An application of the United Kingdom Working Party diagnostic criteria for atopic dermatitis in Scottish infants

The United Kingdom Working Party diagnostic criteria for atopic dermatitis have been characterized in infants and children; however, the need for visual confirmation of flexural dermatitis by a trained investigator limits their use in large epidemiologic studies. We have administered the complete United Kingdom Working Party criteria in a postal questionnaire format to the mothers of year old infants and determined the concordance between mothers' and trained investigator's reports of visual flexural dermatitis. Based on mothers' responses to the questionnaire, 59 infants with atopic dermatitis and 59 controls were identified. In subsequent home interviews conducted by a trained investigator, the United Kingdom criteria questions were repeated and sites of current visible dermatitis were identified by mothers and the investigator as per United Kingdom Working Party protocol. Agreement between the mothers' postal and home interview responses was high: kappa= 0.75-0.94 for individual criteria; kappa= 0.93 for diagnosed atopic dermatitis. Agreement between the mothers' and investigator's observations of visible flexural dermatitis was high for all sites: kappa= 0.88-1.0. The results demonstrate that mothers are able to apply the United Kingdom criteria and accurately report visible flexural dermatitis in their year old infants. The postal application of the United Kingdom Working Party's diagnostic criteria for atopic dermatitis in year old infants appears to be a practical, reliable, epidemiologic tool in the investigation of atopic dermatitis with results comparable with formal application of the criteria by a trained investigator.     

Prevalence of atopic dermatitis in Japanese adults

BACKGROUND: Adult atopic dermatitis (AD) in Japan has become a significant social problem, with as many as one-third of adult patients with severe AD absenting themselves from work or classes due to aggravation of the disease. Reports of such patients have become increasingly common in recent years. Despite the pressing need for epidemiological studies to clarify the prevalence and distribution of AD and to determine its aetiology, no previous research has been carried out on the prevalence of AD within the adult population in Japan. OBJECTIVES: To clarify the prevalence of adult AD in Japan, using the U.K. Working Party's diagnostic criteria. METHODS: The subjects of this study were mostly government officials or their family members visiting the Medical Center of Health Science, Toranomon Hospital in Tokyo for annual health check-ups in the period from September 1997 to August 1998. Questionnaires completed by 10 762 persons (8076 men and 2686 women) aged 30 years or above were analysed. The questionnaire consisted of 14 questions on allergic disease. The U.K. Working Party's diagnostic criteria were used after translation into Japanese. Three types of prevalence were used as indicators of prevalence: point, 1-year and lifetime prevalence. RESULTS: The point prevalence, 1-year prevalence and lifetime prevalence of AD in Japanese adults were 2.9%, 3.0% and 3.3%, respectively. No significant statistical differences were observed between the sexes or among age groups within each sex. The survey indicated that 88.6% of those who had ever had AD were currently affected by active AD, while 93.4% of those who had had at least one episode of AD in the past had experienced an episode over the previous year. CONCLUSIONS: This study gives the first indication of the prevalence of adult AD among the Japanese, based on the U.K. criteria. Both the internal and external validity of this study are believed to be high; it would be safe to conclude that the 1-year prevalence of AD in Japanese adult populations living in urban areas is 3.0%.     

