Objective-To evaluate the impact of childhood atopic eczema on families and assess the personal financial cost of its management. Design-Cross sectional survey. Setting-Paediatric dermatology and paediatric diabetology outpatient clinics. Patients-Parents of 48 randomly selected children with atopic eczema and 46 with insulin dependent diabetes mellitus. Main outcome measures-The impact on family score, the reported cost of relevant medical treatments, medical consultations, relevant hospitalisation, and income loss. Results-Families of children with moderate or severe atopic eczema had a significantly higher impact on family score than families of diabetic children. A conservative estimate of the annual personal financial cost of managing mild, moderate, and severe eczema was Aus$330, 818, and 1255, respectively. The financial cost to the community for the management of atopic eczema in the study groups was greater. The personal financial cost of managing eczema was greater than for asthma. Conclusion-Childhood atopic eczema has a profound impact on the social, personal, emotional, and financial perspectives of families. (Arch Dis Child 1997;76:159-162)

Background: Although the pathogenesis of acne is currently unknown, recent epidemiologic studies of non-Westernized populations suggest that dietary factors, including the glycemic load, may be involved. Objective: The objective was to determine whether a low-glycemicload diet improves acne lesion counts in young males. Design: Forty-three male acne patients aged 15-25 y were recruited for a 12-wk, parallel design, dietary intervention incorporating investigator-blinded dermatology assessments. The experimental treatment was a low-glycemic-load diet composed of 25% energy from protein and 45% from low-glycemic-index carbohydrates. In contrast, the control situation emphasized carbohydrate-dense foods without reference to the glycemic index. Acne lesion counts and severity were assessed during monthly visits, and insulin sensitivity (using the homeostasis model assessment) was measured at baseline and 12 wk. Results: At 12 wk, mean (ȀSEM) total lesion counts had decreased more (P ҃ 0.03) in the low-glycemic-load group (Ҁ23.5 Ȁ 3.9) than in the control group (Ҁ12.0 Ȁ 3.5). The experimental diet also resulted in a greater reduction in weight (Ҁ2.9 Ȁ 0.8 compared with 0.5 Ȁ 0.3 kg; P 0.001) and body mass index (in kg/m 2 ; Ҁ0.92 Ȁ 0.25 compared with 0.01 Ȁ 0.11; P ҃ 0.001) and a greater improvement in insulin sensitivity (Ҁ0.22 Ȁ 0.12 compared with 0.47 Ȁ 0.31; P ҃ 0.026) than did the control diet. Conclusion: The improvement in acne and insulin sensitivity after a low-glycemic-load diet suggests that nutrition-related lifestyle factors may play a role in the pathogenesis of acne. However, further studies are needed to isolate the independent effects of weight loss and dietary intervention and to further elucidate the underlying pathophysiologic mechanisms.Am J Clin Nutr 2007;86: 107-15.

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An intervention study was conducted to assess the effectiveness of a nurse-led eczema workshop in reducing the severity of atopic eczema in infants, children and adolescents. Ninety-nine new patients referred to the Dermatology Department of The Royal Children's Hospital in Melbourne, Australia, for the management of atopic eczema were randomized to receive care from an eczema workshop or a dermatologist-led clinic. Patients were followed-up 4 weeks after the intervention. The primary outcome was the severity of eczema as determined by scores obtained using the Scoring of Atopic Dermatitis (SCORAD) index at a 4-week follow-up visit. The secondary outcome was a comparison of treatments used in both clinics. At the 4-week review the mean improvement in SCORAD was significantly greater in those patients attending the eczema workshop than those attending the dermatologist-led clinic (-9.93, 95% confidence interval -14.57 to -5.29, P < 0.001). Significantly more patients from the eczema workshop improved from moderate severity eczema at baseline to mild at review. There was greater adherence to eczema management in the eczema workshop compared with the dermatologist-led clinic. In this study, patients attending the eczema workshop had a greater improvement in eczema severity thanpatients attending a dermatologist-led clinic, supporting collaborative models of service provision.

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