The prevalence of atopic dermatitis in Oregon schoolchildren

BACKGROUND: Although surveys from many parts of the world have shown that the prevalence of atopic dermatitis (AD) in schoolchildren has increased greatly in the past 40 years, there is no current prevalence information from the United States. OBJECTIVE: Our objective was to investigate the utility of a recently developed European questionnaire to estimate the prevalence of AD in urban and rural Oregon schoolchildren. METHODS: The self-administered Schultz-Larsen questionnaire (SLQ) of AD symptoms and history was completed by the parents of a broad socioeconomic and ethnic mix of 5- to 9-year-old schoolchildren from 6 urban and 2 rural elementary schools in Oregon. Validation assessments included comparisons of the questionnaire scores with clinical examination in a group of age-matched children and with specific history components known to correlate with AD. RESULTS: Data showed a prevalence of 17.2% using standard scoring criteria for the SLQ and with a lower limit of 6.8% according to highly stringent criteria derived from the validation study using dermatologic examination. A single question ("Has a doctor ever said that your child has eczema?") was highly concordant with the questionnaire determination, yielding very high predictive accuracy (91.2%). CONCLUSION: This study of childhood AD frequency indicates a high prevalence of AD in the United States, comparable to that recently observed from studies in Europe and Japan. (J Am Acad Dermatol 2000;43:649-55.).     

Community validation of the U.K. diagnostic criteria for atopic dermatitis in Japanese elementary schoolchildren

BACKGROUND: A simple list of diagnostic criteria for atopic dermatitis for use in epidemiological studies was developed by a U.K. working party. This list served well for both hospital patients with skin diseases and in general population within the U.K. OBJECTIVES: To validate the U.K. diagnostic criteria in Japanese elementary schoolchildren, we collected the questionnaires on regular health checkups, which had been completed by parents of schoolchildren in 2001/2002 and 2004/2005. METHODS: Elementary schoolchildren were examined by dermatologists in eight areas (16,152 children) in 2001/2002 and in three areas (3849 children) in 2004/2005. The questionnaire was distributed to the parents 2 weeks before the skin examination, completed by the parents and collected after the survey. RESULTS: In 2002/2002 comparing the U.K. diagnostic criteria with the findings on clinical examination used as the reference standard, the U.K. criteria (1-year prevalence measure) showed a sensitivity of 71.8%, specificity of 89.3% and positive predictive value of 44.7%. In 2004/2005 we confirmed that the U.K. criteria for a point prevalence measure showed a higher positive predictive value (59.9%) compared with that for 1-year prevalence measure (49.3%). CONCLUSION: Now that we know the sensitivity and specificity of the U.K. criteria in the population examined in this study, we will be able in the near future to estimate the prevalence of atopic dermatitis in a similar population with reverse operation by questionnaires alone using these criteria without examination by dermatologists. Therefore, the validation study of U.K. criteria could be useful for future epidemiologic surveys.     

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%.     

天津市0～6岁儿童特应性皮炎患病率调查

目的了解天津市城市和农村0～6岁儿童特应性皮炎（AD）的患病率及患病因素。方法采取整群抽样方法，依据儿童哮喘和过敏国际研究协作组问卷，对天津市城市和农村0～6岁儿童进行问卷调查。结果本次调查涉及天津市城市和农村，收回问卷3749份，有效问卷3708份，有41份因填写不规范而未被录入数据库进行统计学分析。城市应答率为84．9％，农村应答率为79．3％，总应答率为82．7％。所调查人群的年龄在不同性别间及城市和农村问分布均衡。经过对调查资料的分析，儿童AD的患病率为2．9％，其中城市为3．5％，农村为2．4％，城市AD患病率高于农村（矿=3．98，P〈0．05）。结论天津市AD的患病率为2．9％，城市AD患病率为3．5％，农村AD的患病率为2．4％。     

Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterparts

BACKGROUND: The prevalence of atopic dermatitis (AD) has been shown to be higher in London-born black Caribbean children than in their white counterparts, but little is known about the severity of the disease. OBJECTIVES: To carry out a longitudinal survey to investigate potential risk factors for AD severity in children. We report our findings in relation to differences in disease severity between white and black children and the effect of inclusion and exclusion of erythema scores on this comparison. METHODS: The recruited children were identified by their general practitioners (GPs) as having presented with AD, and the U.K. diagnostic criteria for AD were used to verify the diagnosis. Interview and clinical examination of children took place up to four times, 6 months apart. Each time, the same observer assessed AD severity using the SCORAD (SCORe Atopic Dermatitis) index. Potential risk factors and confounders were evaluated with a five-page questionnaire. Non-parametric tests were used for statistical analysis and the study participant remained the unit of the analysis. RESULTS: In total, 137 children (82 urban and 55 rural) were recruited, and each seen up to four times. This gave 380 observations (69% of an expected 548). The urban population contained 42 (51%) white children, 26 (32%) black children and 14 (17%) from other races. The rural population was entirely white. The 14 children from other races were completely excluded from the statistical analysis. The black children were all born in the U.K. On crude analysis, children with black skin showed a non-significantly lower risk of severe disease when compared with white children (odds ratio, OR 0.84; 95% confidence interval, CI 0.4-1.76; P = 0.65), while a highly significantly increased risk was found after adjusting for erythema score (OR 5.93; 95% CI 1.94-18.12; P = 0.002). The difference remained significant even after controlling for other potential confounders. CONCLUSIONS: Black children with AD are about six times more at risk of having severe AD than their white counterparts. GPs and dermatologists should note that erythema can be a misleading indicator of severity in black children. Difficulties of assessment due to skin pigmentation might mean that severe cases are not being detected and appropriately treated.     

Prevalence of childhood acne, ephelides, warts, atopic dermatitis, psoriasis, alopecia areata and keloid in Kaohsiung County, Taiwan: a community-based clinical survey

BACKGROUND: Epidemiological study on childhood dermatoses performed by direct inspection of dermatologists is limited. OBJECTIVE: To investigate the prevalence of selective childhood dermatoses in Taiwan. METHODS: In a cross-sectional study carried out in June 2004, 4067 of 7851 children aged between 6 and 11 years living in the Kaohsiung County in south Taiwan were clinically surveyed and examined by two board-certified dermatologists (response rate 52%), regarding the point prevalence of acne, ephelides, warts, atopic dermatitis (AD), psoriasis, alopecia areata (AA) and keloid. RESULTS: Acne vulgaris was found in girls and boys from the age of 6 and 7, respectively, with comedones being the earliest presentation. Ephelides were not infrequently observed in our children (prevalence rate 8.4%, 95% confidence interval, CI 7.9-9.3%). The prevalence of warts on hands was 2.4% (95% CI 1.9-2.9%). The prevalence of AD was 1.7% (95% CI 1.3-2.1%), without gender difference. There were only four cases of AA but no psoriasis was found. Keloid was identified in 13 boys and 10 girls, accounting for 0.6% (95% CI 0.598-0.602%) of the children. CONCLUSION: Acne vulgaris is as common in Taiwan as in Western countries. Ephelides are not uncommon in our population with the main skin types III-IV. A clustered distribution of the wart infection was noted. The low prevalence of AD in Taiwan seems unaltered over the past decade. AA and psoriasis are rare in our series. Most keloids in our children are caused by BCG vaccination.     

