Lifetime Prevalence Of Atopic Dermatitis Research Articles

Atopic dermatitis and hand eczema in Danish adults: A nationwide population-based study.

Atopic dermatitis (AD) and hand eczema often co-occur, particularly among adults. To examine the interplay between AD and hand eczema in the general population, by characterising prevalence, disease severity, contact sensitization, and comorbidities in individuals with one or both conditions. In this cross-sectional study, 100 000 randomly selected adults in the Danish general population received a questionnaire via a secure, digital mailbox linked to their civil registration number. Participants answered questions regarding eczema, disease severity, patch testing, and comorbidities. A total of 40 007 individuals responded to the question on a lifetime prevalence of AD, and the prevalence among adult Danes was 9.0%. Nearly one third of individuals with AD reported moderate to severe disease. AD was associated with contact sensitization and increased hand eczema prevalence. Individuals with both AD and hand eczema reported worse disease severity. Furthermore, having both conditions was associated with an increased risk of psychiatric comorbidities. This study provided updated information about unselected adults with AD in Denmark. Individuals with both AD and hand eczema represent a vulnerable subgroup that physicians should be attentive to.

Association of Sleep Duration and Weekend Catch-Up Sleep with Suicidal Ideation among Adolescents with Atopic Dermatitis.

Atopic dermatitis (AD) is a prevalent allergic disease in children that often causes sleep disturbance and which is associated with diminished quality of life and heightened susceptibility to depression and suicidality. In this study, we investigate the relationship between weekend catch-up sleep (WCUS) and mental health in a sample of 71,434 adolescents with AD and 221,057 without AD using multivariate logistic regression analysis. We hypothesized that adolescents with AD experience shorter total and daytime sleep due to pruritus, with compensatory longer WCUS. We found that the lifetime prevalence of AD was 24.4%, and that adolescents with AD slept less overall, with significantly shorter weekday and weekend sleep durations but longer weekend catch-up sleep (WCUS). Sleep dissatisfaction was markedly higher in the AD group. Interestingly, our results suggest that prolonged WCUS is a protective factor against suicidal ideation in adolescents with AD. The study highlights the importance of addressing sleep patterns in adolescents with AD to enhance mental health. Overall, our findings indicate a need for increased awareness and intervention strategies to ensure sufficient sleep and reduce the risk of suicidal ideation in this population.

33552 Prevalence and severity of atopic dermatitis and hand eczema, and associated lifestyle factors in the Dutch general population

Background: Atopic dermatitis (AD) and hand eczema (HE) lead to a considerable public health burden, especially among patients with moderate to severe disease. A large epidemiologic study has not been conducted in the Netherlands yet. Methods: A cross-sectional study was conducted within the Lifelines Cohort Study by sending a digital questionnaire to 135,950 adults in 2020. Lifestyle factors were extracted from baseline assessment, performed between 2006 and 2013. The association between AD, HE, and lifestyle factors, were analyzed using univariate and multivariate binary logistic regression and linear regression models. Results: 57,798 subjects (42.5%) were included. The lifetime prevalence of AD was 9.3%, and the point prevalence of moderate to severe AD was 2.4%. The lifetime prevalence of HE was 15.0%, and the 1-year prevalence was 7.3%, with a proportion of severe to very severe HE at worst ever of 1.9%. Moderate to severe AD was associated with increased smoking pack years, >2 alcoholic drinks per day, chronic stress, and obesity. In addition, smoking amount and pack years, chronic stress, and obesity showed a positive association with HE in the past year. Conclusion: Moderate to severe disease represents a considerable proportion of patients with AD and HE. The current study also indicates that particular lifestyle factors are associated with AD and HE. Advice regarding lifestyle factors might contribute to improving overall health, of which AD and HE might possibly benefit in conjunction. Further longitudinal studies are required to better characterize the direction of these associations, and develop strategies for prevention.