Adult-onset atopic dermatitis in a patch test population

BACKGROUND: Epidemiological studies about atopic dermatitis (AD) almost exclusively relate to childhood disease with little mention of adult-onset disease. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen. OBJECTIVE: Because the subjects with a chronic and recalcitrant eczema are frequently patch tested, the aim of this study was to evaluate the prevalence of adult-onset AD in a patch test population and the differences existing between the early- and adult-onset subsets. METHODS: This retrospective analysis was performed on 502 adults (458 males, 44 females) affected by eczematous dermatitis, consecutively examined in the Department of Dermatology of the Italian Navy Hospital in Taranto. In this department, all the eczematous subjects are routinely submitted to the following tests: standard series (GIRDCA or SIDAPA with integrative haptens), prick test with environmental aeroallergens and common food allergens and dosage of total serum IgE. If it is required, additional series of patch tests are also applied. Many patients are also submitted to the atopy patch test (APT) with whole bodies of house dust mites at a concentration of 20%. In the AD patients, diagnosed according to the criteria of Hanifin and Rajka, the ages of onset were subdivided into the following categories: infancy (0-3 years); childhood (4-11 years); adolescence (> or =12 years). We arbitrarily also used the age of 18 years as the cut-off mark to allocate the patients to the adult-onset group (AOG) and defined as early-onset group (EOG) the cases encompassed in the aforesaid categories (i.e. onset < or =17 years). RESULTS: 8.8% of all eczemas were adult-onset ADs. 28 (5.6% of all eczemas) adult-onset ADs were 'sole' ADs, while 22 cases (3.2% of all eczemas) were adult-onset ADs in which a contact sensitization was detected. The mean SCORAD indexes, according to the age-of-onset groups, decreased when the age of onset increased. No statistical difference was detected between the EOG and AOG with regard to true contact sensitization, clinically relevant or non-relevant contact sensitization, prevalence of 'pure' AD and 'mixed' AD, and outcome of the APT. The hands were the most frequently affected site in the AOG. CONCLUSION: A small but significant number of patch-test-negative eczematous cases could be adult-onset ADs and, in this instance, the other two allergological tests (i.e. prick tests and dosage of total serum IgE) and an accurate evaluation according to stated clinical criteria should be performed. However, other studies on large series of patients are required to confirm our observation.     

The lack of a relationship between atopic dermatitis and nonmelanoma skin cancers

BACKGROUND: Very little has been published on whether a relationship exists between atopic dermatitis (AD) and skin cancer. OBJECTIVE: The goal of this study was to investigate whether individuals with AD are more likely than other patients with dermatologic conditions to develop nonmelanoma skin cancer. METHODS: This was a case-control, mailed-survey study. RESULTS: Of those contacted, 69.8% (3207 of 4591) filled out the survey. Of the control patients, 18.4% (254) had a history of AD as defined by the United Kingdom Working Party diagnosis criteria and composed 13.7% (210) of the cases. The unadjusted odds ratio of AD to nonmelanoma skin cancer was 0.70 (95% confidence interval 0.57-0.85). After fully adjusting for age, sex, ethnicity, and topical steroid use the odds ratio was 0.78 (0.61, 0.98). Using different definitions of AD had little effect on this result. CONCLUSIONS: It does not appear that patients with a history of AD are more likely to develop nonmelanoma skin cancers than other patients with dermatologic conditions.     

Prevalence of atopic dermatitis and serum IgE values in nursery school children in Ishigaki Island, Okinawa, Japan

There have been many studies of the prevalence of atopic dermatitis (AD), but few population-based epidemiologic studies measure the prevalence in Japan among children aged 5 years and younger. We examined the prevalence of AD, serum total IgE levels and specific IgE antibodies to 10 common allergens among children in Ishigaki Island, Okinawa, Japan in 2001. We also obtained information on the predictability of the U.K. Working Party diagnostic questionnaire criteria for AD in this population. Five hundred and sixty five children aged 5 years and younger were enrolled in this study with informed consent from their parents. The questionnaire of the U.K. Working Party diagnostic criteria for AD was translated into Japanese, and the parents completed the questionnaire sheet. Physical examination and blood sampling were done for all children. Thirty-nine out of the 565 (6.9%) children were diagnosed with AD by physical examination. The total and specific IgE levels were significantly higher in the children with AD than in those without AD. High levels of total IgE were found in 33.3% of the children with AD. A specific IgE to one or more allergens was detected in 64.1% of children with AD. However, a substantial population of children without AD also had high levels of total IgE (12.7%) and a specific IgE to one or more allergens (30.2%), and the increment of total and specific IgE levels was significantly associated with age. The percentage of positive answers to the questionnaire of the U.K. Working Party diagnostic criteria for AD was significantly higher in children with AD (59.0%) than in children without AD (5.3%) (P<0.0001). Its specificity was 94.7%. The false negative rate was 41%. In conclusion, the prevalence of AD was relatively low in children in Ishigaki Island. High levels of total IgE were found in only one third of children with AD under 5 years of age. The Japanese translated form of the questionnaire of the U.K. Working Party diagnostic criteria for AD should be refined to improve its sensitivity.     