No significant increase within a 3-year interval in the prevalence of atopic dermatitis among schoolchildren in Baranya County, Hungary

BACKGROUND: The prevalence of atopic dermatitis (AD) in children has significantly increased worldwide in the past decades. Although it is well known that the number of AD patients has also been growing in Hungary, there are only a few published prevalence studies that allow international comparisons. OBJECTIVES: The aim of this study was to estimate the prevalence of AD among schoolchildren in Baranya County in 2005 and to compare the data with those from 2002. METHODS: The data from the 1454 children (771 girls, 683 boys) surveyed in 2002, and 1454 children (760 girls, 694 boys) surveyed in 2005, respectively, aged 7-14 years were analysed. The distinct populations of the 7- to 9-year-old age groups were separately compared in relation to their lifetime AD prevalence. RESULTS: The prevalence of AD accounted for 15.1% in 2002, and 16.1% in 2005. In the compared distinct 7- to 9-year-old populations the prevalence rates were 17.0% in 2002 and 17.1% in 2005. There were no statistically significant differences between the data of the two surveys. CONCLUSIONS: The results indicate the high prevalence rate of AD nearly approaching the markedly high values registered in the welfare countries, and could indicate that AD has reached a plateau in Hungary.     

凉山地区雀斑流行病学调查

目的了解凉山地区雀斑患病情况及患病规律,探讨汉族与彝族、农村与城区患病差异。方法采用整群抽样,社区调查方式进行。参与者现场填写问卷,接受皮肤病专业医师检查。资科以EpiData录入,使用SPSS13.0进行数据分析。结果共调查10503人,发现雀斑患者2875人。粗患病率27.4%(标准化患病率23.6%)。5岁以后患病率逐渐增加,20～29岁达到高峰,患病率33.6%,30岁以后患病率逐渐下降。男性患病率17.2%,女性患病率34.5%(P0.01)。农村患病率31.5%,城区19.4%(P0.01)。汉族患病率27.7%,与彝族患病率27.3%相近(P0.05);汉族男性患病率16.4%,彝族男性患病率21.2%(P0.01);汉族女性患病率35.8%,彝族女性患病率31.5%(P0.01)。结论凉山地区雀斑患病率为27.4%。女性患病率高于男性,男女患病率之比为1∶2;农村患病率高于城区。汉族与彝族总体患病率相近,彝族男性患病率高于汉族男性,彝族女性患病明显低于汉族女性。     

Vitiligo prevalence study in Shaanxi Province, China

BACKGROUND: Recent publications, especially those based on population surveys, show that the presumed vitiligo prevalence of 1-2% is overestimated. OBJECTIVE: To obtain the vitiligo prevalence in Shaanxi Province, China, through a population survey. METHODS: Approximately one-thousandth of the 36.05 million people in Shaanxi Province, China, were selected through stratified four-stage cluster sampling. They lived in 180 investigation units and all were investigated in a door-to-door survey. Vitiligo and suspected vitiligo patients were marked in the basic questionnaire. They were encouraged to complete a well-prepared questionnaire and send it back to the investigation center. The questionnaire assigned to the investigators contained questions about vitiligo characteristics, such as the area affected, number of areas, and whether or not the affected areas were covered by scurf. Professional dermatologists verified these results. RESULTS: There were 42,833 people in 180 investigation units. The sex, residence, and educational level of these individuals were representative of the population of Shaanxi Province. The investigation team reported 43 vitiligo patients and 14 with suspected vitiligo. During the verification period, three patients and all those with suspected vitiligo were excluded. In total, there were 40 patients (17 women and 23 men). Eleven lived in urban areas and 29 in rural areas. CONCLUSIONS: The prevalence of vitiligo in Shaanxi Province is 0.093% (95% confidence interval, 0.067-0.127%). No significant difference was found between males and females or between urban and rural residents.     

全国1984年银屑病流行调查报告

1984年全国24个省、市、自治区,在53个调查点上按统一计划进行了大规模银屑病流行病学调查.调查人口总数为6,617,917人,共计发现银屑病患者11,393人.估计总患病率为1.23‰.为了比较各地的患病率,进行了标准化处理.男性患病率高于女性,城市患病率高于农村,北方患病率高于南方.地处东北的吉林省德惠县和北京首都钢铁公司患病率最高,分别为4.2‰编及4.86‰,而南方广东省农村最低,患病率为0.04~0.07‰.从年发病率也可看出城乡差异,城市的年发病率为同年农村的2~4倍.1984年的全国银屑病发病率为0.12‰,约为当年患病率的十分之一.     

