A comparative study of the impairment of quality of life in Czech children with atopic dermatitis of different age groups and their families

Background Atopic dermatitis (AD) still remains one of the most common childhood inflammatory skin diseases. As a chronic disease, it can have a physical and psychological effect on social functioning of the affected child as well as their family. The objective of this study was to evaluate the quality of life of children with AD of different age groups and their families. Methods A total of 203 children with a diagnosis of AD from newborn to 18 years of age and 202 of their parents took part in our study (as one parent did not return the questionnaire). All participants, according to their age, completed the following questionnaires: Infants’ Dermatitis Quality of Life Index (IDQOL); Children’s Dermatology Life Quality Index (CDLQI) – text and cartoon version; and Dermatitis Family Impact questionnaire (DFI). Results The mean total IDQOL score in our study was 8.18 (SD = 5.84, n = 120). The mean total CDLQI scores in the groups of children from 7 to 13 and from 14 to 18 years were 8.58 (SD = 4.98, n = 48) and 9.89 (SD = 5.26, n = 35). There was also a proven influence of the child’s AD on the quality of life of his parents with the mean score: 7.98 (SD = 6.41, n = 202). Conclusions The study demonstrated and confirmed that AD significantly impairs the children’s quality of life in all age groups and also quality of life of their families. Such data give us patient‐oriented information that is of great importance for understanding the situation of individuals with AD and its influence on members of their family.     

Impairment quality of life in families of children with atopic dermatitis

Atopic dermatitis (AD) not only changes the life of the affected child but also affects the physical, social and emotional functioning of parents. The aim of the study was to assess the quality of life of parents of children with AD and to correlate it with the disease severity. It was a cross sectional, self-administered questionnaire study performed in parents of children with AD attending dermatology clinics affiliated to the College of Medicine, Qassim University, Saudi Arabia. The parents were asked to complete the validated Arabic version of the Dermatitis Family Impact (DFI) questionnaire. The severity of AD was evaluated by using the objective SCORAD index. Atopic dermatitis was considered mild when the score was <15, moderate at 15-40 and severe at >40. Out of a total of 774 children, 283 (36.6%) had mild, 259 (33.4%) moderate and 232 (30%) severe AD. The mean DFI score was 13.86±4.23. The DFI score of parents of children with severe AD (18.13±1.97) was significantly higher (P<0.001) as compared to mild (9.62±2.76) and moderate (14.68±2.26) AD. Family history of atopy in children and social class of parents had significant effect on the mean DFI scores. The highest scoring DFI domains were expenditure (mean score 1.74), sleep disturbance (mean score 1.73), food preparation (mean score 1.67) and emotional distress in parents (mean score 1.6). Tiredness and exhaustion in parents and housework were moderately affected, while the least affected areas were family leisure activity, treatment difficulties, time for shopping and relationship between family members. The severity of child's AD directly affects the quality of life of parents. The DFI is of value to guide appropriate management of children with AD and can be used as an added parameter in clinical trials concerning the management of children with AD.     

Psychological adjustment in parents of young children with atopic dermatitis: which factors predict parental quality of life?

BACKGROUND: Bringing up children with atopic dermatitis (AD) is widely perceived as being stressful because parenting demands considerable time and energy. There have been only a few studies to assess the extent of problems experienced by the parents. OBJECTIVE: To assess the psychosocial well-being of parents caring for a young child with AD and to examine the relationship between parental quality of life and disease-related and sociodemographic variables. METHODS: One hundred and eighty-seven parents of young children with AD attending an inpatient rehabilitation clinic participated in the study. At admission, parents completed a set of questionnaires (assessing health-related quality of life, coping with the disease, family functioning). Dermatologists assessed disease severity using the severity scoring of AD index (SCORAD). RESULTS: In general, parents cope well with their situation. Compared with normal values, high rates of psychological distress were observed in a subsample of parents of children with AD. Parents of children with a higher severity of disease reported a significantly higher impact on family functioning, a greater financial burden and a higher level of disease management. Parental disease management could be predicted by the familial situation, their personal well-being and the severity of disease of their child. Differences attributed to their child's gender or age were not observed. CONCLUSIONS: Childhood AD has a profound impact on the emotional and social well-being of many of the parents. The results underline the importance of psychological treatment approaches designed to increase parental well-being and ability to cope with stress and social strain.     