Atopic dermatitis: which are the diagnostic criteria used in medical literature?

INTRODUCTION: Diagnosis of atopic dermatitis currently relies on diagnostic criteria scales developed by Hanifin and Rafka in 1980 and by the "United Kingdom Working party" in 1994. Some authors have proposed: "AEDS" [sM1] and "Atopiform Dermatitis", which has led to the distinction between different sub-populations and the exclusion of certain diseases from the diagnosis of atopic dermatitis. The aim of our study was to collect the criteria retained in the scientific medical literature during the year 2002 for the definition of atopic dermatitis and to try to understand not only the interest but also the questions that the various definitions lead to. METHOD: A PubMed research was launched with the key word "atopic dermatitis" from January to September of 2002. All the scientific articles either in French or in English were studied. RESULTS: Hanifin and Rafka's criteria were selected in 44 p. 100 of the scientific articles, and the "United Kingdom Working Party" criteria in 12 p. 100. Personal definitions were used in 21 p. 100 of the articles; these were based on the level of total and specific IgE or on personal clinical criteria. For twenty-three p. 100 of the authors, the definition of atopic dermatitis was not specified. DISCUSSION: There was not just one definition of atopic dermatitis. This may affect the interpretation of diagnostic or therapeutic papers concerning the disease, because there has been no proof that these definitions cover the same population of patients.     

成人发病型特应性皮炎：一个值得关注的新概念

【摘要】 特应性皮炎（AD）多始于婴儿或儿童，而成人发病型AD即年龄 ≥ 18岁发生AD并没有受到应有的关注。成人发病型AD在遗传因素、发病诱因、发生机制、临床表现等方面与儿童发病的AD既有重叠，也有差异。认识并接受成人发病型AD概念，并在临床工作中加以实践，无疑具有重要的现实意义。成人发病型AD要得到广泛认可有很多问题必须解决，尤其是要建立适合成人发病型AD的诊断标准和管理模式等。     

特应性皮炎临床特征及诊断标准评估：基于2000—2020年165例住院患者的回顾性分析

【摘要】 目的 分析和总结特应性皮炎（AD）患者临床特点,探讨Williams、日本和中国AD诊断标准的满足情况及差异。方法 回顾性分析陆军军医大学西南医院2000年10月至2020年5月期间根据Williams标准或中国张氏标准确诊的165例特应性皮炎住院患者病历资料。采用Williams、日本和中国AD诊断标准重新评估,比较不同标准之间的差异。计量资料组间比较采用t检验、方差分析或秩和检验;计数资料组间比较采用卡方检验或Fisher确切概率检验。结果 165例AD患者中,66例（40.00%）2岁之前发病;95例（57.58%）伴有个人和/或家族特应性疾病史,其中75例伴有个人特应性疾病史,最常见的是过敏性鼻炎（28.48%）、哮喘（20.00%）,50例伴有家族特应性疾病史,30例同时伴有个人和家族特应性疾病史。98例（59.39%）对尘螨过敏,其中Ⅵ级过敏48例。外源性AD 130例（78.79%）,内源性AD 35例（21.21%）,两组发病年龄、嗜酸性粒细胞计数差异均有统计学意义（均P < 0.001）。满足Williams标准142例（86.06%）,不满足者23例,两组之间发病年龄差异有统计学意义（P = 0.007）;满足中国张氏标准150例（90.91%）,不满足者15例,两组之间嗜酸性粒细胞计数差异有统计学意义（P = 0.001）;满足中国姚氏标准160例（96.97%）;全部满足日本标准。满足Williams标准、日本标准、张氏标准和姚氏标准的患者之间发病年龄、嗜酸性粒细胞计数、总IgE水平差异均无统计学意义（P > 0.05）。结论 早期发病的AD更易合并最高级别的尘螨过敏;外源性AD较内源性AD患者发病年龄更低,嗜酸性粒细胞计数更高;满足Williams标准的患者较不满足的患者发病年龄更低,满足中国张氏标准的患者较不满足的患者嗜酸性粒细胞计数更高。     