Prevalence of adult self-reported atopic dermatitis in Greece: results from a nationwide survey

Atopic dermatitis (AD) is a common chronic inflammatory skin disorder. In Greece, there is a lack of data on AD epidemiology. The objective of the present study was to estimate the self-reported prevalence of AD and the prevalence of moderate/severe AD in the adult population in Greece. A nationwide cross-sectional survey with a structured questionnaire was conducted, between June 17th, 2021 and July 12th, 2021, using Computer Assisted Telephone Interviewing (CATI) and Computer Assisted web Interviewing (CAWI) data collection methods. Several different self-reported AD definitions, as extracted from the literature, were used. Self-reported moderate/severe atopic dermatitis was estimated using the Patient Oriented Eczema Measure (POEM). More than 30,500 persons were invited to participate; among them, 3,001 were recruited for the survey. The 12-month self-reported AD prevalence in Greece ranged from 1.7% to 6.4%, while lifetime prevalence reached 11.4%. At least half of the responders who identified with AD during the last 12 months had moderate to very severe eczema. The multivariate analysis confirmed that age, atopy-related comorbidities (asthma, allergies, and rhinitis), a family history of AD, rhinitis, and asthma were factors that are independently associated with AD, irrespective of the definition used. The 12-month and lifetime prevalence of AD in adults in Greece ranges from 1.7% to 6.4% and 3.7% to 11.4%, respectively. At least half of the adults with AD suffer from moderate-to-severe disease. Our study is a first step in understanding AD epidemiology in Greece and may provide useful insights for healthcare decision makers.

Atopic dermatitis in schoolchildren and adolescents: a critical review of Italian epidemiological data and systemic treatments

The epidemiology of atopic dermatitis (AD) is largely different in pre-school and schoolchildren. We summarized the available epidemiological data on schoolchildren (6-11 years) and adolescents (12-17 years) in Italy and reviewed information on systemic treatments for moderate-to-severe AD in adolescents.In January 2019, we searched for data on prevalence and/or incidence of AD and on the efficacy, effectiveness and safety of systemic AD therapies. Papers were evaluated and selected, and relevant information was extracted. Twenty papers from 17 studies reported original epidemiological information on AD in Italy.Most studies were conducted before 2005. Though variations emerged between studies, the lifetime prevalence of AD was estimated between 15-17% in schoolchildren and between 8-13% in adolescents. The (12-months) period prevalence of AD was estimated between 8-10% in children and between 8-11% in adolescents. Up-to-date information on the prevalence of severe AD is not available. Cyclosporine A may be used in pediatric age patients (children and adolescents) with persistent or severe AD refractory to topical treatments, but its use has several limitations, and is not recommended in patients younger than 16 years. The treatment paradigm of AD is still far from being satisfactory.We provided a quantitative synthesis of AD epidemiology in Italian schoolchildren and adolescents. Recent data are needed, as most information dates back to the 1990s or early 2000s, and data on the incidence of AD, the proportion of severe cases, and treatment of severe cases in the real-world setting are scanty.

Atopic dermatitis in schoolchildren and adolescents: a critical review of Italian epidemiological data and systemic treatments

The epidemiology of atopic dermatitis (AD) is largely different in pre-school and schoolchildren. We summarized the available epidemiological data on schoolchildren (6-11 years) and adolescents (12-17 years) in Italy and reviewed information on systemic treatments for moderate-to-severe AD in adolescents. In January 2019, we searched for data on prevalence and/or incidence of AD and on the efficacy, effectiveness and safety of systemic AD therapies. Papers were evaluated and selected, and relevant information was extracted. Twenty papers from 17 studies reported original epidemiological information on AD in Italy. Most studies were conducted before 2005. Though variations emerged between studies, the lifetime prevalence of AD was estimated between 15-17% in schoolchildren and between 8-13% in adolescents. The (12-months) period prevalence of AD was estimated between 8-10% in children and between 8-11% in adolescents. Up-to-date information on the prevalence of severe AD is not available. Cyclosporine A may be used in pediatric age patients (children and adolescents) with persistent or severe AD refractory to topical treatments, but its use has several limitations, and is not recommended in patients younger than 16 years. The treatment paradigm of AD is still far from being satisfactory. We provided a quantitative synthesis of AD epidemiology in Italian schoolchildren and adolescents. Recent data are needed, as most information dates back to the 1990s or early 2000s, and data on the incidence of AD, the proportion of severe cases, and treatment of severe cases in the real-world setting are scanty.

