Prevalence of atopic dermatitis in adults | Anais Brasileiros de Dermatologia (Portuguese)

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Mazzuoccolo, Claudio Alberto Salvador Parisi" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Maria Valeria" "apellidos" => "Angles" "email" => array:1 [ 0 => "maria.angles@hospitalitaliano.org.ar" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Carolina Andrea" "apellidos" => "Antonietti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Ana Clara" "apellidos" => "Torre" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Estefanía" "apellidos" => "Juszkiewicz Franzé" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Luis Daniel" "apellidos" => "Mazzuoccolo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => 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"Tamanyo" => 65682 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flowchart of patients, members of a health insurance program of a Community University Hospital, evaluated in the period between January 1, 2015, and January 1, 2018." ] ] ] "textoCompleto" => "Atopic Dermatitis (AD) is a chronic, recurrent inflammatory skin disease affecting between 15% and 20% of children, and 2% and 3% of adults.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Cases with onset in childhood and persistence of the disease through adulthood (10%–30%) tend to have a history of atopy. However, when AD first presents at an adult age, there may be no such association and the diagnosis is generally more complex.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>In adults, the disease has a significant impact on the quality of life, which is aggravated by the underdiagnoses and is related to a significant increase in healthcare costs.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> Little information is available in our country about epidemiology on AD in adults.This study aimed to describe the prevalence of AD and its clinical features of our cohort of patients.A cross-sectional observational study was conducted between January 1, 2015, and January 1, 2018, in adult patients that were members of a health insurance program of a Community University Hospital in Hospital Italiano, Buenos Aires (IPHI). This health insurance program covers around 160,000 members who are mainly middle-income class and inhabitants of Buenos Aires. Patient data are centrally recorded in a personal health record.Patients older than 17 years of age, those who were active members of IPHI between January 1, 2015, and January 1, 2018, and were in follow-up for at least 6 months, were included in the study. A diagnosis of AD was defined as having 3 or more of the major Hanifin and Rajka criteria.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> AD was considered to be severe in the presence of at least one of the following: systemic treatment, phototherapy, complication-related hospital admissions (infections and/or skin or systemic inflammation in which active AD was the point of entry), and/or erythroderma.Specialists in allergy and dermatology reviewed the medical records of the randomly selected patients. For robustness of the data on the features and prevalence of AD during the study period with an expected frequency of 3%,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> a half-width of 0%–3%, and a 95% Confidence Interval, 350 clinical records had to be evaluated. The sample size was calculated using Power and Precision software. Patients that met the inclusion criteria were selected by random sampling and the prevalence of AD over the study period was calculated using the total number of clinical records evaluated, expressed as a proportion with its confidence intervals, as the denominator.The Institutional Ethics Committee approved the study.Overall, 350 patients with a mean age of 60 years (SD 20) were randomly included in the study (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>); 59% (207) were female.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Of the 350 patients, who were active members of the PMHI between January 1, 2015, and January 1, 2018, 11 had AD. The overall prevalence of AD was 3% (95% CI, 1.5–5.5) and the prevalence of severe AD was 0.3% (1). Of the total cohort of patients with AD, 9% (1) had severe disease. In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> characteristics of the patients with AD are described.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>None of the patients required hospital admission due to erythroderma or skin or soft-tissue infection. <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the treatments used in this group of patients.<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The overall prevalence of AD in adult patients in our population was 3%. To our knowledge, this is one of the first studies exploring the prevalence of AD in Latin America. <a class="elsevierStyleCrossRef" href="#bib0020">4</a>In our study, the onset of AD was observed after the age of 19 in more than 50% of the patients. In a similar way, a recent meta-analysis published by Lee et al. reported that adulthood onset of AD was observed in 24% and 53% of the patients in Europe and America respectively.<a class="elsevierStyleCrossRef" href="#bib0025">5</a>AD prevalence as well as the female preponderance (73%) in our population are in agreement with other reports.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> Different studies have evaluated the prevalence of AD mainly based on self-administered surveys and the Working Party criteria.<a class="elsevierStyleCrossRef" href="#bib0030">6</a> A study conducted<a class="elsevierStyleCrossRef" href="#bib0035">7</a> in 11 European countries and the United States, found a prevalence of AD in adults ranging from 0.3% (Switzerland) to 6.2% (Estonia), whereas other studies carried out in the United States and Japan observed a prevalence between 2.9%<a class="elsevierStyleCrossRef" href="#bib0020">4</a> and 10.7%<a class="elsevierStyleCrossRef" href="#bib0035">7</a> respectively. These data agree with the overall prevalence of 3% found in our study.The study conducted in Australia<a class="elsevierStyleCrossRef" href="#bib0040">8</a> is methodologically similar to ours; nevertheless, it differs in that Chidwick et al. identified patients based on AD diagnosis in the clinical records. Another difference is that in the Australian study, both adult and pediatric patients were included. The overall prevalence found in that study was two-fold higher than in ours within the population of adults older than 20 years.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Regarding disease severity, we observed that 10% of the patients had severe AD. This observation is similar to that of Chidwick et al., who found that 15.6% of the study population was classified as having severe disease.<a class="elsevierStyleCrossRef" href="#bib0040">8</a>Among the atopic comorbidities, allergic rhinitis (36%) was the most frequently observed such as in other studies,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> while obesity was the most common non-atopic comorbidity (55%). In our study, psychological disturbances were seen in 18% of the patients, a rate similar to that found in the Australian study (18.9%).