Childhood Atopic Dermatitis Impact Scale: reliability, discriminative and concurrent validity, and responsiveness

OBJECTIVE: To evaluate the test-retest reliability, discriminative and concurrent validity, and responsiveness of the Childhood Atopic Dermatitis Impact Scale (CADIS), a quality-of-life scale with 5 domains. DESIGN: Prospective, longitudinal study. SETTING: Two academic pediatric dermatology practices. PATIENTS: A total of 301 parents of children younger than 6 years with atopic dermatitis. MAIN OUTCOME MEASURES: Participants completed the CADIS, sociodemographic items, and other clinical questions at enrollment and at a 4-week follow-up. In addition, 41 participants completed the CADIS again 48 hours after baseline. Disease severity was measured using the Severity Scoring of Atopic Dermatitis (SCORAD) index for all children. RESULTS: Of 301 enrolled participants, 270 (90%) completed the enrollment materials and 228 (84%) of these completed the 4-week follow-up materials. Thirty-four (83%) of the 41 participants completed the 48-hour materials. Intraclass correlation coefficients of CADIS scores at enrollment and at 48 hours ranged from 0.89 to 0.95. Correlations between CADIS scores and the SCORAD index scores (range, 0.42-0.72) demonstrated that more severe atopic dermatitis is associated with worse quality of life. Scores from all 5 domains of the CADIS significantly differentiated patients at each severity level as measured by the SCORAD index (P<.001). Participants who rated their children as "improved" at the 4-week follow-up had significantly better CADIS scores than those who rated their children as having the "same" or "worse" skin disease (P<.05). CONCLUSIONS: These data confirm the test-retest reliability, concurrent validity, and discriminative validity of the CADIS. In addition, responsiveness evaluation demonstrates that the CADIS accurately measures change in patients whose disease improves.     

Mental health comorbidity in youth with atopic dermatitis: A narrative review of possible mechanisms

The presence of atopic dermatitis (AD) in youth has been linked to a variety of mental health concerns including disruptive behavior, symptoms of anxiety and depression, and diagnoses of attention deficit/hyperactivity disorder and autism spectrum disorder. However, the factors accounting for these relationships are not well understood. The current review summarizes possible mechanisms identified in previous research and highlights areas for future investigation. Among the primary mechanisms studied to date, child sleep is the only factor that has been characterized in relative detail, with findings generally supporting the mediating role of sleep problems in the relationship between AD and psychological symptoms. There is substantial evidence suggesting a negative impact of child AD on parent mental health and the impact of parent mental health on child psychological functioning, although the latter has not been assessed specifically in populations of children with AD. There is also preliminary support for other mechanisms, including pruritus and pain, atopic comorbidities, social functioning, and systemic antihistamine use, in the development of mental health concerns in pediatric AD. Furthermore, research suggests the presence of bidirectional relationships between AD and psychological functioning via inflammatory responses to stress and impaired treatment adherence. Overall, significant additional research is needed to better characterize the nature and magnitude of the relationships among these multiple mechanisms and various psychosocial outcomes. Nevertheless, the findings to date support routine screening of psychological health in patients with AD as well as screening for potential risk factors, which may also serve as targets of therapeutic intervention.     

