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PubMed2000

The excess of atopic eczema in East Germany is related to the intrinsic type.

BACKGROUND: Prevalence data for atopic eczema based on a dermatological examination have not so far been available for East and West Germany. Possible differences in the proportions of extrinsic and intrinsic types of eczema, and how far these could explain differences in the prevalence of eczema, need to be clarified. OBJECTIVES: To compare the prevalence of atopic eczema in pre-school children between different locations in East and West Germany, and over a period of 7 years, at three time points. Additionally, to determine the proportions of intrinsic and extrinsic types of eczema by taking skin prick test reactivity into account. METHODS: Repeated cross-sectional studies in 1991, 1994 and 1997 in 5-6-year-old pre-school children at five different locations in West Germany (n = 2075) and six in East Germany (n = 1926) were carried out. Individuals with eczema were identified by an examination performed by physicians of the Department of Dermatology. In addition, a skin prick test and a standardized questionnaire were used. RESULTS: The overall prevalence of atopic eczema in these children was 10.4%. At all three times of investigation (1991, 17.5% vs. 11.2%; 1994, 12.6% vs. 8.7%; 1997, 11.2% vs. 4.5%) and in the total group (12.9% vs. 8.2%), the prevalence was significantly higher in East than in West Germany. After controlling for influences of sex, parental history of atopic diseases, observer and socio-economic status in multiple logistic regression analyses, these differences remained significant for 1991, 1994 and for the overall group (odds ratio, OR 1.78, 95% confidence interval, CI 1. 43-2.21). Girls (OR 1.56, 95% CI 1.27-1.92) and children whose parents had a higher level of school education (OR 1.17, 95% CI 1. 00-1.37) were affected more frequently. Of all children, 26.6%, and of those with eczema, 41.9% exhibited at least one reaction in the prick test (OR 2.21, 95% CI 1.75-2.80; sensitization in eczema vs. no eczema). Whereas 50.4% of the children with eczema in West Germany were sensitized, only 36.5% of the diseased children in East Germany reacted positively in the prick test (OR 1.77, 95% CI 1.12-2. 79). CONCLUSIONS: These results are in accordance with findings regarding allergic sensitization and hay fever and might indicate that factors other than allergy are responsible for the higher prevalence of atopic eczema in East Germany.

Allergens↗
PubMed2005

[The influence of ageing and seasons on infantile eczema - a population-based cohort study of babies aged 4 months and 10 months].

BACKGROUND: This is probably the first report of a population study on infantile eczema performed for 12 months at two ages of 4 months and 10 months on the same infant group. METHODS: The Fujiidera Health Center services the health needs of 181,994 inhabitants of Habikino and Fujiidera cities. Between September 1990 and August 1991,1775 newborns were called for a health check-up performed twice a months when they reached 4 months of age. This was repeated for a year when the infants reached 10 months of age. A total of 1493 4-month old infants and 1264 10-month old infants were examined. An expert dermatologist joined this and performed a complete skin examination throughout the study. The eczematous skin changes were evaluated at 50 different points on the body and scored using an originally made chart. Scratch marks were also evaluated at each area. Based on the scores computed eczema was diagnosed when the total score crossed a threshold number. Based on this the examiner diagnoses were categorized as follows: Degree 1: no need to visit a doctor, Degree 2: visit to doctor required, Degree 3: treatment required. Gender was not considered. The data was analyzed by an originally made software using DEC-7000 computer. RESULTS: Of all the 4-month old infants examined 329 (22.0%) were initially diagnosed to have eczema while of all the 10-month old infants examined 268 (21.2%) were initially diagnosed to have eczema. Further, out of the 329 4-month old infants initially diagnosed with eczema, 228 were again examined when they were 10-months old. Of this sample; 123 (9.7%) infants showed continued symptoms of eczema and 165 (13.1%) infants no longer showed signs of eczema. In addition, out of the 976 4-month old infants initially diagnosed without eczema, 145 (11.5%) newly developed eczema at 10 months. Hence the cumulative diagnosis rate of eczema reached 34.3%. Meanwhile the monthly diagnosis number was significantly higher in Feb (OR 1.84, p=0.031) and significantly lower in Aug (OR 0.21, p<0.001) than the expected number calculated from monthly examination number and the annual diagnosis rate at 4 months. This observation was also the case at 10 months (Feb; OR 2.19, p=0.02, Aug; OR 0.36, p=0.015). The degree of eczema was significantly higher (p<0.001, Mann-Whitney's U test) at 4 months than 10 months. When this was seen monthly, degree 3 was most prevalent in February-March, while degree 2 was most prevalent in October-January for the 4-month olds. For the 10-month olds, both the degree 3 and degree 2 were quite low throughout the year and only degree 1 showed a monthly change similar to degree 2 plus degree 3 of the 4-month olds. CONCLUSION: We therefore conclude that eczematous skin manifestations of infantile eczema are easily changeable by age at less than 1 year and are strongly influenced by seasons.