183 Association of atopic dermatitis, ultraviolet radiation and climate factors: a systematic review and ecological meta-analysis

Previous studies found conflicting results about the relationship of ultraviolet radiation (UVR) and climate with atopic dermatitis (AD) prevalence. We examined the relationship of UVR and climate with lifetime and point AD prevalences globally. A systematic review was performed of all published observational studies in MEDLINE, EMBASE, LILACS, Scopus, Cochrane library and GREAT that analyzed AD prevalence. Mean UVR dose exposure was determined from the Tropospheric Emission Monitoring Internet Service. Mean daily temperature and total precipitation were obtained from the Intergovernmental Panel on Climate Change Data Distribution center. Linear and nonlinear associations (penalized spline term) of AD prevalence with mean and maximum UV dose exposures, temperature and precipitation were assessed using generalized linear mixed-effects regression models. Overall, 284 studies met inclusion criteria. The pooled global lifetime and point prevalences (95% confidence interval [CI]) of AD were 13.8% (12.6, 14.9%) and 9.4% (7.6, 11.3%), respectively. Lifetime prevalence of AD was inversely and non-linearly associated with mean UVR dose exposure (P=0.003) and temperature (P=0.01). Point prevalence of AD was inversely and non-linearly associated with mean UVR dose exposure (P=0.04) and linearly associated with mean temperature (beta [95% CI]: -0.19 [-0.34, -0.05], P=0.01). Lifetime and point prevalence of AD were not associated with precipitation levels. Snowy climate was associated with higher lifetime (beta [95% CI]: 4.79 [1.34, 8.25]) and point (6.13 [1.43, 10.83]) prevalences of AD compared to equatorial climate. Similar results were seen in studies of children and/or adults. The results of this ecological study support a role for UVR, temperature and climate type in global AD prevalence.

Focus Sessions (FS)

OBJECTIVES: To determine the prevalence of atopic dermatitis (AD) in the general European population and to assess differences in contact allergy and avoidance of products between subjects with AD in lifetime and those who had not. MATERIALS AND METHODS: In five European countries (The Netherlands, Germany, Italy, Portugal and Sweden) a random sample of 12 377 participants, aged 18 to 74 years were interviewed using a standardized questionnaire. Questions were asked about previous atopic dermatitis and avoidance of products because of a skin reaction. A random sample of 3119 participants was patch tested. TRUE Test panel 1, 2 and 3 and investigator-loaded chamber systems were used, testing for a total of 47 allergens, including the individual fragrance allergens of fragrance mix (FM) I and FM II. Reading was performed at day 3. RESULTS: The physician-diagnosed lifetime prevalence of AD was 7.1% (95% CI 6.7-7.6). The age-standardized physician diagnosed life time prevalences of AD stratified per country were: Germany: 9.4% (95% CI 8.5-10.3); The Netherlands: 8.5% (95% CI 7.2-10.1); Sweden: 7.2% (95% CI 6.1-8.4); Italy 4.2% (95% CI 3.3-5.3); Portugal: 3.3% (95% CI 2.6-4.2). The prevalence of contact allergy to at least one allergen was not significantly different between those with AD in lifetime (31.1%) and those without AD (27.8%). Males with AD were significantly more sensitized to allergens of TRUE Test panel 2 (14.9%) than those without AD (6.9%) (P = .026). The prevalence of contact allergy to individual allergens was not significantly different for those with AD and those without, except for p-phenylenediamine in males: AD (4.0%), no AD (0.7%) (P = .023). The prevalence of a positive patch test reaction to the group of preservatives was slightly albeit not significant (P <.09) higher in subjects with AD in lifetime (8.9%) compared to those without (6.2%). Subjects with AD in lifetime reported significantly more avoidance of products because of any skin reaction compared to subjects without AD, regarding leave on products, rinse off products, household products, jewels/metals and topical medication (all differences significant P <.001). This avoidance behaviour was independent from having a contact allergy and could be replicated in AD patients with and without contact allergy. CONCLUSION: The lifetime prevalence of atopic dermatitis was higher in Germany, the Netherlands and Sweden compared with Italy and Portugal. Although patients with atopic dermatitis reported significantly more avoidance of products due to skin problems they were not more frequently sensitized.