Development and validation of a questionnaire for diagnosing atopic dermatitis.

In this paper we describe the development and validation of a questionnaire for atopic dermatitis used in population surveys in Denmark. The Danish questionnaire was developed from the UK Working Party's questionnaire for atopic dermatitis and includes a severity score. The study included 61 children aged 3 to 14 years recruited from our Department of Dermatology, two kindergartens and a primary school. A validator was appointed to evaluate whether each child had current or previous atopic dermatitis. Compared to the validator's diagnosis, the sensitivity of the UK Working Party criteria was 90% (95% CI; 74-98) and the specificity was 97% (95% CI; 82-99). The criteria for atopic dermatitis have a satisfactory sensitivity and specificity for diagnosing current atopic dermatitis, but the natural course of the disease complicates the validation of investigational instruments. We suggest that future epidemiological studies aimed at establishing new knowledge on atopic dermatitis should include history, current symptoms and findings and a severity score.     

Adult-onset infective dermatitis associated with HTLV-I. Clinical and immunopathological aspects of two cases

Infective dermatitis associated with HTLV-I (IDH) is a chronic, infected childhood eczema. Two adult-onset cases of IDH were studied, one of which was associated with HAM/TSP. The patients were submitted to dermatological, neurological and pathological examination. Immunohistochemical studies were made using CD3, CD4, CD8, CD20, CD79a, and CD57 antibodies. Cytotoxic granules were investigated using granzyme B, perforin, and TIA. The patients presented infected erythematous, scaly lesions with mild itching and a good response to sulfamethoxazole/ trimethoprim. A differential diagnosis with atopic dermatitis (AD) and seborrheic dermatitis (SD) was made, based on: the distinctive morphology and distribution of the lesions, presence of exudative and infected lesions, and mild pruritus. The inflammatory infiltrate was composed predominantly of CD8+ lymphocytes that did not present cytotoxic granules. We concluded that IDH can begin in adulthood and may be associated with HAM/TSP. The immunohistochemical findings were different from those observed in AD and SD.     

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.     

Dermatological future of european patients with atopic dermatitis

Background  The dermatological becoming of children presenting with atopic dermatitis (AD) is not well known.
Objective  We performed a study on the presence of AD and other dermatological diseases in subjects with a previous history of AD.
Methods  An opinion poll was conducted in eight countries through a telephone interview: Belgium, France, Germany, Greece, Italy, Portugal, Spain and Switzerland.
Results  Among 4369 interviewees, 12.25% declared a history of AD in infancy and 12.4% declared to suffer from a dermatological disease (27% of patients had a history of AD and 10.3% did not have it). Current declared cases of atopic eczema or contact eczema were more frequent in patients with previous history of AD (39.3% vs. 21.5%), whereas these patients appeared less affected by rosacea (2.9% vs. 7.9%). Some differences were observed between different countries.
Conclusion  The main interests of this study are the large number of subjects, originating from eight different countries, and its focus on the dermatological future of patients with AD, which is not limited to AD itself.     

