Predictors of atopic dermatitis severity over time.

BACKGROUND: Atopic dermatitis (AD) is a chronic relapsing disease that has increased in prevalence during the last 4 decades. However, little is known about factors that affect disease severity. METHODS: We carried out a longitudinal observational study that included children aged 5 to 10 years recruited from general practices in the United Kingdom. General practitioners identified potential patients and the United Kingdom diagnostic criteria for AD were used to verify the diagnosis in children. The scoring AD index was used to assess disease severity. In addition, information was obtained from parents at the first interview as to age of onset, social class, ethnic group, child's atopy, family history of atopy, and other potential risk factors using a 5-page piloted questionnaire. The aim was to document risk factors for AD severity over time by sequential repeated interview and clinical examination during a 2-year period. The scoring AD index was skewed to the right so nonparametric tests were used for statistical significance. RESULTS: In all, 137 children (65 boys [47%] and 72 girls) with AD were recruited and seen up to 4 times; 40 in March 1998, 104 in October 1998, 116 in March 1999, and 120 at the final visit in October 1999, giving our study an 88% follow-up rate. The severity scores were ranked into 3 categories (80% mild, 18% moderate, and 2% severe) according to suggested guidelines. From this population we were able to show that those with eczema that commenced during the first year of life, which was accompanied by asthma, hay fever, or both, and associated with living in an urban area, had more severe disease independent of other potential risk factors. CONCLUSION: This study has systematically studied AD severity in a community-based design. Researchers and clinicians should be aware of those factors reported in our study as patients exposed to these factors may have a different disease outcome. Further studies on disease severity are needed.

Relationship between quality of life and disease severity in atopic dermatitis/eczema syndrome during childhood.

PURPOSE OF REVIEW: Atopic dermatitis is a chronic relapsing itchy disease that has an effect on children and families' quality of life. The purpose of this review is to give workers in the field an easy-to-read, up-to-date and accessible summary of recent advances in the relationship between quality of life and disease severity in atopic dermatitis/eczema syndrome during childhood. This review, however, concentrates on original articles that have been published since 1 April 2002, and reports a relationship between disease severity and quality of life scores in childhood atopic dermatitis. RECENT FINDINGS: It has been shown that childhood atopic dermatitis has a major impact on children and families' quality of life. Researchers also reported that scores on quality of life and disease severity were positively correlated at a point in time and over a period of time. They also showed that children and quality of life measures have improved after medical interference. SUMMARY: Despite the limitation of the studies reviewed, it is logical to conclude that childhood atopic dermatitis has affected children and families' quality of life. These studies have also reported that disease severity and quality of life are correlated in childhood atopic dermatitis at a point in time and over time. However, these aspects should be studied further in order to evaluate the long-term impact of the disease and its variation during childhood. Disease severity and quality of life should be measured independently.