilic oesophagitis (allergic inflammation of the oesophagus), a pathway known as the “atopic march”. The authors, based in Ireland and the U.S.A., aimed to find reproducible patterns (i.e. clinically relevant characteristics) that could help doctors predict whether childhood AD will clear or progress, by surveying several recent studies with large patient cohorts (groups studied). These studies show that most atopic children, in fact, do not follow the classical “atopic march” but can follow various disease courses. Although the data came from different sources or were described in different ways, the authors identified common characteristics of early‐childhood AD that may help estimate risk of developing persistent disease (i.e. that progresses into adulthood) and related allergic diseases. They found that children who get severe AD at a very young age and who have parents with a history of related diseases, have a higher risk of disease progression. Genetic factors, allergies, and living in an urban environment also increase this risk. The authors provide a practitioner's guide that could help doctors to identify children with AD at higher risk of disease progression and to decide on the best course of action for their treatment, such as regular check‐ups or referring them to a specialist for further testing or treatment.