Impairment of Quality of Life and Mental Health Status in Adult-Onset Atopic Dermatitis

BackgroundPatients with atopic dermatitis (AD) have an impaired quality of life (QoL). To our knowledge, impairments in mental health status and health-related QoL (HRQoL) have not yet been evaluated in adult-onset and child-onset AD in a large-scale study.ObjectiveThis study compared the mental health status and HRQoL (using the EuroQoL [EQ] five-dimensional [5D] questionnaire) in child-onset AD and adult-onset AD to those in normal controls.MethodsWe used nationwide, population-based, cross-sectional data from the Korean National Health and Nutrition Examination Survey conducted from 2008 to 2013. We performed multiple logistic regression analyses with adjustments for age, sex, body mass index, income, education level, drinking status, current smoking, regular exercise, diabetes mellitus, hypertension, and dyslipidemia, and analyzed odds ratios (OR) for factors associated with impaired QoL.ResultsThe OR for strong psychological stress, depressed mood, and suicidal ideation were significantly increased in adult-onset AD patients compared to in normal controls. In addition, the OR (95% confidence interval [CI]) values for the EQ-5D questionnaire responses (for physical activity, self-control, daily activities, pain/discomfort, and anxiety/depression) were significantly high in adult-onset AD compared to in normal controls after adjustments for covariates. However, patients with child-onset AD showed a significantly increased OR (95% CI) only for problems in pain/discomfort in the EQ-5D questionnaire.ConclusionAdult-onset AD patients suffer from impaired HRQoL and significant mental problems compared to normal controls. Dermatologists should focus not only on the clinical phenotype but also patients’ psychological health status to ensure a better treatment outcome.     

Twenty‐five years quaternium‐15 in the European baseline series: does it deserve its place there?

For allergens to be included in the European baseline series, they should have allergy rates of at least 1%. In several studies quaternium‐15 had lower scores. Also, many cases of sensitization are already detected by formaldehyde contact allergy. The aim of this study was to evaluate whether quaternium‐15 deserves continued inclusion in the baseline series on the basis of current criteria: 1% positive reactions, common occurrence in the environment, many relevant reactions. We used the literature survey method in this study. Only the United Kingdom has rates consistently over 1%. The mean for all other countries together and for many individual nations is lower than 1%. At least half of the reactions are already detected by formaldehyde sensitivity, which lowers rates for allergy to quaternium‐15 per se (i.e. not caused or at least detected by formaldehyde sensitivity) to less than 0.6% for all countries except the United Kingdom. Neither common occurrence in the environment nor a high percentage of relevant reactions has been ascertained. It may well be argued that quaternium‐15 does not deserve its place in the European baseline series and could be incorporated in a cosmetic screening series or preservative series instead. In the United Kingdom, routine testing should be continued.     

Systematic review of atopic dermatitis disease definition in studies using routinely collected health data

Atopic dermatitis (AD) is a skin disease that involves dry, itchy skin and scaly rashes. It is a common disease, especially in children, and is often simply referred to as ‘eczema’. In recent years, researchers have used medical records stored electronically and information from insurance claims to study AD. Because these databases are designed for clinical care and billing purposes and not explicitly for research, correctly identifying patients with AD in these data can be challenging. If patients are not correctly identified, studies using these databases may find misleading results. This study, conducted by a group of researchers from the United States, Canada, and United Kingdom, sought to find out how researchers identify patients with AD in data routinely collected by hospitals and health organizations. We systematically searched three large databases (PubMed, EMBASE, and Web of Science) and identified 59 studies which used routinely collected data to find out how common AD is in different populations. We found that researchers identified patients with AD in a variety of different ways. For example, patients’ records are often given numerical codes to represent medical diagnoses, and researchers used different sets of codes. Researchers also varied in whether they used information about patients’ medications and number of hospital or clinic visits related to AD. In addition, researchers rarely showed that their approach to identifying AD patients was accurate. Results from studies of AD will be difficult to interpret and compare if researchers do not have reliable ways of identifying AD patients in electronic medical records and insurance claims. Going forward, more studies are needed to develop and test strategies for identifying AD patients in these types of data so that the approaches used by researchers will be standardized. The authors offer suggestions for how to describe the approaches so that they will be more comparable.     