Quality of Life of Parents Living with a Child Suffering from Atopic Dermatitis Before and After a 3‐Month Treatment with an Emollient

Abstract: Atopic dermatitis (AD) can be extremely disabling and may cause psychological problems for affected children and their families. Moisturizers and emollients are important in the baseline daily skin care of patients with AD. To assess the effect of a 3‐month, twice‐daily treatment with an emollient on the quality of life (QoL) of parents with a child with mild to moderate AD (SCORing Atopic Dermatitis [SCORAD] ≤30, a multicenter open trial was performed by eight dermatologists on 191 volunteers. Evaluation by the dermatologist of the child’s clinical condition (SCORAD) and of the efficacy and overall safety of the treatment was associated with a QoL questionnaire completed by one parent of the atopic child. A self‐assessment of the global QoL and of the efficacy and overall safety was also performed. During the study, mean SCORAD dropped from 28 to 12 (p < 0.001), with good improvement in skin dryness and pruritus criteria. At the same time, the self‐assessment of the global parent QoL scores dropped from 4.4 to 2.1 (p < 0.001) with 60%, 48% and 79% favorable parent opinions regarding wellbeing or improvement of the health condition, quality of sleep, and efficacy of the emollient, respectively. This trial revealed the efficacy of the product in improving parent QoL (85% of parents noted improvement in QoL), and its global safety was considered to be very good or good, with 80% favorable opinions in parents’ declarative judgements and dermatologists’ assessments. The emollient evaluated improves the course of AD and can improve the QoL of patients and their families.     

A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases

BACKGROUND: Chronic disease can have physical and psychological effects which affect social functioning. These effects can be better understood from the perspective of parent and child by the use of health-related quality of life (HRQL) measures. Various HRQL measures are now available, of which generic health measures have been the most widely used. These permit comparison between different diseases and also the normal population. OBJECTIVES: To cross-validate a new generic HRQL proxy measure for children, the Children's Life Quality Index (CLQI), with an established speciality-specific dermatological questionnaire, the Children's Dermatology Life Quality Index (CDLQI), in a group of children with chronic skin diseases. The impairment of HRQL in the same group of children with skin disease was then compared with that associated with other common chronic childhood diseases using the CLQI. METHODS: The CDLQI was completed by 379 children aged 5-16 years with skin disease of more than 6 months' duration. Their parents (n=379) and parents of 161 children aged 5-16 years with other chronic diseases were also asked to complete a proxy measure, the CLQI. RESULTS: Using linear regression analysis, the CLQI and the CDLQI scores showed a strong linear association (rs=0.72, P<0.001) and on a Bland-Altman plot, reasonably good agreement (expressing scores out of 100, the 95% limits of agreement were from -25.5/100 to 26.7/100). In the child's opinion psoriasis and atopic dermatitis (AD) caused the greatest impairment (CDLQI scores of 30.6% and 30.5%), followed by urticaria (20%) and acne (18%). Using the generic CLQI (scored 0-36), from the parental perspective the highest score was for AD (33%), followed by urticaria (28%), psoriasis (27%) and alopecia (19%). Comparing this with children with other chronic diseases, those with cerebral palsy had the highest score (38%), followed in descending order by those with generalized AD (33%), renal disease (33%), cystic fibrosis (32%), urticaria (28%), asthma (28%) and psoriasis (27%). Diseases such as epilepsy (24%) and enuresis (24%) scored higher than diabetes (19%), localized eczema (19%), alopecia (19%) and acne (16%). CONCLUSIONS: Using the CLQI we have shown that HRQL impairment in children with chronic skin disease is at least equal to that experienced by children with many other chronic diseases of childhood, with AD and psoriasis having the greatest impact on HRQL among chronic skin disorders and only cerebral palsy scoring higher than AD. Cross-validation of the CLQI with the CDLQI in the group of children with skin disease demonstrates a strong linear association and good agreement between the two.     

