125 : 4 OCTOBER 2005
ABSTRACTS 853
1. LIFETIME PREVALENCE AND CHARACTERISTICS OF PHOTODERMATOSES IN EUROPE
4. THE NATURAL COURSE OF ATOPIC DERMATITIS – MODEL-BASED CLUSTERING BY
LATENT CLASS MIXTURE MODELS
T. L. Diepgen, O. Kuss, C. Gromann
Ã
Ã
M. Bock, L. Anastasopoulou,w C. Antoniou,w F. A u b i n , z T. Bruckner, B. Faivre,z N.K.
Gibbs,y F.R. de Gruijl,z C. Jansen,# A.S. Jansens,z T.C. Ling,y S. Niemela¨ ,# S. Pavel,z L.E.
Dept. of Dermato-Epidemiology, Occupational
Hospital Heidelberg
& Environmental Dermatology, University
Ã
Rhodes,y C.A. Stratigos,w T.L. Diepgen
Ã
Dep. of Clinical Social Medicine, Univ. of Heidelberg (D); wA. Sygros Hosp., Univ. of Athens
Background: Knowledge about the course of a chronic disease is important for patients,
physicians and health authorities. Surprisingly few studies have been published regarding the
natural history of atopic dermatitis, a chronically relapsing skin disease, and most of the
studies are biased due to many reasons.
Methods: In a prospective cohort study data on the prevalence of atopic dermatitis were
followed up over 7 years in 1314 newborns. The diagnosis of atopic dermatitis was based on
four different sources of information: 1. the reported diagnosis by the family physician, 2. the
examining doctor’s opinion on reported relevant symptoms, 3. the diagnosis given by the
examining doctor, and 4. a computer algorithm who constructed diagnoses from typical
morphological skin phenomena. Relying on previous work of Nagin, a Latent class mixture
model was used to estimate, in a data-dependent and model-based fashion, a clustering of
typical binary atopic dermatitis disease histories in children.
Results and Conclusions: The following four subgroups could be identified by statistical
modeling: Group 1 (78.8% ꢀ 2.8) children remaining free of disease; Group 2 (7.0% ꢀ 3.0)
children with a age-independent estimated AD prevalence; Group 3 (8.0% ꢀ 1.9) children
with an increasing prevalence of AD, starting from a very low level of prevalence; Group 4
(6.2% ꢀ 0.9) children already having a high risk of AD at time of birth and increasing risk until
the age of seven years. The proposed model has the capability to identify rather than assume
distinctive groups of disease histories, to estimate the proportion of the population following
each such group, to relate group membership to individual risk factors and covariates, and to
use the group membership probabilities for displaying average profiles of group members.
Nagin DS (1999) Analyzing Developmental Trajectories: A Semi–Parametric, Group–Based
Approach. Psychological Methods, 4, 139–77.
(GR); zDep. of Dermatology, Univ. Hospital, Besanc¸ on (F); yUniv. of Manchester (UK);
zLeiden Univ. Medical Centre (NL); #Univ. of Turku (FI)
Objectives/Methods: Although photodermatoses are common skin diseases, epidemio-
all.net) we performed a survey in indoor workers (mainly hospital staff) on prevalence, signs,
symptoms and treatment of photodermatoses (sun allergies) using a standardised question-
naire within Europe.
Results: In 6 centres distributed from the Mediterranean to Scandinavia, the data of 6866
participants were analysed. 18% of them answered that they do get an itching rash/ abnormal
skin after sun exposure (a so-called sun allergy), which does not fit the criteria of a sunburn. In
29% the photodermatoses have been confirmed by a physician (55% dermatologists). Women
are nearly three times more often affected than men (23% vs. 9%). Comparing the different
centres we found the following lifetime prevalence rates for photodermatoses: Athens (Greece)
men 15%/women 26%, Besanc¸on (France) 5%/21%, Heidelberg (Germany) 9%/29%, Leiden
(Netherlands) 7%/26%, Manchester (Great Britain) 9%/26% and Turku (Finland) 2%/14%.
Increasing pigmentation correlates with a decrease of photodermatoses (overall prevalence
skin type I 32%, II 26%, III 14%, IV 9%). About half of the photodermatoses have been treated
mostly with sun block cream (65% of those treated). Other treatments: steroid cream (42%),
phototherapy (9%) or steroid tablets/injections (7%). Only 54% get their rash during springtime
but over 90% during sunny holidays. 93% get itching during the rash. 25% of people with
photodermatoses report a reduction of their quality of life.
Conclusions: Our data document the high prevalence of photodermatoses in Europeans. In-
terestingly, we found no increase in regions far away from the equator, but we found a more
pronounced sex ratio.