Aging↗
PubMed1996

Immunological studies of herpes simplex virus infection in children with atopic eczema.

This study examines the role of immune defence mechanisms in herpes simplex virus (HSV) infections in atopic eczema and whether impairment of these mechanisms explains the susceptibility of some children with atopic eczema to cutaneous HSV infections. Ten children with eczema herpeticum and 13 with atopic eczema and recurrent HSV infection affecting multiple skin sites were studied, together with relevant control groups. In all children with atopic eczema, in vitro lymphoproliferation in response to stimulation with concanavalin A (Con A) was significantly decreased and natural killer (NK) cells (CD16 + 56) were reduced compared with non-atopic controls. IL-2 receptors, a marker for lymphocyte activation, were decreased during the acute phase of eczema herpeticum, and for 1 month thereafter. A positive stimulation index (> 3) to HSV antigen, and high HSV IgG antibody titres measured by ELISA, Western blotting and neutralization assay, were seen in children with eczema herpeticum by 6 weeks, and also in children with atopic eczema and recurrent HSV infections. No evidence of an HSV-specific immune defect (either cell-mediated or humoral) was found in atopic eczema. Impairment of cell-mediated immunity in atopic eczema was suggested by the reduced response to Con A. It is likely that reduced numbers of circulating NK cells and a decrease in IL-2 receptors during early eczema herpeticum contribute to the susceptibility of children with atopic eczema to cutaneous HSV infections.

Acute Disease↗
PubMed2003

The prevalence, characteristics of and early life risk factors for eczema in 10-year-old children.

Eczema is a common infantile disease but its nature and extent during later childhood remains unclear. In a whole-population birth cohort study (n = 1456) we examined prevalence and characteristics of eczema amongst 10-year-old children. At this age 1373 (94%) children completed ISAAC questionnaires, 1043 (72%) skin prick testing and 953 (65%) serum inhalant IgE antibody screening. At 10 years of age prevalence of eczema ever was 41.0% and for current eczema was 13.7% (combined current itchy rash and eczema ever). Most current eczema (71.0%) began before 4 years of age, but was associated with low morbidity at 10 years. Amongst children with diagnosed eczema at 4 years of age, 56.3% had current eczema at 10 years. Atopy (positive skin test) and other allergic states were associated with current eczema (p < 0.001). Risk factor analysis for current eczema identified independent significance for atopy (p = 0.01), rhinitis (p = 0.04) and food allergy (p = 0.01) at 4 years, plus maternal asthma (p = 0.03). Diagnosed rhinitis at 4 years emerged as a significant predictor of persistent disease. Eczema is not simply a transient infantile condition but a common problem at 10 years of age, often reflecting persistent disease from early childhood. Inherited predisposition towards atopy is the predominant risk factor for this state.

Child↗
PubMed2005

Fifteen-year follow-up of hand eczema: predictive factors.

