Atopic dennatitis (AD) is a conUllon chronically relapsing skin disorder affecting 9-20% of those born after 1970 [Schultz Larsen 1993]. TI,e aetiology is still not entirely elucidated and research is complicated by the multifactorial nature of the disease. Both genetical and environmental factors are involved in the pathogenesis of AD. The prevalence of atopic dennatitis seems to have increased along with astluna and allergic rhinitis during the past three decades [Williams 1992, Schultz Larsen 1996]. Several studies from different countries reported a two- to three-fold increase of the prevalence of AD over the past three decades. However, the reasons for this evolution of atopic diseases still remain to be elucidated. Furthennore, large, unexplained variations in prevalence have been reported between countries and within countries [ISAAC 1998], suggesting a critical role for environmental thctors in disease expression. Although some risk factors such as gender, parental smoking, and early exposure to allergens Olouse dust mite, pets, cow's milk and solid food) have becn identified, the role of other risk factors like socio-economic status, outdoor and indoor pollution and infections in early life are still a matter of discussion. Studies on the genetical and immunological background have provided new insights into the mechanisms involved in atopic diseases. However, therapeutical practice has not yet changed. Recently guidelines based on consensus have been established for the management of AD [Me Henry 1995]. Emphasis is put on educating and infonning the patients. Although these and other guidelines provide a good franlework for managing AD, the unpredictable course of the disease with exacerbations and remissions may fiustrate both patients and physicians [przybilla 1994]. Patients with AD account for about 30% of demlatological consultations in general practice, and dennatological consultations account for about 20% of all consultations in general practice [Rook 1986]. However, little attention has been paid to AD in tenns of research. A Medline literature search (title, abstract, and subject heading) from 1996 to May 1999 showed 8,986 publications related to astlUlla, but only 942 related to AD. This is surprising when the impact of the two diseases is compared. In tenns of prevalence, AD is more conunon than asthma in Y01Ulg children [Peat 1994, Burr 1989]; in tenns of economic resources, the direct fimUlcial cost in the care of a child with moderate to severe AD is substantially higher than for the average child with asthma [Su 1997]; and in tenns of family impact - taking into account fmaneial burden, familial/social impact, personal strain and mastery - even in mild AD, the impact on fanlilies was found to be equivalent to that for children with insulin dependent diabetes mellitus [Su 1997]. Consequently AD should not be perceived as a minor skin disorder, but it should be recognised as a disease with considerable social, personal and fInancial burden.

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Glaxo Wellcome, Medeco S.v., UCS Pharma, Yamanouchi
H.J. Neijens (Herman)
Erasmus University Rotterdam
Erasmus MC: University Medical Center Rotterdam

Wolkerstorfer, A. (1999, September 8). Evaluation of severity and therapy in children with atopic dermatitis. Retrieved from