5. PREVALENCE OF HAND ECZEMA
M. Radulescu, S. Berg, G. Radulescu, T. Bruckner, R. Scheidt, T. L. Diepgen
Dep. of Clinical Social Medicine, University of Heidelberg, Germany
2. THE ASSOCIATION OF EARLY INFECTIONS AND ATOPIC DERMATITIS – A RETRO-
SPECTIVE CASE – CONTROL STUDY IN CHINESE CHILDREN IN PRIMARY CARE IN
HONG KONG
Objectives: Several studies concerning the prevalence of hand eczema in certain occu-
pations have been performed during the last years, but few data exist from population-based
surveys. The following study investigates the 1-year prevalence and point prevalence of hand
eczema in the population of Heidelberg, Germany.
A. Chuh, W. Wong, and A. Lee
Department of Community and Family Medicine, Chinese University of Hong Kong
Objectives: To investigate the association of early infections and atopic dermatitis (AD) in
Chinese children in primary care in Hong Kong.
Methods: 2500 randomly selected inhabitants of Heidelberg between 20 and 60 years of age
were asked to fill in a questionnaire on hand eczema consisting of both symptom-based and
diagnose-related questions. The questionnaire was developed according to the one validated
and published in 1992 by Smit et al. Furthermore, the study population was asked about a
possible correlation between skin changes and occupation.
Results: With 192 persons having already moved out of the study area and a remaining
sample size of 2308, the response rate was 73%. For yet another 5% of the study population,
reasons for non-response could be assessed. Of the 1690 responders, 22% had experienced
at least one of the following symptoms on their hands during the last 12 months: redness and
swelling, redness and fissures, vesicles, scaling and fissures, itching and fissures. 41% of
affected persons reported their symptoms persisting for longer than 3 weeks, and in 77% of
affected persons the symptoms occurred more than once. However, a self-reported diag-
nosis of hand eczema during the last 12 months was given by only 6% of study participants,
and only 3,5% reported a present hand eczema. 6% of study participants (26% of persons
with skin changes on their hands) established a relationship between their symptoms and
occupation, a further 4% was not sure how to answer.
Methods: Our setting were two primary care surgeries run by
a family physician. We
searched our database with ‘‘atopic dermatitis’’ and ‘‘atopic eczema’’ and retrieved medical
records of all infants and children (below 8) with AD diagnosed between 1 April 2003 and 31
March 2004. An age-limit of 8 was used as the surgery commenced service 9 years ago.
Records of children above 8 might not have reliable early history documented.
The diagnoses were all made by one of us (AC) with training in paediatrics and derma-
tology. We checked whether the diagnostic criteria according to the United Kingdom Working
Party was fulfilled, and excluded children who do not fulfil the diagnostic criteria, not of
Chinese origin, or not cared by us since birth.
For each child with AD, we retrieved the record of the next child of same sex and similar
age ( ꢀ 1 year) who consulted us but did not have AD as a paired control.
For all study and control subjects, we retrieved the following information from records: (1)
whether the child had a febrile episode or a clinical infection before age of 6 months, number
of such episodes, diagnoses made, (2) whether the child was hospitalised before 6 months,
number of such episodes, diagnoses made, and (3) whether the child was prescribed an-
tibiotics before 6 months, number of such episodes, diagnoses made. For (1), febrile ep-
isodes clearly documented to be related to vaccinations were not included.
Conclusions: Symptoms possibly pointing to hand eczema are often to be found in our
study population, but only a fraction of the persons affected seems to be aware of the
diagnosis. If symptom-related questions are used in questionnaire surveys, the prevalence of
hand eczema could be overestimated, but asking only for a self-reported diagnosis could
lead to an underestimation of the true values for prevalence. Validated criteria for the
diagnosis of hand eczema should be defined in order to facilitate questionnaire studies.
One of us then re-checked the records for validity of diagnosis and accuracy of information.
Results: Records of 375 children were retrieved. Of such, 182 were not cared by us since
birth. Of the remaining 193, 132 (74 boys and 58 girls) had documented evidence of fulfilling
the diagnostic criteria. They aged from 4 months to 8 years (mean: 3.8 years). The 132 control
subjects aged from 5 months to 8 years (mean: 3.6 years).
33 (25%) children with AD had a total of 48 febrile episodes or infection before 6 months,
while 39 (31%) controls had 59 febrile episodes or infection (p ¼ 0.46). Viral respiratory tract
infections were the commonest, followed by otitis media. 4 (3%) children with AD and 3 (2%)
controls were hospitalised during the first 6 months (p ¼ 0.46). 9 (7%) children with AD and 8
(6%) controls were given antibiotics during the first 6 months (p ¼ 0.82).
