Prognosis of the Eczema-Asthma Syndrome

Abstract

MIGRAINEBRTnSH 825 MEDICAL JOURNAL possibility of constitutional factors, as illustrated by a family tree which shows that four members of a family received fatal damage to their kidneys in connexion with medication against migraine. REFERENCES Ask- Upmark, E. (1929). Acta path. microbiol. scand., 6, 383. (1953). Acta med. scand., 147, 191. (1957). Life, Death, and Disease in Sweden. Almqvist and Wiksell, Stockholm. Dahmen, H. (1958). Munch. med. Wschr., 100, 1846. Essen-Moller, E. (1956). Social-med. T. 33 271 Jasiiiski, B., and Wuhrmann, F. (1958) (1955) showed that 55% of such children will still have eczema at the age of 13 years and 50% will have asthma. Purdy (1953) states that a similar percentage will still be affected at the age of 20. Meenan's (1959) investigations of older subjects showed that about 30% of the skin lesions never clear up We have had an opportunity of assessing a group of children who were admitted some years ago to the skin dep;A-t:eint of the Belfast City Hospital suffering from infantile eczema. We were interested in the outlook for these children, through the years, from both the skin and the respiratory viewpoint. MethodsThe records of the skin department for the years 1947-50 were searched, and 43 cases of infantile eczema were found. Similar criteria to those of Purdy (1953) were used in the selection of cases: (1) the diagnosis must have been either infantile eczema or dermatitis (note: during the period the term seborrhoeic was not used in this unit for any child); (2) the face must have been clearly involved; (3) the patient must have been 24 months old or younger when first seen with the disease; (4) the patient must have been 12 months old or younger at the onset of the disease; and (5) there must have been no obvious acquired predisposing facto! such as scabies, pediculosis, or antecedent napkin erythema.Letters were sent to the parents requesting the attendance of these children for interview. If they did not attend and lived within 30 miles (48 km.) of Belfast, they were visited in their homes by one of us. If they lived at a greater distance the parents were provided with a form on which they could indicate the child's present state of health. This was necessary in only two of the 43 cases.An independent observer who did not know the present state of the children reviewed the case-histories and separated the cases which he considered to indicate a diagnosis of seborrhoeic eczema from those in which a contact factor probably played a part.Of the 43 cases of infantile eczema, three could not be traced by any means at our disposal, including visits to the last known address, contact with their family doctors, and, finally, the help of the General Health Services Board. Of the remaining 40 patients, one had died of leukaemia and one had emigrated. The cases were further subdivided as in Table I. In attempting to assess the respiratory complications, 23 children were selected from the above group of 29 with true infantile eczema, and solely on the basis of their...

Evolution of Atopic Dermatitis

“…The severity of atopic dermatitis at a young age is cor related in their study with the occurrence of asthma later on. Burrows and Penman [2] draw the same conclusion.…”

“…There are less than 50 patients in the study of Burrows and Penman [2], Boddin [1], Finn [3] and Stifler [8], between 50 and 100 in the study of Rajka [6], Vowles et al [9], Purdy [5] and Musgrove and Morgan [4]. There are 492 patients in the study of Roth and Kierland [7], Results rely sometimes only on questionnaires [7] or on questionnaires followed by interviews [2][3][4][5].…”

“…Musgrove and Morgan [4] select children seen under 5 years of age. Particular attention is drawn on the clinical aspect of the der matitis by Burrows and Penman [2] and by Purdy [5] to avoid inclusion of seborrheic dermatitis. Roth and Kierland [7] included patients of all ages provided there was a 20-year time lapse since the diagnosis of atopic der matitis was established.…”

“…There are 492 patients in the study of Roth and Kierland [7], Results rely sometimes only on questionnaires [7] or on questionnaires followed by interviews [2][3][4][5]. In one instance patients were seen at home [9], The time between the first record of atopic dermatitis and the control examination is usually around 20 years but varies between 12 [2] and 45 years [6], Our results on the evolution of atopic dermatitis in infants are similar to those found by Musgrove and Morgan [4], Boddin [1] and Vowles et al [9] who estimate that in 57.5, 57 and 55% of the patients, respectively, atopic der matitis continues until adult age.…”

“…Notwithstanding the high occurrence of atopic derma titis, our knowledge of the natural course of the disease is rather restricted. The literature gives widely variant percentages of continuing dermatitis in adult age ranging from 25 up to 80% [1][2][3][4][5][6][7][8][9]. We looked for the evolution of the dermatitis in the patients who were seen in our department for the first time some 20 years ago.…”