Williams J R, Burr M L, Williams H C
Department of Epidemiology, Statistics and Public Health, University of Wales College of Medicine, Heath Park, Cardiff CF14 4XN, U.K.
Br J Dermatol. 2004 Jun;150(6):1154-61. doi: 10.1111/j.1365-2133.2004.05869.x.
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.
尽管人们对可能易患特应性皮炎（AD）的因素的了解越来越多，但对于可能加重现有疾病的因素却知之甚少。AD患者以及参与该疾病管理的人员通常都知道影响其病程和严重程度的因素。然而，关于这些因素的分布及其相对重要性，几乎没有可用的证据，现有的信息来自诸如医院患者等特定群体，因此可能无法代表整个AD患者群体。
确定以社区为基础的患有AD的学童样本所感知的19种潜在加重和缓解因素的分布及其相对重要性。
使用一份问卷从威尔士的八所综合学校中识别出所有8年级和9年级（12至14岁）患有AD的儿童。然后要求这些人完成一份补充问卷，问卷要求他们针对19种因素中的每一种说明：（i）它是否会使他们的湿疹好转，（ii）它是否会使他们的湿疹恶化，（iii）它是否没有效果，或者（iv）他们是否不知道其效果。
接受调查的儿童中近10%（2501名中的250名）被认为患有AD，其中90%（250名中的225名）完成了补充问卷。大多数AD患者发现，没有至两种因素能缓解他们的症状，而没有至五种因素会加重他们的症状。运动出汗、织物（尤其是羊毛）和炎热天气是三种最常见的加重因素，分别影响了41.8%、40%和39.1%的AD受访者。三种关键的缓解因素是类固醇乳膏（占AD受访者的22.2%）、保湿剂/化妆品（16.4%）和药物/药片（13.8%）。近60%的受访者认为食物对他们的症状没有影响。也有证据表明，12.4%（225名中的28名）的参与者可能在使用他们不知道含有类固醇的乳膏。
这些发现揭示了在具有代表性的AD患者群体样本中，食物、气传变应原、汗液、气候、疾病、压力和治疗等因素对于AD病程相对被感知到的重要性。鉴于患者及其护理人员越来越多地参与到这种慢性病的管理中，在临床咨询期间可以探讨此类信息。这些发现也为未来的分析研究提供了假设生成的基础。