Gender differences in health-related and family quality of life in young children with atopic dermatitis

Background Atopic dermatitis (AD) has an established impact on health‐related quality of life (HRQoL) and family QoL. Objectives This study was designed to investigate gender differences in health‐related and family QoL in children with AD. Methods Cohorts of 25 girls and 25 boys with AD aged <4 years were selected from 102 children with AD. Children in the girls’ and boys’ groups were individually matched across groups for age and severity of AD according to their scores on the SCORAD Index (SCORing of Atopic Dermatitis). The children’s parents filled in the Infants’ Dermatitis Quality of Life (IDQoL) Index and the Dermatitis Family Impact (DFI) questionnaires. Results The impact of AD on QoL (P < 0.05) and family QoL (P < 0.05) was more severe in girls. The severity of AD as assessed by the parents was equal in both groups. More parents of girls reported that AD impacted on the “child’s mood” (P < 0.05) and “enjoying family activity” (P < 0.05). “Child’s mood” and “sleep disturbance” were highly scored by parents of girls (P = 0.01 and P < 0.05, respectively). Severity of AD as assessed by parents and IDQoL Index scores correlated with SCORAD scores in both groups. Scores on the DFI correlated with patient age in boys. The child’s age correlated with the emotional distress of parents in both groups and had an impact on “relationships in the family” in girls only. Several DFI items and overall family QoL correlated with patient age in boys. Conclusions The impact of AD on QoL and family QoL was more severe for girls. Relationships between parents progressively worsen with patient age in girls. Reported gender differences should be further investigated and may influence educational programs and advice given to parents of children with AD.     

A new instrument for assessing quality of life in atopic dermatitis: international development of the Quality of Life Index for Atopic Dermatitis (QoLIAD)

BACKGROUND: Atopic dermatitis (AD) is a chronic or chronically relapsing inflammatory skin condition that can have a considerable impact on those affected. There are a number of instruments available to measure outcome in dermatological conditions but none have been developed specifically for AD. In addition, most measure symptoms and/or daily functioning, which are potential influences on quality of life (QoL) rather than assessments of the construct itself. OBJECTIVES: The aim of the current study was to develop a new instrument specifically designed to measure QoL in adults with AD-the Quality of Life Index for Atopic Dermatitis (QoLIAD). METHODS: The instrument was developed based on the needs-based model of QoL and was produced in several different countries simultaneously. Its content was derived from 65 in-depth interviews with relevant patients in the U.K., Italy and the Netherlands. The initial version of the measure was produced in U.K. English and translations were produced for the Netherlands, Italy, Germany, France and the U.S.A. using a dual translation panel methodology. A Spanish version was developed using the same adaptation process after the instrument was finalized. Field-test interviews were conducted with approximately 20 patients in each country to assess face and content validity. The instrument [in addition to the Dermatology Life Quality Index (DLQI) and the Psychological General Well-Being Schedule (PGWB)] was then administered to up to 300 AD patients in each country at two time points to finalize the instrument and test its psychometric properties. RESULTS: The initial version of the QoLIAD had 56 items that reflected the areas of need fulfillment identified in the qualitative interviews as having been affected by AD: mental and emotional stimulation, physical and emotional stability, security, sharing and belonging, self-esteem, personal development and fulfillment. Comments from patients in field-test interviews resulted in the removal of 14 items, to leave a 42-item instrument that was considered relevant and acceptable. The number of patients participating in the survey were 286 in the U.K., 46 in the Netherlands, 213 in France, 187 in Germany, 178 in the U.S.A. and 83 in Spain. Application of the Rasch model to these data identified the final 25-item QoLIAD. Unidimensionality was confirmed, with deviation of the total scale from the Rasch model evident at a single time point in one country only (the U.K.). All language versions, with the exception of the Dutch measure, had test-retest reliability coefficients in excess of 0.85. The test-retest in the Netherlands was 0.80. However, this country had the smallest sample size and the corresponding reliability for the DLQI was only 0.40. The QoLIAD had adequate internal consistency and the initial indications of construct validity were good. The levels of association with the DLQI indicated that the two instruments measure related but distinct constructs. CONCLUSIONS: The QoLIAD is a practical, reliable, valid and culturally applicable instrument for measuring the impact of AD and its treatment on QoL in clinical trials or in routine clinical practice.     

