Factors influencing atopic dermatitis-a questionnaire survey of schoolchildren's perceptions

Although there is growing knowledge about factors that may predispose to the onset of atopic dermatitis (AD), little is known about factors which may exacerbate existing disease. AD sufferers and those involved in the management of the disease are often aware of factors that influence its course and severity. However, there is little available evidence on the distribution and relative importance of such factors, and what information exists is derived from selected groups such as hospital patients and may not therefore be representative of the AD population as a whole.

To determine the distribution and relative importance of 19 potential exacerbating and relieving factors as perceived by a population-based sample of schoolchildren with AD.

A questionnaire was used to identify all children with AD in years 8 and 9 (12-14-year-olds) from eight comprehensive schools across Wales. These individuals were then requested to complete a supplementary questionnaire which asked them to state for each of 19 factors whether (i) it makes their eczema better, (ii) it makes their eczema worse, (iii) it has no effect, or (iv) they do not know its effects.

Almost 10% (250 of 2501) of children surveyed were considered to have AD, and 90% (225 of 250) of these completed the supplementary questionnaire. Most AD sufferers found that none to two factors relieve their symptoms whilst none to five factors exacerbate them. Sweating from exercise, fabrics (especially wool) and hot weather were the three most common exacerbators, affecting 41.8%, 40% and 39.1%, respectively, of AD responders. The three key relievers were steroid creams (22.2% of AD responders), moisturizers/makeup (16.4%) and medicines/tablets (13.8%). Almost 60% of respondents believed foods have no effect on their symptoms. There was also evidence to suggest that 12.4% (28 of 225) of participants may use creams which they are not aware contain steroids.

These findings shed light on the relative perceived importance of factors such as food, aeroallergens, sweat, climate, illness, stress and therapies for the course of AD in a representative population sample of AD sufferers. Such information might be explored during clinical consultations given the increasing participation of sufferers and their carers in the management of this chronic disease. These findings also form the basis of hypothesis generation for future analytical studies.