Diagnosis of eczema in preschool children and course of disease during childhood

University dissertation from Department of Dermatology and Venereology, Lund University

Abstract: Popular Abstract in English The dissertation is divided into two parts. The first part deals with the development of a questionnaire diagnostic instrument for atopic dermatitis (AD). The second part concerns following a cohort and assessing the natural history of AD, in which the effect of specified risk factors is analysed. In Värmland, Sweden, a questionnaire that diagnoses AD in infants and preschool children was developed and validated. Physician diagnosis was used as the gold standard, and the questionnaire diagnosis was compared against that. Children with and without AD were recruited consecutively from childcare centres. The first study on preschool children included 60 individuals. The second validation study on infants included a sample of 476 children. The children were examined clinically for the presence of eczema. The examining physicians were blinded to the answers to the questionnaire. Physician diagnosis was adopted as the gold standard, and the questionnaire diagnosis was compared against that. It was shown that the questionnaire was able to diagnose AD with high accuracy both in infants and in preschool children (sensitivity 0.87 and 0.91, respectively; specificity 0.98 and 1.00, respectively). Further, a cohort of children was followed over a five-year period. An investigation was made as to whether children with AD had greater odds of developing asthma and rhinitis; also, the factors associated with remission of AD were identified. A high proportion of AD children subsequently developed asthma and rhinitis (adjusted odds ratio [aOR] 3.07; 95 % CI 1.79–5.27; aOR, 2.63; 1.85–3.73), though 52% of children also underwent remission of AD. For the development of asthma and rhinitis, the odds were increased for severe, early-onset, and persistent AD; for remission, the odds were increased for milder AD, later-onset AD, and atypical location of AD. Thus, for both development of asthma and rhinitis and for remission of AD, the most important factors were the aspects of AD. The main supervisor of this work was Åke Svensson, Lund University. The work for this dissertation was conducted in association with my co-supervisors Carl-Gustaf Bornehag, Karlstads University and Mikael Hasselgren, Örebro University. The studies presented here are part of the Dampness in Buildings and Health (DBH) study and the Swedish Environmental Mother and child Asthma and allergy study (SELMA) study.