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.     

The psychosocial burden of childhood atopic dermatitis

Atopic dermatitis is an extremely common childhood disease of increasing prevalence that greatly affects the quality of life of afflicted children and of their families. The disease alters the emotional and social functioning of the affected child and their family. The complex multidimensional effects of atopic dermatitis in children and families have been described qualitatively and measured quantitatively with quality of life instruments. Emotional effects on both the child and parents are predominant. The burden of atopic dermatitis can be improved by targeting parents and caregivers with education, psychosocial support, and specialty care.     

The Impact of Chronic Skin Disease on Daily Life (ISDL): a generic and dermatology-specific health instrument

BACKGROUND: In dermatological research and clinical practice, there is a need for comprehensive self-report instruments that assess a broad spectrum of health implications of chronic skin diseases, including generic and skin-specific aspects of disease-related quality of life. The advantages of dermatology-specific, multidimensional instruments over generic instruments or single-dimensional quality-of-life measures are in the detailed and specific information they provide about health areas that are affected by the skin condition and that may change through therapeutic intervention. OBJECTIVES: The development of a multidimensional health status inventory for chronic skin diseases (Impact of Chronic Skin Disease on Daily Life, ISDL) is described. The dermatology-specific part of the inventory assesses dimensions of physical functioning, more specifically skin status, physical symptoms of itch, pain and fatigue and scratching responses as well as disease-related stressors like stigmatization. The generic part gauges dimensions of psychological functioning, disease-related impact, illness cognitions and social support by means of existing scales validated for other chronic diseases. METHODS: Reliability and validity of the questionnaire were studied in various samples of patients with psoriasis and atopic dermatitis. RESULTS: The ISDL showed high reliability and test-retest reliability in both patient groups. Convergent validity was indicated by moderate to strong correlations with other validated questionnaires. The scales proved sensitive to change both for dermatological ultraviolet B radiation therapy and cognitive behavioural treatment for itching. CONCLUSION: With its convincing results for reliability and validity the present evaluation supports the usefulness and applicability of the instrument for different chronic skin diseases.     

Validation of a self-administered questionnaire in Chinese in the assessment of eczema severity

The purpose of this study was to validate the Chinese version of the Nottingham Eczema Severity Score (NESS) in determining the severity of atopic dermatitis (AD). Each parent or patient filled out a questionnaire in Chinese based on the NESS. A physician then repeated the NESS independently. Finally, the severity of AD was evaluated according to the Scoring Atopic Dermatitis (SCORAD) scale. The NESSs, severity grades, and SCORAD were analyzed for agreement and correlation. The severity grading agreed with the physician's grading in 38 of 52 parents (73%) and in 16 of 18 children (89%) who self-evaluated the severity of their AD. The weighted kappa (95% confidence interval [CI]) for parents with children less than 10 years old, parents with children > or =10 years old, and patients who self-evaluated their AD were 0.79 (0.66-0.91), 0.85 (0.69-1.00), and 0.74 (0.36-1.00), respectively. The R2 for the NESS by parents, the NESS by patients, and the SCORAD scores was 42.1%, 47.5%, and 49.8%, respectively. When compared with the parents, the older children who self-evaluated their AD showed a better correlation of the NESS with the SCORAD index. The self-administered questionnaire appears to be useful in assessing AD severity in Chinese children.     

