Casuistic Revision of Childhood Atopic Dermatitis during Last Three Years in Braga's Hospital

Research Article

Austin J Dermatolog. 2014;1(4): 1019.

Casuistic Revision of Childhood Atopic Dermatitis during Last Three Years in Braga's Hospital

Resende C1*, Araújo C1, Resende J2, Vieira AP1 and Brito C1

1Department of Dermatology and Venereology, Hospital de Braga, Portugal

2Department of Economy and Cef.Up, Universidade do Porto, Portugal

*Corresponding author: Cristina Resende, Department of Dermatology and Venereology, Hospital de Braga, Sete Fontes - São Victor, PT-4710-243 Braga, Portugal

Received: May 12, 2014; Accepted: August 22, 2014; Published: August 27, 2014

Abstract

Background: Atopic dermatitis (AD) is an inflammatory disease, occurring in association with personal or family history of atopy.

Methods: A retrospective study of AD patients, admitted in the consultation of Pediatric Dermatology of our hospital, between the years 2011 and 2013, was carried out. For the purposes of this study, a modified and simplified procedure was adopted for recording severity of AD in our patients, named three-item severity score (TIS score), using three items of Scoring of Atopic Dermatitis (SCORAD) index (erythema, edema and excoriations).

Results: There were 160 patients, with age ranging from 1 month to 15 years and with an equal sex ratio. The prevalence of AD was 17.1%. The most frequent symptom was pruritus (86.9%). Eighty-six percent of patients initiated symptoms before 5 years. The severity of AD was mild/moderate in 139 patients (86.9%) and severe in 21 patients (13.1%). The family and/ or personal history of atopy were positive in 134 patients (84%). Common aggravating factors included wintertime (46.9%) and allergens (16.3%), being the most frequent aeroallergens. Serum IgE was elevated in 17 patients (33.3%). Most patients could be controlled with topical measures (86.3%).

Discussion: The pattern of AD in our Department is similar to other studies, except for a higher prevalence of mild AD, a lower elevation of serum IgE and comparing with countries with tropical weather we have an additional aggravating factor: the lower temperatures during winter, which disturbed barrier function of the stratum corneum.

Keywords: Atopic dermatitis; Atopic march; Allergens; Infantile eczema

Abbreviations

AD: Atopic Dermatitis; SCORAD: Scoring of Atopic Dermatitis; TIS score: Three-item Severity Score

Introduction and Objective

Atopic dermatitis (AD) is the most common chronic inflammatory skin disease, which affects up to 20% of children and 1-3% of adults in most countries of the world [1,2]. Characteristic features of AD include pruritus and a chronically relapsing course [1,3]. AD is a complex genetic disorder and is often accompanied by other atopic disorders, such as allergic rhinitis, conjunctivitis and asthma [1,4]. These conditions may appear simultaneously or develop in sequence [1]. AD is more frequent in infants and young children, while asthma and pollen allergy predominate in adolescents [1,4]. This sequence is referred to as atopic march [1]. Considering that the atopic disease progression starts with AD, management should be concentrated, not only on the treatment of acute flares, but also on the maintenance therapy [1,4].

The criteria of Hanifin and Rajka have been commonly applied to diagnose AD [2]. There is no pathognomonic laboratory biomarker for diagnosis of AD, since the most typical feature, the elevation of total or allergen-specific IgE in serum is not present in all individuals suffering from AD [1,2]. Consequently the term intrinsic AD has been introduced to differentiate it from extrinsic (IgE associated) forms of AD [2,4].

The purpose of our study is to describe the epidemiologic and clinical characteristics of AD of patients observed in routine consultation and to analyze the different therapeutic modalities used and compare our data with other published series.

Materials and Methods

A retrospective and descriptive study was carried out on patients, with less than 15 years of age, admitted with the diagnosis of AD at our hospital, over a 36-month period, "between" January 2011 to December 2013. Our Hospital is localized in Braga, a city in the northwestern Portuguese district of Braga.

The criteria for the diagnosis of AD in our patients were based on those of Hanifin and Rajka. Dermatologic data were collated from patient's case records. The following information was specifically looked for: sex, age of the first manifestation, personal and family history of atopy, precipitation factors, clinical form, localization, laboratory findings, and number of consultations, therapeutic measures, complications and outcome. For the purposes of this study, a modified and simplified procedure was adopted for recording severity of AD in our patients, named three-item severity score (TIS score), using three items of Scoring of Atopic Dermatitis (SCORAD) index (erythema, edema and excoriations) [5].

We decided to include in our study only patients with AD observed in routine consultation and we excluded the patients admitted at the urgency with the diagnosis of AD, because in Braga's hospital, the majority of patients in urgency with the diagnosis of AD are observed by Pediatrics and our aim was to study the AD only in Dermatology's consultation.

The statistical analysis was performed using the Excel 2007.

Results

During these three years, 160 patients with AD had been admitted in our consultation and they constituted 17.1% of Pediatric Dermatology consultations. Eighty-three patients (51.9%) were girls and 77 patients (48.1%) were boys, with a female to male ratio of 1.08. The age of onset ranged from 1 month to 15 years, with an average of 2.9 years. The majority of the patients developed symptoms of AD in the first 5 years of life (86, 3%). Table 1 shows the age distribution of patients with AD.