Support for 2 variants of eczema

Abstract

Studies investigating the natural history and risk factors for eczema have historically considered eczema as a single entity, without regard for the individual's atopic status. The association between atopy and eczema is complex, and as many as (2/3) of patients with eczema are not atopic. To investigate the risk factors for eczema in relation to the child's atopic status in a cohort of high-risk children. A prospective birth cohort of 263 children was followed for 5 years and closely examined for eczema. Antenatal and postnatal data on environmental exposures were collected by interview. Skin prick test to define atopic status was performed at 6 months and 2 and 5 years of age. Of the subjects, 66.1% had eczema in the first 5 years, and the majority (85.5%) reported onset of rash in the first year. A third of those with eczema were not atopic (nonatopic/intrinsic eczema). Children with atopic eczema (extrinsic eczema) were more likely to be male, to have been breast-fed longer, and to have a history of food allergies, allergic rhinitis, and current wheeze. Nonatopic eczema was more common in girls, and an association was found with early daycare attendance. This study supports the presence of 2 variants of eczema: atopic eczema occurring early in childhood and nonatopic eczema with early daycare attendance. It is likely that environmental factors have a different effect on these 2 variants of eczema, and future studies should thus consider eczema as 2 variants in determining the effect of attributable risks.