Atopic dermatitis (AD, also known as ‘atopic eczema’ or simply ‘eczema’) is one of the most common chronic dermatologic diseases and is characterized by intense pruritus, sleep disturbances, and large reductions in patients’ quality of life. It may increase the risk of allergies and asthma, and has recently been characterized as a systemic inflammatory disorder. Clinical treatment guidelines recommend standardized approaches for most patients, but emerging evidence and the highly variable clinical course suggest that personalized interventions hold the promise of much more efficacious treatment. Identifying groups of individuals with similar patterns of disease activity will facilitate the identification of factors that drive disease activity over time and form the basis for studies that seek to identify more tailored interventions.

AD has become much more common over the past few decades, suggesting that environmental factors play an important role in the disease. Many studies have found relationships between early life exposures and AD onset, but few have examined how environmental factors affect disease activity over time. Epigenetic factors (functionally relevant changes in chromosomes that do not affect the DNA sequence including methylation patterns) are hypothesized to link socio-environmental exposures with disease trajectory.

The objectives of our study are three fold: (1) to identify subgroups of individuals with distinct disease trajectories (for example, early-onset resolving, early-onset persistent, and late-onset), (2) to determine the extent to which in utero and early life nutritional, microbial, toxic and stress-related exposures are associated with disease trajectory, and (3) to test the extent to which the associations between in utero and early life risk factors are explained by methylation changes that affect how DNA is transcribed.