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AD Severity (ad + severity)
Selected AbstractsLesson from performing SCORADs in children with atopic dermatitis: Subjective symptoms do not correlate well with disease extent or intensityINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2006K. L. E. Hon MBBS Background, Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. Method, Patients with AD younger than 18 years old were recruited from the pediatric dermatology clinic of a university teaching hospital, and AD severity was evaluated by the SCORAD index. Results, One hundred and eighty-two Chinese children with AD (107 boys and 75 girls) [mean (SD) age of 9.6 (4.2) years] were recruited. Their mean (SD) overall SCORAD was 30.1 (19.2). Sleep loss was strongly correlated with pruritus (r = 0.57, P < 0.001). However, the two subjective symptoms were only weakly correlated with the objective signs (extent and intensity) of AD. The correlations between pruritus and extent and intensity were 0.42 (P < 0.001) and 0.38 (P < 0.001), respectively, and the correlations between sleep loss and extent and intensity were 0.38 (P < 0.001) and 0.34 (P < 0.001), respectively. Conclusion, We speculate that the lack of a better correlation was either because pruritus and sleep loss as reported by parents were imprecise, or that mechanisms other than disease extent or severity are responsible for the pathogenesis of these subjective symptoms. [source] Prevalence and risk factors for allergic contact dermatitis to topical treatment in atopic dermatitis: a study in 641 childrenALLERGY, Issue 5 2009C. Mailhol Background:, There is little information regarding the risk of sensitization associated with topical atopic dermatitis (AD) treatment. Objectives:, To assess the frequency of sensitization to topical treatment of AD in children and to determine risk factors associated with skin sensitization. Methods:, Six hundred and forty-one children with AD were systematically patch tested with seven agents of common topical treatment: chlorhexidine, hexamidine, budesonide, tixocortol pivalate, bufexamac, sodium fusidate and with the current emollient used by the child. The following variables were recorded: age, sex, age at onset of AD, associated asthma, severity of AD, and history of previous exposure to topical agents used in the treatment of AD. Skin prick tests to inhalant and food allergens were used to explore the IgE-mediated sensitization. Results:, Forty-one positive patch tests were found in 40 patients (6.2%). Allergens were emollients (47.5%), chlorhexidine (42.5%), hexamidine (7.5%), tixocortol pivalate and bufexamac (2.5% each). Risk factors associated with sensitization to AD treatment were AD severity [OR: 3.3; 95% confidence interval (CI):1.5,7.1 for moderate to severe AD], AD onset before the age of 6 months (OR: 2.7; 95% CI: 1.2,6.1), and IgE-mediated sensitization (OR: 2.5; 95% CI: 1.1,5.9). Conclusions:, Topical treatment of AD is associated with cutaneous sensitization. Antiseptics and emollients represent the most frequent sensitizers and may be included in the standard series in AD children when contact dermatitis is suspected. Risk factors associated with sensitization to AD topical treatments are AD severity, early AD onset and IgE-mediated sensitization. [source] Obesity and the prevalence of allergic diseases in schoolchildrenPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 6 2008Takashi Kusunoki Although the association between obesity and bronchial asthma (BA) has been gaining more attention, few studies have been conducted concerning the relationship between obesity and other allergic diseases. The objective of this study was to determine whether and how childhood obesity is associated with allergic diseases other than BA, such as atopic dermatitis (AD), allergic rhinitis (AR), allergic conjunctivitis (AC), and either AR or AC (AR/AC). A questionnaire was administered to the parents of 50,086 Japanese schoolchildren. Associations between childhood obesity and the various allergic diseases were evaluated by univariate and multivariate logistic models. Significant associations were found between higher body mass index (BMI) and AD (p = 0.03), and lower BMI and AC (p < 0.0001), and AR/AC (p < 0.0001). There was a significantly higher prevalence of BA in girls with obesity (p = 0.009) than in those without obesity. Significantly lower prevalence of AC (p = 0.01) and AR/AC (p = 0.002) among children with obesity, and AR (p = 0.04) and AR/AC (p = 0.0004) among boys with obesity were observed than those without obesity. Those who were obese and had AD were significantly more likely to have severe symptoms (p = 0.01). Overall, childhood obesity has positive associations with BA prevalence and AD severity, whereas it has negative associations with AR and AC prevalence, especially among boys. Changes in the immunologic balance accompanied by obesity might have different effects on each type of allergic disease. Exploring the mechanisms by which childhood obesity affects allergic status should lead to new management options for childhood allergy. [source] Atopic dermatitis: quality of life of young Italian children and their families and correlation with severity scorePEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 3 2007Giampaolo Ricci The aim of this study was to determine the ways in which atopic dermatitis (AD) affects the lives of young Italian children and their families, in terms of quality of life, and correlate it with AD severity and the perception of severity as estimated by the family. The parents of 45 children aged 3,84 months affected by AD were asked to complete two validated questionnaires after clinical examination. The first questionnaire was about the child's quality of life (Infants' Dermatitis Quality of Life Index); the second regarded the family's quality of life (Dermatitis Family Impact questionnaire). In a further question parents were asked to estimate the severity of the disease of the child. Children's quality of life appeared slightly-moderately altered (mean score 10.2) compared with the value of a control group (3.3), and itching, sleep problems and the influence of the disease on the child's mood were the cause of greatest discomfort for the child. Family quality of life appeared moderately altered (mean score 11) compared with the value of the control group (7.4). The greatest problem was the disturbed sleep of the family members. Other important problems were the economic cost for the management of the disease and the tiredness and irritability caused by the disease in parents. Analysis of the responses confirms the incorrect estimation of the severity of the disease perceived by the family. In our opinion, the two questionnaires may be useful in clinical practice to understand better the difficulties suffered by a family with a child affected by AD. They also provide data that may help to improve the clinical approach for the child and the family, and to assess the degree of under-/overestimation of the disease by the family. [source] Serum concentration of macrophage-derived chemokine may be a useful inflammatory marker for assessing severity of atopic dermatitis in infants and young childrenPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 4 2003Ting Fan Leung Chemokines are responsible for the trafficking of leukocytes to sites of inflammation. Serum chemokine levels were previously shown to be increased in adult patients with atopic dermatitis (AD). We tested whether serum concentrations of chemokines, including macrophage-derived chemokine (MDC), thymus and activation-regulated chemokine (TARC), eotaxin (EOX), interferon gamma inducible protein 10 (IP-10) and monocyte chemotactic protein 1 (MCP-1), are useful inflammatory markers for assessing AD severity in infants and young children. To investigate this, we assessed the severity of AD clinically using the SCORing Atopic Dermatitis (SCORAD) index system. Serum chemokine concentrations were determined by sandwich enzyme immunoassay. Twenty AD patients with a median age of 2.1 years [interquartile range (IQR): 0.6,4.2] were recruited. Their SCORAD score was 23.5 (12.5,33.5). Serum concentrations of MDC, TARC, EOX, IP-10 and MCP-1 were 2551 (1978,3935), 1469 (1125,3070), 68 (57,85), 126 (101,226) and 518 (419,614) pg/ml, respectively. Serum MDC levels correlated with SCORAD (r =,0.608, p = 0.004) and its extent (r =,0.629, p = 0.003) and intensity (r =,0.557, p = 0.011) components. Serum TARC concentration showed weaker correlation with extent (r =,0.474, p = 0.035) and intensity (r =,0.465, p = 0.039) of skin involvement but not SCORAD. The median serum levels of MDC (3131 vs. 2394 pg/ml; p = 0.031) and EOX (80 vs. 61 pg/ml; p = 0.046) were also higher in children with moderate as compared with mild AD. The other chemokines did not correlate with AD severity. In conclusion, our results suggest that serum MDC concentration may be a useful inflammatory marker for assessing AD severity in infants and young children. [source] Serum Concentration of IL-18 Correlates with Disease Extent in Young Children with Atopic DermatitisPEDIATRIC DERMATOLOGY, Issue 6 2004Kam Lun Ellis Hon F.A.A.P. Previous studies have suggested that IL-18 may be an inflammatory marker for atopic dermatitis (AD). The purpose of our study was to test whether the serum concentration of IL-18 is a useful inflammatory marker for assessing AD severity in young children. Nineteen AD patients with a median age of 2.2 years (interquartile range 0.7,4.6 years) were recruited. The severity of AD was clinically determined using the Scoring Atopic Dermatitis (SCORAD) index. Their SCORAD score was 23.9 (range 18.6,34.8). Serum IL-18 levels were determined by sandwich enzyme immunoassay. The median serum concentration of IL-18 was 394 pg/ml (interquartile range 204,612 pg/ml). Serum IL-18 levels correlated with SCORAD scores (r = 0.502, p = 0.029) and their extent component (r = 0.633, p = 0.004). When compared with mild disease with low SCORAD scores, the serum concentration in moderate to severe disease was significantly higher (p = 0.014). We concluded that serum IL-18 concentration is elevated in young children with AD. It may be a useful inflammatory marker that correlates with the extent component of AD in particular, and differentiates mild disease from more severe disease when used for assessing AD severity in young children. [source] Validation of a Self-Administered Questionnaire in Chinese in the Assessment of Eczema SeverityPEDIATRIC DERMATOLOGY, Issue 6 2003Kam Lun Hon F.A.A.P. 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 ,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. [source] Serum antidiuretic hormone is elevated in relation to the increase in average total body transepidermal water loss in severe atopic dermatitisBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2005T. Aoki Summary Background, While elevation of antidiuretic hormone (ADH) (arginine vasopressin) levels in the serum has been reported in severe atopic dermatitis (AD), the cause is as yet unexplained. On the other hand, transepidermal water loss (TEWL) is known to increase in the damaged skin due to AD. Objectives, As ADH increases as a result of dehydration of the body, this study examined whether the high ADH level in severe AD is a reaction to the increased water loss through the entire body skin surface area. Methods, Forty-eight patients of different ages and with various degrees of AD along with six age- and sex-matched control persons were the study subjects. Using a quick responsive evaporimeter, an average total body TEWL (ATEWL) value was obtained for each subject. Laboratory tests including ADH, serum lactate dehydrogenase (LDH) and peripheral blood eosinophil count (EOS) were also performed. Clinical severity grading was made globally. The relevancy of this grading was empirically demonstrated by its statistically significant relation to LDH and EOS which are commonly known as appropriate gauges for AD severity. Results, ATEWL was observed to be significantly greater in patients with AD of at least moderate severity than in normal controls, and ADH was significantly greater in patients with severe and very severe AD. Both ATEWL and ADH showed a significant relation to AD severity. Finally, a significant correlation was found between ADH and ATEWL. Conclusions, It is possible that elevated ADH is at least in part a reaction to increased ATEWL. [source] Reliance on erythema scores may mask severe atopic dermatitis in black children compared with their white counterpartsBRITISH JOURNAL OF DERMATOLOGY, Issue 5 2002M.A. Ben-Gashir SummaryBackground 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. [source] | ||||||||||||||||||||||