The aim of this study was to identify factors of importance for the long-term prognosis of hand eczema in the general population. In a 15-y follow-up, 868 (78%) individuals with hand eczema, diagnosed and clinically examined in a previous population-based study, answered a postal questionnaire with questions concerning persistence of the disease. In a logistic regression model, the extent of eczema involvement at the initial examination was the strongest negative factor for the prognosis, followed by history of childhood eczema and age below 20 y at onset of hand eczema. These factors significantly influenced both the total time with hand eczema during the 15 y follow-up and occurrence of hand eczema the previous year. The predictive factor for hand eczema 15 y later was doubled for an individual with all three risk factors compared with one without them, 72%vs 35%. Contact allergy to any of the standard allergens also related significantly to current hand eczema. In conclusion, the main determinant for a poor long-term prognosis was widespread hand dermatitis at the initial examination. Other important factors were low age at onset of hand eczema, history of childhood eczema, and contact allergy.

Adult↗
PubMed2005

Prenatal factors associated with the development of eczema in the first year of life.

Prenatal factors have been implicated in childhood eczema, but the relationship between maternal cytokine production during pregnancy and infant eczema is unknown. Non-selected women in their third trimester were enrolled in the Tucson Infant Immune Study. Data from three sources were used to define MD-eczema: parent-completed illness questionnaires at age 2, 3, 4, 6 and 9 months regarding physician-seen eczema, parent-completed questionnaires at 12 months regarding physician-diagnosed eczema, and medical record reviews. Blood samples were taken from mothers during their third trimester and from the umbilical cord at birth. Maternal peripheral blood mononuclear cells and cord blood mononuclear cells were stimulated with ConA/PMA, and supernatants were assayed for IFN-gamma and IL-4, -5, -10, and -13. Of 364 children, 28% were seen by a physician for eczema by 1 yr of age. After adjustment for potential confounders using logistic regression, the odds for development of eczema in infancy were significantly higher when mothers had active eczema in pregnancy (OR, 2.46, CI 1.0-5.8, p <0.042) and when mothers were in the highest tertile of serum IgE production (OR 2.28, CI 1.2-4.4, p <0.013). Colds in the third trimester were associated with lower odds of eczema (OR 0.32, CI 0.16-0.63, p <0.001). Our findings from this cohort study suggest that in utero factors, including maternal IgE, colds, and eczema, may influence the risk of infant eczema.

Arizona↗
PubMed2006

Atopy, eczema and breast milk fatty acids in a high-risk cohort of children followed from birth to 5 yr.

BACKGROUND: The incidence of atopic diseases such as eczema is increasing in westernized societies. The suggestion that there is a "protective" association between the unique fatty acid composition of breast milk, particularly the omega-3 (n-3) and omega-6 (n-6) essential polyunsaturated fatty acid content, and the development of atopic disease in children was investigated in a cohort study of 263 infants born into families with a history of allergy (one or both parents had asthma, hayfever, eczema). The objectives of this study were to determine the lipid profile [specifically in relation to long-chain polyunsaturated fatty acid (LC-PUFA) composition] in maternal breast milk samples collected at 6 wk and at 6 months following birth, and to investigate the potential role of these fatty acids in modulating the phenotype of children at high genetic risk of developing atopic disease. METHOD: Breast milk samples were available from 91 atopic mothers at their child's ages of 6 wk and 6 months. These samples were analysed for the fatty acid spectrum. Analysis of variance was used to detect differences between groups of outcomes (no atopy or eczema, non-atopic eczema, atopy, atopic eczema) at ages 6 months and 5 yr, and a multiple comparisons procedure was conducted to isolate the parameters producing the different results (F-test, LSD test). For the exposure variables, n-3 and n-6 fatty acids are expressed as weight percentage and as a ratio (at both time-points). RESULTS: The fatty acid profiles of maternal breast milk at 6 wk and 6 months were similar. An increased ratio of n-6: n-3 fatty acids in both 6 wk and 6 month milk samples was associated with non-atopic eczema (p < 0.005) but not atopy alone or atopic eczema. CONCLUSION: We found milk fatty acids were a significant modulator of non-atopic eczema but not atopy or atopic eczema in infants at 6 months. In mothers with a history of asthma, hayfever or eczema, their 6-month-old infants were more likely to develop non-atopic eczema if their milk had a higher ratio of n-6: n-3 LC-PUFA.

Child, Preschool↗
PubMed2000

Systematic review of treatments for atopic eczema.