Influences of Environmental Chemicals on Atopic Dermatitis.

Atopic dermatitis is a chronic inflammatory skin condition including severe pruritus, xerosis, visible eczematous skin lesions that mainly begin early in life. Atopic dermatitis exerts a profound impact on the quality of life of patients and their families. The estimated lifetime prevalence of atopic dermatitis has increased 2~3 fold during over the past 30 years, especially in urban areas in industrialized countries, emphasizing the importance of life-style and environment in the pathogenesis of atopic diseases. While the interplay of individual genetic predisposition and environmental factors contribute to the development of atopic dermatitis, the recent increase in the prevalence of atopic dermatitis might be attributed to increased exposure to various environmental factors rather than alterations in human genome. In recent decades, there has been an increasing exposure to chemicals from a variety of sources. In this study, the effects of various environmental chemicals we face in everyday life - air pollutants, contact allergens and skin irritants, ingredients in cosmetics and personal care products, and food additives - on the prevalence and severity of atopic dermatitis are reviewed.

Atopic dermatitis from adolescence to adulthood in the TOACS cohort: prevalence, persistence and comorbidities.

While much is known about childhood atopic dermatitis, little is known about persistence of atopic dermatitis into adult life. We report, to our knowledge for the first time, the clinical course of atopic dermatitis in an unselected cohort of adolescents followed into adulthood. The course of atopic dermatitis from adolescence to adulthood was studied prospectively in a cohort of unselected 8th-grade schoolchildren established in 1995 and followed up in 2010 with questionnaire and clinical examination. The lifetime prevalence of atopic dermatitis was high (34.1%), and a considerable number of adults still suffered from atopic dermatitis evaluated both by questionnaire (17.1%) and clinical examination (10.0%). Persistent atopic dermatitis was found in 50% of those diagnosed in school age, and persistent atopic dermatitis was significantly associated with early onset, childhood allergic rhinitis and hand eczema. A close association was also found with allergic contact dermatitis and increased specific IgE to Malassezia furfur, but not with filaggrin gene defect. Persistence of atopic dermatitis in adulthood is common and affects quality of life. Persistent atopic dermatitis is particularly prevalent in those with early onset, allergic rhinitis and hand eczema in childhood. It is important to recognizing atopic dermatitis as a common and disabling disease not only in children but also in adults.

Recall Bias in Childhood Atopic Diseases Among Adults in The Odense Adolescence Cohort Study

Atopic dermatitis (AD) is a common disease in childhood and an important risk factor for the later development of other atopic diseases. Many publications on childhood AD use questionnaires based on information obtained in adulthood, which introduce the possibility of recall bias. In a prospective cohort study, recall bias was evaluated in 1,501 unselected schoolchildren (mean age 14 years) evaluated for the first time in 1995 with a standardized questionnaire combined with a clinical examination and repeated in 2010. The lifetime prevalence of AD was 34.1% including data obtained both during school age and 15 years later, compared with 23.6% including data only from adulthood. The most important factors for remembering having had AD in childhood were: (i) long duration of dermatitis in childhood; (ii) adult hand eczema; and (iii) concomitant atopic disease. Recall bias for childhood AD affected the results of logistic regression on adult hand eczema and is a significant problem in retrospective epidemiological questionnaire studies evaluating previous AD as a risk factor for development of other diseases.

