The epidemiology of atopic dermatitis at a tertiary referral skin center in Singapore

Atopic dermatitis is a common chronic, relapsing, pruritic ecematous skin c ondition with a predilection for the flexural areas and occurs in patients with a personal or family history of atopy. The aim of this study is to des cribe the profile of atopic dermatitis seen at the National Skin Centre in Singapore. A retrospective chart review was conducted of all the patients w ith atopic dermatitis seen during the first six months of 1994. There were 492 patients whose ages ranged from one month to 74 years with an equal sex ratio. The prevalence was 2%. The onset of the disease occurred before the age of 10 years in 61.2% of patients. In 13.6% of the patients, the onset was after the age of 21 years. Two hundred and fifty-four patients (52%) ha d "pure" atopic dermatitis without concomitant respiratory allergies. Two h undred and thirty-eight patients (48%) suffered from a "mixed" type, with 2 3% having allergic rhinitis, 12% having asthma and 13% having both asthma a nd allergic rhinitis. Two hundred and thirty-one patients (47%) had at leas t one first-degree family member with atropy: atopic dermatitis (17%), asth ma (15%) and allergic rhinitis (15%). Most of the patients, 416 (84.5%), ha d subacute eczema at presentation. Ichthyosis vulgaris was present in 38 pa tients (8%) and pityriasis alba in 13 patients (3%). The most common infect ive complication was bacterial infection (impetiginized eczema, folliculiti s, cellullitis) present in 95 patients (19%) followed by viral infections ( eczema herpeticum, viral warts and molluscum contagiosum) in 17 patients (3 %). Allergies were noted in 43 patients (9%) based on the history given. Th e most common was drug allergies (penicillin and co-trimoxazole) in 28 pati ents followed by food allergies in 11 patients. Common aggravating factors reported include heat, sweating, stress, thick clothing and grass intoleran ce. Most patients could be controlled with a fairly simple regimen of moist urizers, topical steroids and antibiotics for acute flares. Short courses o f systemic steroids were used in 78 patients (16%). Three patients were tre ated with phototherapy, Two on UVAB and one on PUVA. The pattern of atopic dermatitis in Singapore is similar to that reported in the Western literatu re except for a lower prevalence and a significant proportion Of adult onse t atopic dermatitis.