BACKGROUND: Atopic eczema is the commonest inflammatory skin disease of childhood, affecting 15-20% of children in the UK at any one time. Adults make up about one-third of all community cases. Moderate-to-severe atopic eczema can have a profound effect on the quality of life for both sufferers and their families. In addition to the effects of intractable itching, skin damage, soreness, sleep loss and the social stigma of a visible skin disease, other factors such as frequent visits to doctors, special clothing and¿the need to constantly apply messy topical applications all add to the burden of disease. The cause of atopic eczema is unknown, though a genetic pre-disposition and a combination of allergic and non-allergic factors appear to be important in determining disease expression. Treatment of atopic eczema in the UK is characterised by a profusion of treatments aimed at disease control. The evidential basis of these treatments is often unclear. Most people with atopic eczema are managed in primary care where the least research has been done. OBJECTIVES: The objectives of this scoping review are two-fold. To produce an up-to-date coverage 'map' of randomised controlled trials (RCTs) of treatments of atopic eczema. To assist in making treatment recommendations by summarising the available RCT evidence using qualitative and quantitative methods. METHODS DATA SOURCES: Data sources included electronic searching of MEDLINE, EMBASE, the Cochrane Controlled Clinical Trials Register, the Cochrane Skin Group specialised register of trials, hand-searching of atopic eczema conference proceedings, follow-up of references in retrieved articles, contact with leading researchers and requests to relevant pharmaceutical companies. INCLUSION/EXCLUSION CRITERIA: Only RCTs of therapeutic agents used in the prevention and treatment of people with atopic eczema of any age were considered for inclusion. Only studies where a physician diagnosed atopic eczema or atopic dermatitis were included. DATA EXTRACTION: Data extraction was conducted by two observers onto abstraction forms, with discrepancies resolved by discussion. QUALITY ASSESSMENT: The quality assessment of retrieved RCTs included an assessment of: a clear description of method and concealment of allocation of randomisation, the degree to which assessors and participants were blinded to the study interventions, and whether all those originally randomised were included in the final main analysis. DATA SYNTHESIS: Where possible, quantitative pooling of similar RCTs was conducted using the Cochrane Collaboration's methods. Where statistical heterogeneity was found, sources of heterogeneity in terms of study participants, formulation or posology of intervention, and use of co-treatments were explored. Where pooling was not deemed to be appropriate, detailed descriptions of the study characteristics and main reported results were presented along with comments on study quality. RESULTS: A total of 1165 possible RCTs were retrieved in hard copy form for further scrutiny. Of these, 893 were excluded from further analysis because of lack of appropriate data. The 272 remaining RCTs of atopic eczema covered at least 47 different interventions, which could be broadly categorised into ten main groups. Quality of reporting was generally poor, and limited statistical pooling was possible only for oral cyclosporin, and only then after considerable data transformation. There was reasonable RCT evidence to support the use of oral cyclosporin, topical corticosteroids, psychological approaches and ultraviolet light therapy. There was insufficient evidence to make recommendations on maternal allergen avoidance for disease prevention, oral antihistamines, Chinese herbs, dietary restriction in established atopic eczema, homeopathy, house dust mite reduction, massage therapy, hypnotherapy, evening primrose oil, emollients, topical coal tar and topical doxepin. (ABSTRACT TRUNCATED)

Administration, Cutaneous↗
PubMed1995

Pityrosporum ovale extracts increase interleukin-4, interleukin-10 and IgE synthesis in patients with atopic eczema.

