ORIGINAL ARTICLE Trends in eczema in the first 18 years of life: results from the Isle of Wight 1989 birth cohort study A. H. Ziyab 1 , A. Raza 2,3 , W. Karmaus 4 , N. Tongue 2 , H. Zhang 4 , S. Matthews 2 , S. H. Arshad 2,3 and G. Roberts 2,3 1 Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University, Kuwait, 2 The David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight, UK, 3 University of Southampton School of Medicine, Southampton, UK and 4 Department of Epidemiology and Biostatistics, Norman J. Arnold School of Public Health, University of South Carolina, Aiken, SC, USA Clinical & Experimental Allergy Correspondence: Graham Roberts, The David Hide Asthma and Allergy Research Centre, St Mary’s Hospital, Newport, Isle of Wight PO30 5TG, UK. E-mail: g.c.roberts@soton.ac.uk Cite this as: A. H. Ziyab, A. Raza, W. Karmaus, N. Tongue, H. Zhang, S. Matthews, S. H. Arshad and G. Roberts, Clinical & Experimental Allergy , 2010 (40) 1776–1784. Summary Background Trends in the prevalence of eczema in the course of childhood and adolescence are not clear although often a net remission during childhood is assumed. Objectives To investigate the dynamics of change in eczema from 1 to 18 years in a prospective study and to understand the influence of gender and atopy. Methods Detailed information regarding eczema were collected at ages 1, 2, 4, 10 and 18 years from the 1989 Isle of Wight birth cohort (n = 1456). Skin prick testing was performed at 4, 10 and 18 years of age. The 12-month period prevalence, positive and negative transitions (defined as change in disease status in two consecutive study assessments) were stratified by gender and atopic status. Results The period prevalence of eczema from birth to 18 years of age remained relatively constant (11.9–14.2%) with minimal remission. Up to 10 years of age, gender did not influence prevalence. From 10 to 18 years, eczema became more prevalent among girls (16.3% for girls vs. 8.3% for boys, Po0.001) as a result of a greater positive transition in girls (9.4% for girls vs. 4.3% for boys, P = 0.001) and greater negative transition in boys (65.4% for boys vs. 50% for girls, P = 0.04). The higher positive transition of eczema in girls was most pronounced for non-atopic eczema (5.9% for girls vs. 1.5% for boys, P = 0.002). Conclusions We found only a minimal reduction in the prevalence of eczema during childhood and adolescence. During adolescence, more girls develop eczema and more boys outgrow it suggesting a role for gender-specific pubertal factors. Keywords atopy, eczema, gender, incidence, negative transition, positive transition, prevalence, remission Submitted 15 April 2010; revised 31 July 2010; accepted 13 September 2010 Introduction The burden of allergic disorders has increased in the last decades, particularly in westernized countries where ap- proximately 25% of children are affected [1]. Eczema is a chronic inflammatory skin disease characterized by a relapsing–remitting combination of skin dryness, itching and scratching, starting in childhood and perhaps persist- ing into adulthood [2, 3]. Most early childhood eczema is thought to remit [4, 5]. Various epidemiological studies have shown that eczema is more prevalent among boys during childhood with girls being more frequently affected after puberty [6–9]. These findings are based though on cross-sectional surveys. No study has yet investigated the dynamics of changes related to gender and allergic sensiti- zations from birth to adolescence period within one cohort. There are two possible explanations for the changing pattern of eczema during adolescence, firstly, more girls may experience the new occurrence of eczema or secondly, more boys may grow out of eczema. Using the Isle of Wight birth cohort, we aimed to examine the occurrence of eczema from infancy to age 18 years focusing on sex-specific differences in atopic and non- atopic eczema over this period. We hypothesize a gender reversal in the prevalence of eczema during adolescence. Methods The Isle of Wight 1989 birth cohort A whole population birth cohort was established on the Isle of Wight, UK, in 1989 to prospectively study the  EC Epidemiology of Allergic Disease doi: 10.1111/j.1365-2222.2010.03633.x Clinical & Experimental Allergy, 40, 1776–1784  c 2010 Blackwell Publishing Ltd