A survey of traditional Chinese medicine use in children with atopic dermatitis attending a paediatric dermatology clinic

Use of traditional Chinese medicine (TCM) for various paediatric diseases has been popular. Often, parents or caregivers believe that herbs possess therapeutic effects without any harmful consequence. This fallacy is especially prevalent in the caregivers of children with chronic diseases such as atopic dermatitis (AD). We interviewed 227 consecutive children with AD to assess the attitudes of the caregivers to TCM use, based on a 14-item questionnaire. Of these respondents, 67 (30%) admitted that the child had been given TCM in the past 12 months, one-third of these were currently taking TCM and one-quarter had used TCM for 6 months or more. TCM was prescribed by a Chinese medicine practitioner in 63 patients (94%), and herbal tea/soup was the commonest TCM taken. The majority (94%) had not been told of any possible side effects of TCM. Nearly 60% thought that TCM helped to improve their child's AD. Respondents for children with severe eczema were less likely to think that TCM helped to improve their child's eczema than those with mild or moderate eczema. TCM use was not associated with parental ages or 'grandparent as caregiver' but 'severe AD' was an independent factor for TCM use (OR 3.24, 95% CI 1.67-6.31; p = 0.0003).     

Patient experiences and outcomes following facial skin cancer surgery: A qualitative study

Early melanoma and non‐melanoma skin cancer of the facial area are primarily treated with surgery. Little is known about the outcomes of treatment for facial skin cancer patients. The objective of the study was to identify concerns about aesthetics, procedures and health from the patients' perspective after facial skin surgery. Semi‐structured in‐depth interviews were conducted with 15 participants. Line‐by‐line coding was used to establish categories and develop themes. We identified five major themes on the impact of skin cancer surgery: appearance‐related concerns; psychological (e.g., fear of new cancers or recurrence); social (e.g. impact on social activities and interaction); physical (e.g. pain and swelling) concerns and satisfaction with the experience of care (e.g., satisfaction with surgeon). The priority of participants was the removal of the facial skin cancer, as this reduced their overall worry. The aesthetic outcome was secondary but important, as it had important implications on the participants' social and psychological functioning. The participants' experience with the care provided by the surgeon and staff also contributed to their satisfaction with their treatment. This conceptual framework provides the basis for the development of a new patient‐reported outcome instrument.     

Emotional dysfunction, child-family relationships and childhood atopic dermatitis

A link between atopic dermatitis (AD) and emotional dysfunction is now well established but consideration of this has yet to be widely incorporated into clinical management. A biopsychosocial model of the mind-body interaction is considered in conjunction with the theory of childhood emotional development and the impact of a diseased skin, for its effect on a child growing up with AD. AD inevitably adds to the difficulties of parenting, so that parents and children may become locked into dysfunctional relationships. This adds to the stresses for all concerned, and may contribute to the deterioration of the child's skin condition as part of a psychosomatic vicious cycle. There is a strong indication that the psychological dimensions of AD should be taken into account as part of routine management. Further research will be needed to establish the effectiveness of any psychological intervention.     

The family impact of atopic dermatitis in children: the role of the parent caregiver

Although some preliminary work exists examining the impact of atopic dermatitis (AD) in children on their families, there is no empirical work examining specific parent caregiver factors that could contribute to the family impact of this condition. We conducted a cross-sectional, exploratory analysis of how parent caregivers are affected by their child's AD, and how certain parent caregiver characteristics and perceptions affect the family impact of this condition. Parent caregivers of children with AD (n = 49) were administered a survey to collect detailed data on socioeconomic status, health perceptions, and caregiving issues. Family impact of the child's AD was measured using a modified AD Family Impact Scale. Multiple regression analyses revealed that three major factors associated with the parent caregiver were correlated with large increases in the family impact scores: 1) perception that the child's condition is severe (13%, p < 0.01), 2) high use of nonmedical services for child's condition (21%, p < 0.01), and 3) financial concern about the child's condition (18%, p < 0.01). These preliminary data indicate distinct characteristics of the parent caregiver that are associated with higher family impact of AD in children. These parent caregiver factors may be important in identifying suitable audiences and areas for education for optimal management of children's AD.     

