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Background Eczema is a common inflammatory skin disease with varying developmental trajectories/patterns. This study sought to investigate eczema development from infancy to early adulthood by identifying distinct developmental trajectories that describe disease patterns over time and evaluate the role of early life risk factors. Methods The Isle of Wight Birth Cohort (n = 1456) was prospectively assessed at birth, 1, 2, 4, 10, 18, and 26 years. At each assessment, eczema was ascertained based on established clinical criteria. Developmental trajectories of eczema between 1-or-2 and 26 years were identified separately for males and females by applying semiparametric mixture models. Associations were assessed by applying a modified Poisson regression to estimate adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results In both males and females, the following eczema trajectories were identified: unaffected/transient (77.7% vs. 73.0%), mid-onset late-resolving (7.8% vs. 4.4%), late-onset (5.2% vs. 9.5%), and early-onset persistent (9.3% vs. 5.4%). In females, an additional trajectory was identified: early-onset early-resolving (7.7%). Among males, filaggrin gene (FLG) variants (aRR = 2.45, 95% CI: 1.34-4.46) and paternal eczema (2.66, 1.39-5.08) were associated with the early-onset persistent trajectory. Among females, maternal eczema (2.84, 1.42-5.70) and high birthweight (2.25, 1.08-4.69) were associated with the early-onset persistent trajectory. Conclusions Four and five trajectories represented eczema development among males and females, respectively, with different predisposing risk factors. Key messages Males and females may experience a different course of eczema and also sex-specific risk factors.

1280Natural history, developmental trajectories, and determinants of eczema from infancy to 26 years of age