Okul Çağının Ötesindeki Çocuklarda Atopik Dermatit, Prognoz Ve Persistan Hastalık İçin Risk Faktörleri

Abstract

Background and Aim: Atopic dermatitis (AD) is a common chronic inflammatory skin disease of childhood with a heterogeneous clinical course. This study aimed to evaluate the persistence of AD beyond early childhood and to identify clinical, demographic, and environmental risk factors associated with disease persistence in patients with symptom onset within the first year of life. Materials and Methods: This retrospective cross-sectional study included 496 pediatric patients diagnosed with AD between January 1, 2020 and December 31, 2023, whose symptoms began within the first 12 months of life. Diagnosis was based on the Hanifin–Rajka criteria. Demographic, clinical, laboratory, and environmental data were obtained from medical records. Comparisons were made according to AD persistence at ages 3 and 5 years. Logistic regression analyses were performed to identify independent risk factors, and Kaplan–Meier survival analysis was used to evaluate symptom duration. Results: While most patients showed spontaneous remission over time, AD persisted in 20.7% of patients at age 3 and in 8.1% at age 5. The median age at last symptom was 16 months. Kaplan–Meier analysis demonstrated significantly longer symptom duration in patients with asthma symptoms, allergic rhinitis, higher disease severity (objective SCORAD), parental atopy, and early-life exposure to tobacco smoke. In multivariate analysis, age at symptom onset, parental atopy, asthma symptoms, and objective SCORAD were identified as independent predictors of persistence at both time points. No significant associations were found between persistence and sex, mode of delivery, prematurity, breastfeeding duration, total IgE levels, or eosinophil counts. Conclusion: Although early-onset AD is generally self-limiting, a clinically relevant subgroup of patients exhibits persistent disease. Disease severity, parental atopy, and concomitant atopic conditions are key determinants of persistence. Early identification of high-risk patients may facilitate individualized management and long-term follow-up strategies. Keywords: Atopic dermatitis, persistence, childhood, risk factors, SCORAD, asthma, allergic rhinitis.