Higher body mass index is a significant risk factor for acne formation in schoolchildren

Obesity is frequently accompanied by peripheral hyperandrogenism, which may be associated with increased sebum production and the development of severe acne. Body mass index (BMI) is one of the most accurate ways to measure and determine obesity. The aim of the present study was to study the correlation between obesity and the point prevalence and patterns of acne in schoolchildren. A total of 3,274 children (aged 6-11 years) from Magong Township were examined by two board-certified dermatologists. The acne prevalence was 7.3%, with more girls affected than boys (ratio = 1.5). Comedones were more commonly observed than inflammatory acne (10.4% vs. 6.9%). The mean of BMI in non-acne students (18.2 +/- 3.4) was significantly lower than that in acne subjects (19.5 +/- 3.7), without gender difference. Overall schoolchildren with a BMI < 18.5 had less prevalence rate of acne, especially the inflammatory lesions, while those with a BMI-for-age > or = 95% had a significantly higher rate of acne development.     

Is there a rural/urban gradient in the prevalence of eczema? A systematic review

Background Eczema affects approximately 10% of all schoolchildren in the western world and has shown an increase over the past decades in ‘developing’ countries. Numerous factors have been suggested that might contribute to the increasing prevalence of eczema. A plausible explanation is the role of environmental factors. As part of the ‘hygiene hypothesis’ it has been thought that eczema is more common in urban than in rural communities, but such a notion has never been assessed systematically. Objective Our aim was to assess whether there is a rural/urban gradient for the prevalence of eczema and, if so, to what extent. Methods All data sources were identified through a search in MEDLINE and EMBASE. All primary studies comparing the prevalence rate of eczema between urban and rural populations were assessed for eligibility. Included articles were reviewed for methodological quality and a relative risk was calculated to indicate the risk of eczema in urban over rural areas. Results Twenty‐six articles were included for analysis. Nineteen showed a higher risk for eczema in an urbanized area, of which 11 were significant. Six studies showed a lower risk of eczema in an urbanized area, of which one was statistically significant. One study had a relative risk of 1·00. Results were more homogeneous among studies of good methodological quality. A pooled relative risk could have been calculated but was not because of heterogeneity. Conclusion There is some evidence of a higher risk for eczema in urban compared with rural areas, suggesting that place of residence may have a role in the pathogenesis of eczema. Future reviews on environmental circumstances should be carried out to reveal the factors associated with a higher prevalence of eczema in urban areas and the association with other allergic diseases.     

深圳市1～7岁儿童特应性皮炎流行病学调查

目的 了解深圳市1～7岁儿童特应性皮炎(AD)的患病情况及影响因素,分析不同标准诊断结果差异.方法 2013年12月1日至2014年3月1日采用问卷与体检相结合的方式调查深圳市1～7岁儿童AD的患病情况.结果 共纳入1 504名儿童,其中男716例、女788例.以有经验皮肤科医生的临床诊断为标准,AD总患病率为11.84％(178例),男性患病率为11.73％(84例),女性为11.93％ (94例).男性与女性患病率差异无统计学意义(x2=0.01,P＞0.05).基于Williams诊断标准,AD总患病率为3.92％(59例),男性患病率为4.05％(29例),女性为3.81％(30例).早产是AD发病的危险因素(x2=5.43,P＜ 0.05).结论 深圳市1～7岁儿童AD患病率明显上升,早产是AD的危险因素;以有经验皮肤科医生的临床诊断作为标准可以减少AD漏诊.     

