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Longitudinal atopic dermatitis control and persistence vary with timing of disease onset in children: A cohort study
Joy Wan1, Nandita Mitra2, Ole J Hoffstad3
1Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Section of Pediatric Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Insights
Children with later onset of atopic dermatitis (AD) experience better disease control and less persistence. Early-, mid-, and late-onset AD represent distinct clinical subtypes.
Area of Science:
- Pediatric Dermatology
- Immunology
- Epidemiology
Background:
- Atopic dermatitis (AD) onset timing varies significantly in children.
- Distinct early-, mid-, and late-onset AD trajectories have been identified.
Purpose of the Study:
- To evaluate longitudinal disease control and persistence based on age at AD onset.
- To determine if age at onset influences AD outcomes over time.
Main Methods:
- Prospective observational cohort study using the Pediatric Eczema Elective Registry.
- Longitudinal assessment of AD control and persistence biannually for up to 10 years.
- Generalized linear latent and mixed modeling analysis.
Main Results:
- Older age at AD onset correlated with better disease control and reduced persistence.
- Each year increase in age at onset decreased odds of poorer control (aOR 0.93) and persistent AD (aOR 0.84).
- Differences in AD control and persistence were most evident from early adolescence onwards.
Conclusions:
- Early-, mid-, and late-onset pediatric AD appear to be clinically distinct subtypes.
- Age at onset is a significant factor in predicting AD disease course.
- Potential biases from self-reported data and longitudinal study attrition were noted.
Background:
Wide variation exists in the timing of atopic dermatitis (AD) disease onset among children. Distinct trajectories of early-onset, mid-onset, and late-onset AD have been previously described.
Objective:
To evaluate longitudinal disease control and persistence with respect to age at onset of AD.
Methods:
A cohort study was performed using the Pediatric Eczema Elective Registry, a prospective observational cohort of subjects with childhood-onset AD. AD control and persistence were assessed biannually for up to 10 years.
Results:
A total of 8015 subjects with 41,934 person-years of follow-up were included. In longitudinal analyses using generalized linear latent and mixed modeling, older age at onset of AD was associated with better disease control and less-persistent AD. For each additional year of age at onset of AD, the adjusted odds ratios for poorer AD control and for persistent AD were 0.93 (95% confidence interval, 0.91-0.94) and 0.84 (95% confidence interval, 0.80-0.88), respectively. Differences in AD control and persistence among subjects with early-, mid-, and late-onset AD were most pronounced from early adolescence onward.
Limitations:
Misclassification bias may arise from using self-reported data on age at onset. Attrition and missing data in longitudinal studies may introduce bias.
Conclusion:
Early-, mid-, and late-onset pediatric AD appear to be clinically distinct subtypes of the disease.
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