Atopic dermatitis is not a protective factor for melanoma but asthma may be

There is evidence from cohort studies for an inverse association between atopic dermatitis and asthma and cutaneous melanoma. However, these studies have been too heterogeneous and did not show statistically significant results. Also, this association has not been compared to traditional melanoma risk factors. To test for associations between history of atopic disorders and melanoma life-time prevalence, and for associations between atopic disorders and melanoma prognosis. Validated questionnaires from the European Community Respiratory Health Survey and International Study of Asthma and Allergies in Children protocol on life-time prevalence of atopic disorders were sent to 280 patients with histopathologically confirmed melanoma. The control group consisted of their spouses. The skin phototype was also assessed using a validated questionnaire. One hundred and eighty-four melanoma patients and 169 controls responded to the questionnaire. The life-time prevalence of atopic dermatitis and hayfever was not different in melanoma patients (8.7 % vs. 8.2, p = 0.890 and 15.2 vs. 18.3 %, p = 0.432, respectively). Asthma was non-significantly lower in melanoma patients (3.8 vs. 8.2 %, p = 0.075). Atopic melanoma patients did not differ from non-atopic patients in terms of Breslow thickness, metastases and second melanomas. Atopic dermatitis is not a protective factor in cutaneous melanoma but a history of asthma may be.

Self-reported Lifetime Prevalence of Atopic Dermatitis and Co-morbidity with Asthma and Eczema in Adulthood: A Population-based Cross-sectional Survey

Atopic dermatitis and its co-morbidity with asthma and allergy is well described in younger age groups. However, population-based studies on adults with atopic dermatitis in childhood are sparse. The aims of this study were to determine: (i) the prevalence of self-reported childhood atopic dermatitis in the population; and (ii) its association with present self-reported hand eczema, eczema, allergy, urticaria and asthma. A questionnaire was sent to a cross-sectional random sample of the Swedish population (n=7,985), age range 18-84 years (response rate 61.1%). The questionnaire included the question "Have you had childhood eczema?" and questions on 5 other medical problems (hand eczema, other eczema, asthma, urticaria and allergy). Persons reporting eczema in childhood reported increased odds ratios (OR) for hand eczema (4.01), other eczema (3.88), urticaria (2.50), allergy (2.98), and asthma (2.06) as adults. The combination of eczema, allergy and asthma had an OR of 14.10 (95% confidence interval 8.44-23.54). Adults in the age range 18-84 years reporting childhood atopic dermatitis still have high co-morbidity with eczema, asthma, urticaria and allergy.

Prevalence and risk factors of atopic diseases in German children and adolescents

Atopic diseases became an important health problem in affluent Western societies. To study the prevalence and factors associated with the risk of atopic diseases in Germany, data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analysed (n = 17,450). Standardized, computer-assisted personal interviews with parents and parent-administered questionnaires provided physician diagnoses of allergic rhinoconjunctivitis, atopic dermatitis and asthma as well as data on demographic characteristics, migration background, birth order, age at the beginning of nursery, atopic diseases of parents, parents' smoking status, parents' occupation, breastfeeding and living environment. The life-time prevalence of atopic dermatitis was 13.2% (95% confidence limit: 12.5-13.9%), 10.7% (10.1-11.3%) for allergic rhinoconjunctivitis and 4.7% (4.3-5.1%) for asthma. At least one atopic disease in parents was the strongest factor associated with atopic diseases in the offspring, with a prevalence ratio of up to 2.6. High and middle socio-economic status (prevalence ratio, 95% confidence limit: 1.28, 1.12-1.46; 1.15, 1.01-1.32) were associated with the risk of atopic dermatitis, whereas a two-sided background of migration reduced the risk (0.76, 0.65-0.88). Factors that reduced the risk of allergic rhinoconjunctivitis were parents working as self-employed farmers (0.48, 0.30-0.76) and older siblings (0.80, 0.71-0.89), whereas the beginning of nursery school at older age was associated with an increased risk in children who were cared for outside the family before school age (1.05, 1.00-1.10). Living in mould-infested rooms (1.64, 1.23-2.19), an urban living environment (1.20, 1.02-1.42) and a smoking mother and/or father (1.20, 1.02-1.40) were associated with the risk of asthma. Our results are in line with the so-called 'hygiene hypothesis', which emphasizes the role of environmental factors in addition to a genetic predisposition in the development of atopic diseases. Research on factors associated with atopic diseases can facilitate decisions on preventive strategies. Further studies are needed to explore trends in prevalence and risk factors for atopic diseases.