Validation of the U.K. diagnostic criteria for atopic dermatitis in a population setting

Summary One reason why so little is known about the epidemiology of atopic dermatitis (AD) is lack of suitable diagnostic criteria. A simple list of diagnostic criteria for AD for use in epidemiological studies has recently been developed by a U.K. working party. These have performed well in hospital validation studies of subjects with skin diseases. This study sought to validate the newly proposed criteria for AD in a population setting by conducting a cross-sectional survey of 695 schoolchildren aged 3–11 years in three randomly selected primary schools in West Lambeth, London. As a point prevalence measure, the U.K. criteria had a sensitivity of 70%, a specificity of 93%, and a positive predictive value of 47% when compared with a dermatologist's examination findings. Subsequent analysis suggested that most children classified as false positives had suffered from AD in the last year, but were inactive at the time of examination. When adjusted for these cases, the sensitivity and specificity increased to 80 and 97%, respectively, corresponding to positive and negative predictive values of 80 and 97%, respectively. The U.K. diagnostic criteria for AD appear to work well as a 1-year period prevalence measure in London schoolchildren. Further validation in adults and other countries are needed.     

Prevalence of inflammatory bowel disease in Japanese psoriatic patients

Psoriatic patients reportedly have a higher prevalence of inflammatory bowel disease (IBD); however, there have been few research studies of Japanese psoriatic patients. To elucidate the prevalence of IBD in Japanese psoriatic patients, a cross‐sectional study was performed. Information was collected regarding psoriatic patients with current or prior history of Crohn's disease (CD) or ulcerative colitis (UC) who were treated at Fukuoka University Hospital from 2010 to 2018. Among 681 psoriatic patients (449 men and 232 women), eight (1.2%, six men, two women) had UC and two (0.3%, one man, one woman) had CD. Diagnosis of IBD preceded psoriasis in five patients, while diagnosis of psoriasis preceded IBD in two; the remaining patients’ records did not have sufficient information. Seven of 10 UC‐positive patients had mild psoriasis, two had moderate psoriasis and one had severe psoriasis. When UC‐positive psoriatic patients were compared with IBD‐negative psoriatic patients, there were no differences in age at onset of psoriasis, age at first visit or complications (e.g. psoriatic arthritis, hypertension, hyperlipidemia, hyperuricemia and diabetes). However, UC‐positive patients had significantly higher body mass index (BMI) (26.7 vs 23.7; P = 0.021), compared with patients without IBD. The CD/UC ratio in this cohort was 0.25, while the prevalence of IBD was 1.2%; these values were both lower than those in previous reports involving Caucasian patients. Patients with psoriasis and UC may have higher BMI and milder skin symptoms than those with psoriasis alone. These observations must be further confirmed by controlled domestic studies with larger samples.     

Prognostic factor of adult patients with atopic dermatitis

The increased prevalence of atopic dermatitis (AD) in adults in recent decades suggests that dermatologists may be expected to estimate the prognosis of adult patients with AD when they visit as new patients. We therefore evaluated the change in the extent of involvement and analyzed the factors that contribute to the prognosis of adult AD. A retrospective chart review was performed for 65 adults patients (median age at first visit, 25 years) with AD who had been followed monthly for over 10 years. The median area of involvement at first visit was 19%. The area of the eruptions and peripheral eosinophil counts decreased significantly in the fifth and 10th years with standard treatment. The values of immunoglobulin (Ig)E were also reduced after 10 years. Patients with high values of serum total IgE and peripheral eosinophil count, and long duration of AD had wide areas of eruptions 10 years after the first visit. Total IgE had the highest correlation with area of involvement after 10 years. Although the prognosis of adult AD is not poor, patients with high IgE values are expected to have ongoing eczema with wide distribution after 10 years of follow up.     

Epidemiology of atopic dermatitis in Poland according to the Epidemiology of Allergic Disorders in Poland (ECAP) study

