Atopic dermatitis in 5-6-year-old Swedish children: cumulative incidence, point prevalence, and severity scoring

Background: This study aimed to evaluate the cumulative incidence, point pr evalence, and severity of atopic dermatitis (AD) in a pediatric population. We also aimed to identify differential diagnoses relevant to AD in this po pulation. Methods: Children scheduled for a health visit at 5.5 years of age were sel ected consecutively during the period October 1997-March 1998 from two citi es in southern Sweden (Goteborg and Kristianstad). Schultz Larsen's questio nnaire was used to evaluate the cumulative incidence of AD. Clinical examin ation was performed by dermatologists (A.B. and Angstrom .S.) for those chi ldren with active eczema. The UK working party's criteria were used for the clinical diagnosis of AD. The SCORAD index was used to evaluate the severi ty of eczema. This index includes evaluation of extent, intensity, and subj ective symptoms to a maximum score of 103 points. Results: In Goteborg 1219 and in Kristianstad 742 questionnaires were answe red regarding 1961 children, 1004 boys and 957 girls. The response rate was 89%. According to the answers to Schultz Larsen's questionnaire, the cumul ative incidence of AD in the whole material was 20.7% (406/1961) (CI 95% 18 .9-22.5). In Goteborg, 104 of the examined children fulfilled the UK workin g party's criteria, equivalent to a point prevalence of 8.5% (CI 95% 7.0-10 .1). In Kristianstad, the corresponding point prevalence was 11.5% (CI 95% 9.2-13.8). The severity of AD was evaluated in all children with visible ec zema. SCORAD evaluation was performed in 155 of the 157 children with visib le eczema. The majority of children had mild or moderate eczema; mean value 20.5 (CI 95% 18.7-22.3), median 19.6. Of the 96 children who did not fulfi l the criteria of AD, other skill disorders were diagnosed in 51 at the cli nical examination. Dry skin was by far the most common differential diagnos is. Conclusions: We have used validated protocols to evaluate the cumulative in cidence, point prevalence, and severity of AD in a population-based study i n southern Sweden The present study, involving a rural and urban pediatric population, shows that AD is common, usually classified as mild or moderate , and seems to increase over time.