Trends of allergic symptoms in school children: large‐scale long‐term consecutive cross‐sectional studies in Osaka Prefecture, Japan

Trends in the prevalence rates of allergic symptoms in children have been discussed extensively, but it remains uncertain which symptoms increase or decrease over time owing to the lack of large-scale long-term consecutive cross-sectional studies performed on a representative population of children. To clarify the trends in the prevalence rates of allergic symptoms in Japanese children. Total population questionnaire surveys were conducted 15 times from 1975 to 2006 for all children attending public elementary schools in Osaka Prefecture, Japan, with the number of subjects ranging from 460,000 to 900,000. Parents of the children completed the questionnaire about allergic symptoms and other symptoms, including wheeze, physician-diagnosed atopic dermatitis, rhinitis, and itching eyes. Response rates were consistently over 90%. The prevalence of wheezing was constant until 1983, then increased from 1983 until 1993, then stabilized at about 4.4%. The lifetime prevalence of atopic dermatitis increased to 24% by 1993, and then decreased. The prevalence of rhinitis increased to 25% by 2003, whereas the prevalence of non-seasonal symptoms plateaued from 1993 on at 11% and vernal symptoms increased. The prevalence of itching eyes continued to increase to 21% in 2006, and vernal symptoms increased sharply. In Osaka Prefecture, Japan, the turning point when the prevalence of wheezing in schoolchildren had begun to increase was 1983. And the turning point when the increase in the prevalence of wheezing, atopic dermatitis, and non-seasonal allergic rhinitis turned to decrease or constant was 1993. The prevalence of rhinitis and itching eyes in spring was still increasing in 2006.

Association of blood mercury concentrations with atopic dermatitis in adults: A population-based study in Korea

Atopic dermatitis is one of the most common inflammatory skin diseases among children and adults. Although the risk factors for atopic dermatitis have not yet been fully identified, exposure to mercury may be an important environmental risk factor. The objective of this study was to evaluate the association between mercury body burden and prevalence of atopic dermatitis in an adult population. We recruited participants ( n=1990) aged 20 years or older, using stratified random sampling of Korean census blocks. Demographic characteristics and medical history of atopic dermatitis were collected from participants by questionnaire, and mercury levels were determined by an analysis of blood samples. We found that demographic factors such as sex, age, alcohol drinking status, income, and fish or shellfish consumption were important covariates determining blood mercury concentration. Sex and cigarette smoking status were important demographic variables affecting the prevalence of atopic dermatitis. After adjusting for demographic factors, blood mercury concentrations were positively associated with lifetime prevalence of atopic dermatitis [odds ratio (OR), highest vs. lowest tertile=1.50; 95% confidence interval (CI), 1.02–2.21; p for trend=0.057]. This association became stronger for 1-year prevalence of atopic dermatitis (OR, highest vs. lowest tertile=1.82; 95% CI, 1.17–2.83; p for trend=0.026). Mercury body burden and atopic dermatitis prevalence vary across demographic characteristics, and increased blood level of mercury was related to an incidence of atopic dermatitis in this adult population.

Prevalence of Atopic Dermatitis in Italian Schoolchildren: Factors Affecting its Variation

The frequency of atopic dermatitis in Italian children and its relationship with selected variables were analysed in a large survey of skin health conducted in Italy. In 1997 we conducted a survey on schoolchildren aged 12-17 years from 13 areas of northern, central and southern Italy. For the present analyses, 3179 Caucasian children (1618 males, 1561 females) were considered. A diagnosis of atopic dermatitis was reported in 224 cases (7.0%). The frequency of reported atopic dermatitis was significantly higher in children with asthma (rate ratio (RR) 4.5; 95% confidence interval (CI) 3.1-6.5). The lifetime prevalence of a diagnosis of atopic dermatitis was higher among schoolchildren reporting a diagnosis of psoriasis (RR 5.5, 95% CI 3.0-10.1) and vitiligo (RR 16.1, 95% CI 6.5-39.5). This study gives estimates of the lifetime prevalence of atopic dermatitis in adolescents in Italy and emphasizes the direct association between the condition and other immune-related skin diseases.