The odds ratio of having AD for children with no febrile episode or infection to those with
one or more febrile episodes or infection was 1.26 (95% CI: 0.71–2.18).
Conclusions: There is no significant association between early infection and the risk of AD
in our sample of Chinese children in primary care in Hong Kong.
3. SELF-MANAGEMENT IS EFFECTIVE IN ATOPIC DERMATITIS – RESULTS OF THE
GERMAN ATOPIC DERMATITIS INTERVENTION STUDY (GADIS)
T. L. Diepgen, U. Gieler
6. LIFETIME PREVALENCE OF ATOPIC DISEASES IN A POPULATION-BASED SAMPLE
OF AN ELDERLY POPULATION: RESULTS OF THE ESTHER-STUDY
Ã
M. Wolkewitz, D. Rothenbacher,w M. Lo¨ w,w C. Stegmaier,z H. Ziegler,z M. Radulescu1, H.
Ã
on behalf of the GADIS-study team
Brenner,w and T. L. Diepgen
Department of Clinical Social Medicine, Ruprecht-Karls-University Heidelberg, Germany;
Ã
Background: Atopic dermatitis (AD) is a well known but difficult to treat common, chron-
ically relapsing, inflammatory skin disease with a high economic burden, high impact on the
quality of life and an increasing prevalence within the last decades. Patient education pro-
grams are part of patient empowerment to solve problems with chronic diseases but there
efficacy has not yet been proven for AD. The aim of our study was to evaluate the efficacy of
an educational program for the self management of AD in children.
Methods: Age related standardized atopic dermatitis group intervention programs have
been developed by a National Study Group for the following three age groups: parents of AD
children aged 0 to 7 years, parents and children aged between 8–12 years and adolescents
aged 13–18 years. The standardized treatment program consisted of 6 weekly group ses-
sions of 2 hours each. Inclusion criteria were the diagnose of atopic dermatitis in a child or
adolescent with the severity of eczema according to the SCORAD scale of at least 20 points.
In a randomised prospective controlled trial we investigated the efficacy of these atopic
dermatitis intervention programs in the three different age groups. The groups were ran-
domised and compared with a waiting control group (0–7 years: n ¼ 518; 8–12 years: n ¼ 208;
13–18 years: n ¼ 148) and followed up for 1 year. Besides severity of eczema according of the
SCORAD scale, standardized questionnaires regarding subjective severity, quality of life and
itching behaviour were used. The changes of the investigated parameters at the beginning of
the study (T0) and 12 months after the end of the education program (T3) were analysed by
using analyses of covariance.
wThe German Center for Research on Ageing, Ruprecht-Karls-University Heidelberg,
Germany; zSaarland Cancer Registry, Germany
Objectives: Prevalence studies of atopic diseases such as atopic dermatitis, 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 atopic diseases in an elderly population in
Saarland, Germany, and determined the association between the duration of school edu-
cation (as a proxy measure of socio-economic status) and atopic diseases. Family history and
size of residence with respect to atopic diseases have also been examined.
Methods: This study was conducted between June 2000 and December 2002 in the State of
Saarland, Germany. 9961 participants aged 50 to 75 years were recruited by their general
practitioner . All filled out a standardized questionnaire and reported whether a physician ever
had diagnosed an atopic disease (hay fever, atopic dermatitis or asthma).
Results: Overall, 9949 subjects (mean age 62 yrs., 45 % male) were included in this analysis.
The lifetime prevalence for asthma, atopic dermatitis and hay fever was 5.5%, 4.3% and
8.3%, respectively. Duration of school education (o ¼ 9 years, 10–11 years, 411 years ) was
strongly associated with atopic dermatitis and hay fever, but only tentatively with asthma.
With increasing duration of school education the prevalence of atopic dermatitis (3.7%, 5.7%,
6.8%; P trend o.0001) and hay fever (7.2%, 11.2%, 12.8%; P trend o.0001) increased
continuously.
Results and Conclusions: The drop out rate after 12 months follow-up was relatively low in
all three age groups (0–7 years: 17.9%; 8–12 years: 11.1%; 13–18 years: 18.9%). Significant
better effects were observed in the intervention group compared to the control group with
regard to severity of eczema in the SCORAD, subjective severity, itching cognition and quality
of life in all three age groups. Our results demonstrate that this educational group intervention
program is effective in the long term disease management of atopic dermatitis in children
aged between 0 and 18 years. Our educational program should be considered a part of the
routine care of children and adolescents with AD.
Conclusions: The lifetime prevalence for atopic dermatitis is considerably lower in the
elderly compared to recent studies on prevalence among children and adolescents. Adults
with a longer duration of school education appeared to have a higher risk for atopic diseases.
Awasthi, Pamita