Evidence for a possible role of the lipophilic yeast Pityrosporum ovale in the pathophysiology of atopic eczema has been found both in laboratory and therapeutical studies. Positive type I prick test reactions to P. ovale correlate with the intensity of eczematous skin lesions in the head and neck regions of patients with atopic eczema. Furthermore, antifungal treatment has been shown to be helpful in atopic eczema. In the present study the effect of P. ovale on IgE synthesis and cytokine production (IL-2, IFN gamma, IL-4, IL-10) was investigated in patients with atopic eczema, in vitro. Eight patients with atopic eczema were studied; of these, 5 patients had specific IgE antibodies against P. ovale, as determined by fluoroimmunoassay (RAST). The control group consisted of 5 healthy non-atopic, P. ovale IgE-antibody-negative volunteers. Freshly isolated peripheral blood mononuclear cells (PBMC) were incubated in the presence of different antigen concentrations (0.01, 0.1, 1.0, 10 micrograms/l x 10(6) cells) of P. ovale. IgE contents in the cell culture supematants were significantly elevated in RAST(+) patients with atopic eczema (p < 0.05), compared with RAST(-) atopic eczema patients and healthy volunteers. Coincubation of P. ovale-stimulated PBMC with IL-4 (50 U/l/ 1 x 10(6) cells) resulted in a significantly higher IgE synthesis only in the RAST(+) atopic eczema patients. Additionally, incubation of PBMC from RAST(+) patients with atopic eczema led to an elevated synthesis of the TH2 related cytokines IL-4 and IL-10. Within the atopic eczema group, two subgroups differed markedly in their response to P. ovale antigen stimulation with a good correlation to the presence of specific IgE in serum and in vitro IL-4 and IL-10 production. The data support the assumption that P. ovale antigens might play a role in skin inflammation in at least a subgroup of patients with atopic eczema characterized by the presence of specific IgE antibodies to P. ovale.

Adult↗
PubMed2004

Is high mole count a marker of more than melanoma risk? Eczema diagnosis is associated with melanocytic nevi in children.

BACKGROUND: The number of melanocytic nevi is the best single marker of increased melanoma risk. In a previous study, adults with severe eczema were reported to have significantly fewer nevi than adults without eczema. OBSERVATIONS: In a nested case-control design within a randomized, controlled interventional trial of additional sun protection vs standard care in 269 children, a history of eczema was reported by the parents of 44 (16%) of the children. More nevi were found in children with a parental report of previous eczema diagnosis than in children without reported eczema (median, 7.5 nevi vs 5.0 nevi; P =.01). Eczema diagnosis was most significantly associated with more melanocytic nevi in children with lightly pigmented skin (8.5 nevi vs 6.0 nevi; P <.001). In multivariate logistical regression analysis, including assessment of hair color, sun protection practices, and study assignment (intervention vs standard care), eczema status remained significantly predictive of nevi number in children (P <.001). CONCLUSIONS: In contrast to a previous study that associated severe eczema with fewer nevi in adults, in the present study children with a reported history of eczema had more nevi than children without a reported history of eczema.

Case-Control Studies↗
PubMed2007

Severity of hand eczema assessed by patients and dermatologist using a photographic guide.

BACKGROUND: The severity of hand eczema is of interest in epidemiological studies. Ideally, as no validated methods of self-assessment exist, a dermatologist should examine all subjects. However, this is very resource intensive. OBJECTIVES: To examine if severity grading performed by patients with hand eczema using a self-administered photographic guide was in agreement with the assessment performed by a trained dermatologist. Furthermore, to measure the correlation between the severity of hand eczema expressed on a visual analogue scale (VAS) and the clinical severity assessment, using the photographic guide. METHODS: Fifty-three consecutive outpatients with hand eczema were included, a number based on a prestudy statistical calculation. The patients were asked to grade current severity of their hand eczema by choosing one of four groups of photographs representing differing severities of hand eczema. On the same day all patients were examined by an experienced dermatologist, who graded the severity using the same photographic guide. The photographic guide was a modified version of a validated guide for use by physicians. In addition, the patients rated the severity of their hand eczema on a VAS. RESULTS: Fifty-one of the respondents completed the full questionnaire. For 37 of the 51 patients (73%) the clinical severity assessments of patient and dermatologist were identical. The measure of agreement, Cohen's kappa coefficient, was 0.61, indicating good inter-rater agreement. The correlation between the dermatologist-rated severity and the corresponding score by the patients on the VAS was only moderate (Spearman's rank correlation coefficient rho = 0.52). CONCLUSIONS: The photographic guide for the self-assessment of hand eczema is an easy instrument to use, and for research purposes can be a reliable tool for patients with hand eczema to grade severity. A VAS can only be considered as a mediocre tool for estimation of the dermatologist-rated clinical severity, but should be validated as an independent instrument to assess severity of hand eczema.