Association between filaggrin null mutations and concomitant atopic dermatitis and contact allergy

Background. The phenotypic traits of people with the filaggrin mutation (FLG) genotype and atopic dermatitis (AD) are still under elucidation, and the association with concomitant AD and contact allergy (CA) has not previously been examined. Aim. To assess FLG status in a subset of patients with AD and a minimum of one positive patch‐test reaction. Methods. In total, 430 people from a hospital population and 3335 people from the general population were tested for FLG mutations by DNA hybridization to paramagnetic polystyrene beads and analysis on a multiplex analysis system. All of the individuals in the hospital population had a minimum of one CA. AD was diagnosed according to the UK Working Party Criteria, (questions‐only version). Individuals from the hospital population who had both AD and CA were considered as cases, and comparison of mutation carrier frequency was estimated (χ² test) against individuals without AD but with CA from the hospital population, individuals from the general population, and individuals with AD from the general population. Results. The mutation frequency in patients with AD and CA in the hospital population was significantly less than that of people with AD from the general population (OR = 0.54; 95% CI 0.30–0.98). No difference in mutation frequency was found between individuals with and without AD in the hospital population (OR = 1.40; 95% CI 0.70–2.79), or between individuals with AD and CA in the hospital population and in the overall general population (OR = 1.29; 95% CI 0.76–2.20). Conclusions. The spectrum of observable traits characteristic for the FLG mutation genotype in patients with AD is at present not defined. Our results indicate that the subset of patients with both AD and CA represent a phenotype of AD that is not associated with FLG mutations.     

Atopic dermatitis-like pre-Sézary syndrome: role of immunosuppression

We describe here 4 patients with Sézary syndrome masquerading as adult-onset atopic dermatitis. The patients presented with a clinical picture compatible with wide-spread atopic dermatitis and did not fulfil the criteria for Sézary syndrome (lack of lymphoadenopathy and blood involvement, skin histology without presence of atypical cells). In our patients, overt Sézary syndrome developed after immunosuppressive treatment (including cyclosporine). These cases support the validity of the concept of pre-Sézary syndrome, which is a long-lasting, pre-malignant condition, and which may develop to true malignancy in a state of immunosuppression.     

Patch test reactions to mite antigens: a GERDA* multicentre study

We performed patch tests with Dermatophagoides pteronyssinus (Dp) antigen from 2 different sources in 355 non-randomly selected patients with atopic dermatitis(AD) and 398 subjects of a control group. The study demonstrated that contact sensitization to mites occurred in an appreciable% of AD cases(20.8%). Using commonly available assay products. The differences recorded between the 2 materials tested were related to the concentration of P1 antigen. Non-atopic patients rarely showed positive reactions to Dp (0.75%), when strict criteria for readings were applied and if 2 readings were performed, Patients with positive patch tests did not necessarily show positive immediate skin tests. It would be useful to carry out tests systematically in atopic patients, even if it is not yet known what modern treatment would be best for the patient. Laboratories still do not provide standardized house dust mite preparations measuring and codifying their biological acitivity for use in patch of better test materials, in syringes with homogeneous dispersion and concentration.     

Allergic contact dermatitis in patients with atopic dermatitis: A clinical study

BACKGROUND: Atopic dermatitis (AD) is a chronically relapsing dermatitis with no known cure. Due to the chronic nature of the condition, frequent and long term topical therapy is used. This may lead to sensitization, resulting in allergic contact dermatitis (ACD). AIMS: The aim of the study was to observe the frequency of ACD in atopic patients in this part of the country using Indian standard battery. METHODS: A total number of 30 cases of AD were taken for the study. Diagnosis of AD cases was based on the criteria of Hannifin and Rajka (1980). All the selected cases of AD had mild to moderate grade of severity. All these cases were treated and patch tested during the remission period. The duration of the study was 12 months. RESULTS: Out of the 30 AD cases, 7 cases showed positive ACD with patch test allergens. CONCLUSION: This study shows that ACD is not uncommon amongst atopic individuals.