Epidemiological studies (International Study of Asthma and Allergies in Childhood [ISAAC], The European Community Respiratory Health Survey [ECRHS]) revealed considerable geographical differences in prevalence of atopic dermatitis (AD). The aim of our study is to present the epidemiology and the risk factors of AD in a Polish population. A total of 18 617 subjects were selected. The sample included respondents in eight cities and one rural area each over 150 000 citizens. The study had two parts: (i) questionnaire survey conducted among all respondents (response rate, 64.4%); and (ii) allergological examination performed among 25.7% with skin prick test (SPT) with 15 aeroallergens. AD was identified in 3.91% of subjects, more often in females, living in the cities, with a mother and/or father with atopy and with a higher education and higher economic status. Comorbidities of AD were atopic rhinitis (AR) in 26.17% and AR and asthma in 14.6%. AD was diagnosed by allergologists in 311 subjects (6.5%). Positive SPT occurred in 66.9% persons with AD (house dust mite, 33.1%; grasses/crop plants, 30.6%). Of the patients, 9.5% with perennial versus 9.3% seasonal and 9.6% with polyvalent versus 9.0% monovalent sensitization had AD. AD prevalence in Poland is below the mean rate for Europe, but risk factor profile is similar to other countries. AD is more frequent in female, well‐educated individuals, of high socioeconomic status, with atopic parents and who live in a city. Seasonal and monovalent atopy play a more essential role in subjects with AD compared with AR and asthma.     

Prevalence of atopic dermatitis in Korea

This study was designed to estimate the prevalence and personal or family history of atopic dermatitis in school children in 3 areas of Korea: urban (Seoul), industrial (Ulsan) and rural (Chunchon). On the basis of dermatologists' physical examinations and the questionnaires completed by parents or guardians, the prevalence of atopic dermatitis was estimated to be 3.3% in the industrial area, 6.6% in the rural area and 7.8% in the urban area. The frequency of atopic dermatitis decreased with age and was significantly lower in the industrial area than in the rural and urban areas.     

南京市2249名中小学生异位性皮炎调查分析

目的：了解南京地区青少年异位皮炎的发病情况。方法：对南京地区４所学校２２４９名７～１８岁年龄段的学生进行普查。结果：１９９８年５～６月南京地区青少年异位性皮炎时的时点患病率为０．８９％,其中城市患病率１．２５％,农村患病率为０．４８％,城市和农村男性患病率分别为１．６８％和０．８０％,女性为０．８２％和０．１８％。同时证实了Ｗｉｌｌｉａｍｓ标准在我国普遍人群应用有较好的诊断效率。结论：（１）１９９８年５～６月南京地区青少年异位性皮炎的时点患病率表现为城市高于农村,男性高于女性;（２）Ｗｉｌｌｉａｍｓ标准适用于我国７～１８岁年龄段人群的流行病学调查。     

The prevalence of common skin conditions in Australian school students: 2. Atopic dermatitis

The prevalence of atopic dermatitis (AD) was recorded following examination by dermatologists and dermatology registrars of a random sample of 2491 school students throughout the State of Victoria, Australia. The overall prevalence, based on clinical examination, was 16.3% (95% confidence interval, CI 14.1-18.5), being higher in girls (17.7%; 95% CI 15.0-20.4) than boys (14.8%; 95% CI 11.8-17.8). Using the U.K. Working Party Diagnostic Criteria for AD reduced the prevalence to 10.8% (95% CI 9.3-12.3) with the prevalence in girls 12.3% (95% CI 10.1-14.4) and in boys 9.2% (95% CI 7.1-11.4). The prevalence was highest in 4-6 year olds (18.7% on clinical examination, 11.5% using the U.K. Working Party Criteria), decreasing with increasing age to 11.6% on clinical examination (8. 6% on U.K. Working Party Criteria) among 16-18 year olds. Most of those with AD were classified as having mild disease (54.1%), with 32.1% classified as having minimal and 13.8% as having moderate to severe disease. Over 80% of those who reported on the questionnaire that they had dermatitis that was then confirmed on examination had been using one or more products to treat it. Nearly 90% of these products were classified as efficacious, with medical practitioners being the major source of advice for their use (77%). Pharmacists (8%), family/friends (6%) and others (9%), including beauticians and naturopaths, made up the remainder of the persons from whom those affected had sought advice about their treatment. These data, the first community-based prevalence data on AD published from Australia, confirm that the condition is common among those of school age. There is a need for AD to be included among those conditions that are discussed in health education lessons in schools.