Defining (D) Atopic Dermatitis (AD) And Measuring Its Impact (I) (For Professionals)

Defining (D) Atopic Dermatis (AD) And Measuring Its Impact (I) (For Professionals)

D

Is termed eczema which to divide in atopic and non atopic.

The other type is contact dermatitis (allergic or non allergic). 2004

What is a good definition ?:

• It is valid
• It is repeatable
• It is accepted by others
• It is easy to define
• It makes sense (coherence)

Many different tools have been used to define atopic dermatitis (AD):

• The Most famous: Hanifin et Rajka (H & R)

1. 3 major elements: pruritus, lichenification, chronic relapsing course, personal family history
2. 3 minor elements: dry skin, ichtyosis…..over 20 elements

• Then: UK refinement of H & R criteria

1. Itch
2. plus 3 or more of:

1. flexural involvement
2. family history of flexural involvement
3. history of dry skin
4. beginning before 2 years of age (not valid if beginning after 4 years of age)

• many other tools exist: millenium criteria (IgE), danish….to conclude a widely accepted common diagnostic tool is lacking and until this happens, it will be difficult to compare studies and measure them according to one’s own practice.

B

• Frequency of AD

1. More frequent in affluent countries: more than 15% of the childhood population in the UK, Finland, Sweden. More than 10% of the childhood population in New Zealand and Central Europe.
2. Quite interestingly though there has been a strong increase in SE Asia (where the prevalence was low) and generally in urban areas.
3. Concerning Adult AD: its prevalence among the population is about 10% in Europe and other countries such as Thailand

• AD has a poor prognosis and risks continuing in adulthood:

1. if early onset
2. if severe in signs and symptoms…
3. Overall 40%-60% of childhood AD persists into adulthood
4. Of those having had childhood AD,  1/4 keep to have hand eczema as adults

• Costs of AD

1. In European countries, the brunt of the cost is carried by families (465 million pounds each year in the UK) rather than the social welfare system

• Quality of life (QoL) impairement:

1. increased anxiety among patients with atopic dermatitis
2. increased stress among patients with atopic dermatitis
3. higher prevalence of depression among patients with atopic dermatitis
4. avoidance of certain jobs: 40% of patients with AD do so.

Contributors:

Dr Christophe HSU – dermatologist. Geneva, Switzerland

Source of information: Flohr C. Definition and burden of AD. 19th Congress of the European Academy of Dermatology and Venereology (EADV) – Gothenburg (Göteborg), Sweden (Sverige).