Importance of genetic factors in the etiology of atopic dermatitis: A twin study

The susceptibility to develop atopic dermatitis can be attributed both to genetic and environmental causes. We estimated the relative impact of genetic and environmental factors in the etiology of atopic dermatitis in a population-based sample of twins. From the birth cohorts of 1953-1982 who were enrolled in The Danish Twin Registry, a total of 11,515 twin pairs were identified in a nationwide questionnaire survey. Subjects were classified as atopic dermatitis cases when responding affirmatively to the question, "Do you have, or have you ever had, eczema in the folds of your elbows or knees?" Latent factor models of genetic and environmental influences were fitted to the observed data using maximum likelihood methods. The overall lifetime prevalence of atopic dermatitis was 7.3%. A cotwin of an affected identical twin had a sevenfold increased risk of atopic dermatitis compared with a threefold increased risk among cotwins of an affected fraternal twin, relative to the general population. Genes accounted for 82% and nonshared environmental factors accounted for 18% of the individual susceptibility to develop atopic dermatitis. The same genes contributed to the susceptibility to atopic dermatitis both in male and female patients (p = 0.98). The estimates were adjusted for age. The susceptibility to develop atopic dermatitis is attributable to mainly genetic differences between people. However, differences in environmental exposures also are of importance.

Lifetime prevalence of self-reported atopic diseases in a population-based sample of elderly subjects: results of the ESTHER study

Prevalence studies of atopic diseases such as atopic dermatitis (AD), hay fever and allergic asthma have mostly been performed in children. Studies in the adult population are still rare. We estimated the lifetime prevalence of different atopic diseases in an elderly population in Saarland, Germany. Additionally we investigated the association between atopic diseases and sociodemographic factors including age, gender, duration of school education (as a proxy measure of socioeconomic status), family history, and size of place of residence. This study was conducted between June 2000 and December 2002 in the State of Saarland, Germany. Participants aged 50-75 years (n=9961) were recruited by their general practitioner in the context of a general health screening examination. All filled out a standardized questionnaire and reported whether a physician had ever diagnosed an atopic disease (hay fever, AD or asthma). Overall, 9949 subjects (mean age 62 years, 45% men) were included in this analysis. The lifetime prevalence of reported AD, hay fever and asthma was 4.3%, 8.3% and 5.5%, respectively. Lifetime prevalence of AD and asthma among women, and lifetime prevalence of hay fever among both genders, strongly decreased with age. Duration of school education (<or= 9 years, 10-11 years, > 11 years) was strongly associated with AD (3.7%, 5.7%, 6.8%; P trend < 0.0001) and hay fever (7.2%, 11.2%, 12.8%; P trend < 0.0001), but only tentatively with asthma. The lifetime prevalence of AD is considerably lower in the elderly compared with the prevalence reported among younger adults in recent studies. Adults with a longer duration of school education appeared to have a higher risk for atopic diseases.

Evolving management of atopic dermatitis

Atopic dermatitis is a common, complex inflammatory skin disorder with an immunological basis, characterized by eczematous dermatitis and pruritis. The prevalence of atopic dermatitis is increasing in industrialized areas of the world, including the USA and western Europe. There is an estimated 15–20% lifetime prevalence of atopic dermatitis in young school-age children in the USA and western Europe. Evidence suggests that atopic dermatitis may represent an entry point for allergic disease, with some data supporting claims that 50–80% of children with atopic dermatitis may develop other symptoms of the atopic triad, including allergic rhinitis and asthma. There has been an evolution in the understanding of the pathogenesis and epidemiology of atopic dermatitis, leading to the introduction of new therapeutic agents and treatment options. Ongoing studies are now evaluating if early effective treatment of atopic dermatitis in an infant modifies the risk of developing other atopic disease or alleviates its im...