Adolescent↗
PubMed2005

Worm infestation and the negative association with eczema (atopic/nonatopic) and allergic sensitization.

BACKGROUND: Worm infestations may play a role in preventing allergies. There is a lack of epidemiological information from Western countries on the association between worm infestation and eczema. OBJECTIVE: To investigate the association between worm infestation and eczema in a proper temporal sequence and under consideration of allergic sensitization. METHODS: Two surveys were performed in East German school children. Questionnaire data included the history of eczema and worm infestation and their time of onset. Specific IgE antibodies to five common aeroallergens were measured and used to define nonatopic and atopic eczema. Logistic regression analyses were performed to control for relevant confounders (age, sex, parental school education and history of allergies). In order to confirm the findings a corresponding conditional regression analysis was applied on cases and controls matched by age and sex. RESULTS: A total of 4169 children participated (response 75 and 76%) who were, on average, 9.2 years old (47% girls). Overall 17.0% reported a prior worm infestation (Ascaris 44%, Oxyuris 33%) and 18.1% had a history of eczema. Eczema occurred significantly less frequent in children who had a worm infestation (prior to the onset of eczema) compared with children without such a history (8.1%vs 16.5%, OR(adj): 0.45, 95% CI: 0.33-0.60). The finding was confirmed by the corresponding matched case-control analysis (OR(adj): 0.57, 95% CI: 0.41-0.79). Atopic eczema was affected more by a prior worm infestation (OR(adj): 0.31, 95% CI: 0.18-0.56) than the nonatopic eczema (OR(adj): 0.58, 95% CI: 0.40-0.84). A total of 29.1% exhibited specific IgE antibodies to at least one aeroallergen. Sensitized children gave significantly less frequent a history of worm infestation (14.2%vs 18.3%, OR(adj): 0.74, 95% CI: 0.60-0.92). Stratified analysis revealed that this effect most pronounced for a sensitization to house dust mite. CONCLUSIONS: A worm infestation is associated with a reduced frequency of subsequent eczema, especially the atopic type. Furthermore allergic sensitization, especially to house dust mite, and worm infestation are negatively associated. The data support the concept that a lack of immune-stimulation by parasitic infections contributes to the development of allergies.

Case-Control Studies↗
PubMed1997

[Immunology in medical practice. V. Constitutional eczema].

Constitutional eczema (late atopic dermatitis) is a frequent condition: some 30% of the skin diseases seen by the GP involve constitutional eczema. A number of links with (external) factors have meanwhile been established. Patients with constitutional eczema often suffer from food allergy (over 60% of the children with the eczema) and many are allergic to airborne allergens (especially housedust mite allergen). The skin of patients with constitutional eczema has a diminished barrier function against irritants (soaps, acids, bases, water, detergents, biological juices (fruit, meat, fish, vegetables). In 90% of the patients with constitutional eczema the skin contains colonies of Staphylococcus aureus (in 5% of people without eczema). S. aureus can influence the eczema through exoantigens (so-called superantigens) and through conventional antigens that may evoke an IgE-mediated immune response. Emotional stress may influence the eczema. The close anatomical relationship between mast cells and nerve endings and between Langerhans cells and nerve endings suggest that the autonomous nervous system can modulate the immune system of the skin and consequently, the eczema. These factors should be taken into account in the treatment: reduction of exposure to food and airborne allergens and to irritants, treatment and prevention of S. aureus infections and psychological support. New therapies include cyclosporine, autologous IgG antigen complexes and phototherapy.

Adult↗
PubMed1999

Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood.

BACKGROUND: Little is known about the prevalence of atopic eczema outside Northern Europe. OBJECTIVES: We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world. METHODS: A cross-sectional questionnaire survey was conducted on random samples of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world. Those children with a positive response to being questioned about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema. Children whose atopic eczema symptoms resulted in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema. RESULTS: Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers. The prevalence range for symptoms of atopic eczema was from less than 2% in Iran to over 16% in Japan and Sweden in the 6 to 7 year age range and less than 1% in Albania to over 17% in Nigeria for the 13 to 14 year age range. Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe, and lower prevalences were reported in Eastern and Central Europe and Asia. Similar patterns were seen for symptoms of severe atopic eczema. CONCLUSIONS: Atopic eczema is a common health problem for children and adolescents throughout the world. Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups, suggesting that environmental factors may be critical in determining disease expression. Studies that include objective skin examinations are required to confirm these findings.