Psychosocial sequelae in 29 children with giant congenital melanocytic naevi

Giant congenital melanocytic naevus (GCMN) may be expected to affect psychosocial functioning of children and their parents due to deviant appearance and painful treatment. To obtain insight into clinical aspects and psychosocial functioning of those suffering from GCMN, 29 children diagnosed with GCMN syndrome or single GCMN received a dermatological examination, were interviewed, and their mothers and teachers completed standardized questionnaires on the child's competence and behavioural/emotional problems and their own adjustment. Social problems were reported for 30% of the patients and behavioural/emotional problems for 25.9%. There was no correlation between visibility of the naevus, treatment or child age and psychological problems. Mothers reported considerable psychosocial burden. It is concluded that children with GCMN are at increased risk of social and behavioural/emotional problems, and mothers suffer considerable psychological impact of their child's condition.     

The influence of cultural and educational factors on the validity of symptom and diagnosis questions for atopic eczema

Valid questions for atopic eczema are necessary to identify risk factors in epidemiological studies. We have examined the influence of cultural and educational factors on the validity of some questions on atopic eczema used in the International Study of Asthma and Allergies in Childhood by using data from a cross-sectional study on 1511 children aged 6 years from East and West Germany. We tested three questions in relation to a point prevalence of atopic eczema as recorded by a dermatologist: (i) has a physician ever diagnosed eczema in your child? (ii) Has your child ever had an itchy rash which came and went for at least 6 months? (iii) Has your child ever had ‘neurodermatitis’ (atopic eczema, endogenous eczema)? The point prevalence of atopic eczema on the day of investigation was 11.1% (134 of 1217). According to the questionnaire, 15.7% of the children had had physician-diagnosed eczema, 14.1% had had neurodermatitis and 11.3% had had an itchy rash for > 6 months. Fifty-one per cent of parents who had a child with atopic eczema on the day of investigation said that their child had had an itchy rash which came and went for at least 6 months. This sensitivity value is less than that found in another community survey conducted in the U.K., suggesting that the German wording of the question seems to mean something more severe to the parents than the English one. The education of the parents had an influence on the validity of the three questions: parents with < 10 years of schooling often answered symptom and diagnosis questions less positively. Parents with academic degrees, contrary to expectation, did not answer most precisely, this being especially true for the symptom questions. The association between symptom questions and clinical diagnosis was higher in West than in East Germany. We compared lifetime eczema symptoms and diagnosis with a point prevalence clinical diagnosis. In the absence of knowledge of how extraneous factors measured in this paper can affect diseases chronicity, it is difficult to say with certainty that such factors affect the validity of symptom and diagnosis questions on atopic eczema. Our study suggests that more studies are needed to examine the influence of social class, education and location on the validity of symptom questionnaires for atopic eczema. Until then, we recommend that information about such variables should be gathered routinely.     

Prevalence of atopic dermatitis in Leicester: a study of methodology and examination of possible ethnic variation

A study was undertaken to investigate and compare various methods of estimating the prevalence of atopic dermatitis (AD), and to investigate a possible ethnic difference in our local community. Preschool children attending routine child health surveillance clinics and Social Services day nurseries were examined by a trained observer, and their parents were interviewed. In addition, general practice records from a health centre were scrutinized. Three hundred and twenty-two children aged 1–4 years were examined, and the point prevalence of AD was 14% [95% confidence interval (CI) 10–18]. There was no apparent ethnic difference in prevalence. Twenty-seven per cent (95% CI 22–32) of parents reported that their children had suffered from‘eczema’ at some time. General practitioners’ records contained a diagnosis of‘eczema’ in 32% (95% CI 28–36) of 446 children aged 1–4 years. It is clear that methodology must be carefully standardized if comparisons are to be made between different studies. Accurate estimations of the prevalence of AD can probably only be obtained by examination of a population sample by a trained observer. However, the estimates obtained in this study are high, and would tend to support existing evidence that the prevalence of AD is rising.