A systematic review and meta-analysis of risk factors associated with atopic dermatitis in Asia

Abstract

Background Atopic dermatitis (AD) is a chronic, inflammatory skin disorder characterised by intense itch and eczematous lesions. Rising prevalence of AD has been observed worldwide including in Asia. Understanding the risk factors associated with AD may explain its pathogenicity and identify new preventive strategies and treatments. However, AD-associated risk factors and comorbidities specific to Asia have not been systematically reviewed. Methods We performed a systematic review in accordance with the Preferred Reporting Item for Systematic Review and Meta-Analyses (PRISMA) guidelines and summarised epidemiological studies investigating personal, family, and environmental factors and comorbidities associated with AD in Asia. Significant factors were assessed if they can be altered through lifestyle practices and further classified into non-modifiable and modifiable factors. Meta-analysis using the random-effect model was also conducted to provide an overall estimate for several significant factors. Results We identified a total of 162 epidemiological studies conducted in Asia. Among non-modifiable factors, a family history of atopic diseases was the most reported, suggesting the involvement of genetics in AD pathogenesis. Among modifiable factors, the results of meta-analyses revealed maternal smoking as the strongest risk factor with a pooled odds ratio (OR) of 2.95 (95% CI, 2.43–3.60), followed by active smoking (pooled OR, 1.91, 95% CI, 1.41–2.59). Conclusion While a family history may aid clinicians in identifying high-risk individuals, literature has long suggested the importance of gene-environment interaction. This review identified several modifiable factors including medical treatments, indoor and outdoor environmental exposure, and personal and family lifestyle specific to Asia. Based on the meta-analyses performed, prevention strategies against AD may start from changing personal and family lifestyle choices, especially smoking habits.

Epidemiology and Characterization of Atopic Dermatitis in East Asian Populations: A Systematic Review

“…One of the studies cited above notes substantial differences in three Asian cities, with higher prevalence of AD coinciding with increased levels of urbanization [12]. This observaton was also supported in a recent metaanalysis which showed that urbanization in addition to maternal and personal history of smoking were the strongest environmental factors correlating with AD among Asians [21]. There is also basic science supporting this concept, with a potential link between pollution and AD found in the aryl hydrocarbon receptor [22].…”

The Keratinocyte as a Crucial Cell in the Predisposition, Onset, Progression, Therapy and Study of the Atopic Dermatitis

“…AD is a chronic inflammatory disease of the skin characterized by eczematous lesions and a sensation of intense itching. It originates from alteration of the integrity of the epidermal barrier as a consequence of the interaction between genetic and environmental factors [ 99 , 100 , 101 , 102 ]. Due to skin barrier defects, there is an increase in the permeability to antigens, both of chemical and protein nature.…”

Targeting Eczema Treatment by Clearing the Liver Heat and Detoxification: a Clinical Case Report

“…It is worsening in nature, often with recurrent burns, and can perhaps negatively affect the quality of life in affected individuals. A recent epidemiological and meta-analysis study suggests that atopic eczema is genetic-based along with primary causes of external environments, including, smoking [4]. The prevalence of eczema occurs in all age groups; however, it significantly appears during childhood [5].…”