The epidemiology and experience of atopic eczema during childhood: a discussion paper on the implications of current knowledge for health care, public health policy and research

Abstract

Atopic eczema is a chronic skin condition aVecting between 5% and 20% of children aged up to 11 years at one time or other. Research suggests that prevalence is increasing and various environmental factors have been implicated in the aetiology. While often seen to be a minor problem, research suggests that it can cause considerable disruption to the lives of children and their carers and involves significant cost for the family and health care systems. The current consensus is that the majority of cases of atopic eczema are most appropriately managed within primary care. However, management of the condition is problematic because diagnosis is often diYcult. Consultations tend to focus on the physical aspects of the problems neglecting the psychosocial, while treatment remains mainly palliative and can be as diverse as the condition itself. More appropriate and eVective primary care management and support for children with atopic eczema and their carers will only be developed if health professionals become more aware of the social context of the disease and the impact on the lives of those aVected. Public health responses focusing on primary prevention are also needed. This paper reviews a diverse literature on the epidemiology of the condition, the way in which it aVects the lives of children and their carers and the factors that shape their help seeking decisions. The aim is to contribute to a more substantial knowledge base for public health and primary care developments and to point to areas for future research (J Epidemiol Community Health 2000;54:581-589)

Clinical and cost-effectiveness of once-daily versus more frequent use of same potency topical corticosteroids for atopic eczema: a systematic review and economic evaluation

“…There is little convincing evidence of differences in the prevalence of atopic eczema by gender, 13 but there is evidence of variation by age. Atopic eczema most commonly begins in infancy.…”

“…8 There is little evidence on difference in the prevalence of atopic eczema amongst different ethnic groups. 13 One community study of 322 children in Leicester found that there were no apparent ethnic differences in prevalence, but that Asian children were three times more likely to be referred to secondary care than their white counterparts. 17 There is some evidence of a difference in the prevalence of atopic eczema across different socioeconomic groups.…”

“…There are difficulties associated with estimating prevalence and incidence of atopic eczema from the present literature, owing to the small number of community studies, the dominance of crosssectional rather than longitudinal study designs and differences in definition of disease and differences in study-specific methodology. 13 Specifically, there are a number of studies reporting estimates based on different age groupings and there are variations across studies in the reporting of either point prevalence or period prevalence; only a small number of studies report both (see Appendix 1). Rates for period prevalence tend to reflect a rate of half that shown in estimates related to lifetime prevalence of disease.…”

“…There is some evidence of genetic influences 13,21 and a number of environmental factors have been implicated in the onset or exacerbation, or both, of atopic eczema, including house dust mites, pollen, tobacco, air pollution and low humidity. Factors such as excessive use of soaps and other household irritants are also thought to exacerbate the condition.…”

Children and adolescents living with atopic eczema: an interpretive phenomenological study with Chinese mothers

“…In the last two decades, there has been increasing interest in the question of whether a mother's attitude and personality may have a direct influence on her child's adherence to treatment for atopic eczema in the West (Fischer 1996, Su et al 1997, Fennessy et al 2000. The nurse-parental relationship is associated with greater self-efficacy and maternal confidence in being able to manage children's AE.…”