Adolescent↗
PubMed1997

Psychological disturbance in atopic eczema: the extent of the problem in school-aged children.

Although psychological factors are widely considered to be important in atopic eczema, there have been few controlled studies to assess the extent of disturbance in affected children and the problems experienced by their parents. This study was designed to find out the degree of psychological difficulty experienced by children with atopic eczema, whether their mothers show higher levels of mental distress than a comparison group, and whether the families of children with atopic eczema have less social support than the comparison group. We investigated 30 school-aged children with atopic eczema for psychological problems using the Rutter parent scale and compared them with 30 children with relatively minor skin lesions such as viral warts. Mental distress in mothers was assessed using the General Health Questionnaire. The Family Support Scale was used to get a measure of the social support experienced by the families. We found twice the rate of psychological disturbance in children in the eczema group compared with the control group. This difference was statistically significant for children with moderately severe eczema and severe eczema, but not for children with very mild eczema. Levels of mental distress were no greater in mothers of children with eczema than in parents of the control group and there was no difference in the degree of social support experienced by their families. These findings indicate that school-aged children with moderate and severe atopic eczema are at high risk of developing psychological difficulties, which may have implications for their academic and social development.

Adolescent↗
PubMed2003

Comparison of parent knowledge, therapy utilization and severity of atopic eczema before and after explanation and demonstration of topical therapies by a specialist dermatology nurse.

BACKGROUND: The failure of patients to take medicines in a way that leads to clinical benefit is a major challenge. A consensus has emerged that, on average, compliance sufficient to obtain therapeutic objectives occurs about half the time, with noncompliance contributing to therapeutic failure in the other half. These figures refer to simple oral regimens. There has been little work assessing compliance/concordance with complex treatment regimens for atopic eczema. Asthma schools led by specialist nurses have been shown to improve knowledge, use of therapies and clinical outcome. OBJECTIVES: To determine the effect of education and demonstration of topical therapies by specialist dermatology nurses on therapy utilization and severity of atopic eczema. METHODS: Fifty-one children with atopic eczema attending a paediatric dermatology clinic were followed for up to 1 year. At each visit the parent's knowledge about atopic eczema and its treatment and therapy utilization was recorded. The severity of the eczema was recorded using the six area, six sign atopic dermatitis severity score (SASSAD) and parental assessment of itch, sleep disturbance and irritability. At the first visit a specialist dermatology nurse explained and demonstrated how to use all of the topical treatments. This education was repeated at subsequent visits depending on the knowledge of the parent. RESULTS: At baseline less than 5% of parents had received/recalled receiving any explanation of the causes of eczema or demonstration of how to apply topical treatments. The eczema was poorly controlled in all children (mean SASSAD 42.9). Of the children, 24% were not being treated with any emollient cream/ointment; the mean use was 54 g weekly. Of the children, 25% were being inappropriately treated with potent or very potent topical steroids. Following repeated education and demonstration of topical therapies by a specialist dermatology nurse, there was an 89% reduction in the severity of the eczema. The main change in therapy utilization was an 800% increase in the use of emollients (to 426 g weekly of emollient cream/ointment) and no overall increase in the use of topical steroids, accounting for potency and quantity used. CONCLUSIONS: This study reinforces the importance of specialist dermatology nurses in the management of atopic eczema. It also confirms the opinion of patients, patient support groups, dermatologists and best practice guidelines that the most important intervention in the management of atopic eczema is to spend time to listen and explain its causes and demonstrate how to apply topical therapies.

Administration, Topical↗
PubMed2007

Validation of the U.K. Working Party diagnostic criteria for atopic eczema in a Xhosa-speaking African population.

BACKGROUND: Reliable diagnostic criteria for eczema are important for epidemiological comparisons. Although the U.K. diagnostic criteria for atopic eczema have performed well in an English language setting, limited data are available from other countries where cultural and linguistic factors may affect their validity. OBJECTIVES: We sought to determine the validity of the U.K. criteria for eczema in relation to clinical assessment by a dermatologist in a Xhosa-speaking South African population. METHODS: A cross-sectional survey of 3067 children aged 3-11 years was conducted in rural, peri-urban and urban settings in South Africa. The prevalence of atopic eczema was determined using the U.K. diagnostic criteria and a clinical assessment by a dermatologist. Questions were translated into the local language (Xhosa). Trained researchers administered the questions to the children's parents or carers. The validity of the U.K. criteria was then determined by calculating the sensitivity, specificity, positive and negative predictive values, and Youden's Index in relation to the dermatologist's examination. RESULTS: The point prevalence of atopic eczema according to a dermatologist was 1.0% [95% confidence interval (CI) 0.6-1.4], while the prevalence of visible flexural eczema according to the U.K. protocol was 1.8% (95% CI 1.3-2.2). The sensitivity and specificity of the U.K. criteria in this setting was 43.7% (95% CI 26.3-62.3) and 97.9% (97.3-98.4), respectively. The positive and negative predictive values of the U.K. criteria were 18.4% (95% CI 10.4-28.9) and 99.4% (95% CI 99.0-99.6), respectively. The presence of visible flexural eczema according to the U.K. photographic protocol was the best predictor of atopic eczema, with a sensitivity and specificity of 81.2% (95% CI 63.5-92.7) and 99.0% (95% CI 98.6-99.3), respectively, and a positive and negative predictive value of 48.1% (95% CI 34.3-62.1) and 99.8% (95% CI 99.5-99.9), respectively. CONCLUSIONS: The validity of the full question-based version of the U.K. diagnostic criteria for atopic eczema in this South African setting is low, which may be due to a combination of translational and cultural issues. However, the one physical sign of visible flexural eczema performed well, suggesting that it alone might be a useful tool for future international comparative prevalence studies.

Child↗
PubMed1996

Preferential expression of T-cell receptor V beta-chains in atopic eczema.

Chronic skin colonization with Staphylococcus aureus is a characteristic feature of atopic eczema, and about 60% of S. aureus strains isolated from the skin of patients with atopic eczema secrete enterotoxins. T-cell stimulation by staphylococcal enterotoxins is restricted to the V beta-chain of the T-cell receptor. Therefore, the expression of different V beta-chains (V beta 3, 5 a,b,c, 6, 8, 12) on peripheral blood T-cells (CD4+) from patients with atopic eczema was measured by flowcytometry before and after stimulation with staphylococcal enterotoxin B. Lymphocytes from healthy donors served as controls. Additionally, the expression of V beta-chains in normal skin and in lesional skin of patients with atopic eczema was determined by immunofluorescence histology. In atopic eczema, higher numbers of CD4+ T-cells expressed V beta 3, V beta 8 and V beta 12 compared to the control group. No correlation between S. aureus enterotoxin B-stimulated V beta-expression and HLA-haplotypes was found. In lesional skin of patients with atopic eczema most of the infiltrating T-cells were V beta 3+, whereas in normal skin only very few T-cell receptor-expressing cells were detected. To evaluate the significance of these T-cell clones for allergic inflammation, T-cells from patients with atopic eczema and normal donors were stimulated with monoclonal antibodies against V beta 3, 5(c) and 8. Afterwards, the proliferative response of lymphocytes as well as IL-5 and IFN gamma synthesis were measured. T-cells from patients with atopic eczema showed a significantly higher proliferation and IL-5 secretion than normal donors after stimulation with monoclonal antibodies against V beta 3 and V beta 8. In contrast, the monoclonal antibodies directed to V beta 5(c) induced a markedly elevated proliferation and IFN gamma production of normal lymphocytes compared to patients with atopic eczema. Our results suggest a preferential expression of certain V beta-subgroups during inflammation in atopic eczema; this may be explained by a selective stimulation of TH2-cells via S. aureus-derived enterotoxins.

Cells, Cultured↗