<a class="elsevierStyleCrossRef" href="#bib0040">8</a>The main limitation of our study is that it was conducted in a middle-class population belonging to a Community University Hospital with a high rate of elderly patients. Therefore, the results may not be translatable to other populations. Nevertheless, we believe that one of the important strengths of the study is that the data were collected from electronic records, which are a reliable and safe source, unlike the self-administered surveys. Moreover, experts in AD reviewed patients’ records.The overall prevalence of AD in adult patients was 3%, meanwhile, for the severe forms of the disease, it was 0.3%. The most frequent comorbidities were allergic rhinitis and obesity. Availability of reliable statistical data on the prevalence of AD in adults enables visualization of the disease and its impact.An unrestricted grant was received from Sanofi Genzyme Argentina for the development of this work.Financial supportNone declared.Authors' contributionsMaria Valeria Angles: Conceived the original idea, contributed to the design and implementation of the research; contributed to the implementation of the research and the analysis of the results; discussed the results and contributed to the final manuscript; approved the final manuscript.Carolina Andrea Antonietti: Conceived the original idea, contributed to the design and implementation of the research; contributed to the implementation of the research and the analysis of the results; discussed the results and contributed to the final manuscript; approved the final manuscript.Ana Clara Torre: Conceived the original idea, contributed to the design and implementation of the research; contributed to the implementation of the research and the analysis of the results; discussed the results and contributed to the final manuscript; approved the final manuscript.Estefanía Juszkiewicz Franzé: Contributed to the implementation of the research and the analysis of the results; discussed the results and contributed to the final manuscript; approved the final manuscript.Luis Daniel Mazzuoccolo: Conceived the original idea, contributed to the design and implementation of the research; supervised the project; discussed the results, and contributed to the final manuscript; approved the final manuscript.Claudio Alberto Salvador Parisi: Conceived the original idea, contributed to the design and implementation of the research; supervised the project; discussed the results, and contributed to the final manuscript; approved the final manuscript.Conflicts of interestAngles MV, Parisi CAS, Mazzuocolo LD: Investigator and speaker for Sanofi and Abbvie.Torre AC: Speaker for Novartis and investigator for Sanofi.Antonietti C: Investigator for Abbvie and Sanofi.Juszkiewicz Franzé E: Investigator for Sanofi." "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financial support" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Authors' contributions" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-08-04" "fechaAceptado" => "2020-10-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Study conducted at the Hospital Italiano de Buenos Aires, Buenos Aires, Argentina." ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 775 "Ancho" => 1675 "Tamanyo" => 65682 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flowchart of patients, members of a health insurance program of a Community University Hospital, evaluated in the period between January 1, 2015, and January 1, 2018." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:2 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient-related features (%) (n = 11)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73% (8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">54 (24)<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Comorbidities (n = 11)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Asthma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18% (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Rhinitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36% (4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hypertension \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Obesity \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55% (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ichthyosis vulgaris \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alopecia areata \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18% (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Down’s syndrome \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">None \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Contact dermatitis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27% (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hand eczema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27% (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ocular involvement (allergic conjunctivitis, keratoconus, keratoconjunctivitis) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810842.png" ] ] 1 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AD-related features (n = 11)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age at diagnosis, in years</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Birth – 12 years (Childhood) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27% (3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13–18 years (Adolescence) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥19 years (Adulthood) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55% (6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age at diagnosis unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">History of anxiety due to lack of response to treatment and/or AD-related social stigma, and/or abulia, isolation, lack of motivation and/or social integration in the context of AD. \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">18% (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810841.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Mean (standard deviation)." ] ] ] "descripcion" => array:1 [ "en" => "Clinical features of the patients with atopic dermatitis." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "UVB, narrow-band ultraviolet; UVA, ultraviolet A; PUVA, psoralen plus UVA." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AD treatment received for at least two months (%) (n = 11)</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cyclosporine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Methotrexate \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0% \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">UVB, and/or UVA, and/or PUVA \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral methylprednisolone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18% (2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous dupilumab \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9% (1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Topical treatment: humectants, emollients, corticosteroids, and/or immunomodulators \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82% (9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mean number of consultations with an allergy specialist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0<a class="elsevierStyleCrossRef" href="#tblfn0010">a</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Median number of consultations with a dermatologist \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (2–6)<a class="elsevierStyleCrossRef" href="#tblfn0015">b</a> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2810840.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "a" "nota" => "Mean (standard deviation)." ] 1 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "b" "nota" => "Median (interquartile range)." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of the treatment received by the patients with AD." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Worldwide time trends in the prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and eczema in childhood: ISAAC Phases One and Three repeat multicountry cross-sectional surveys" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.I. Asher" 1 => "S. Montefort" 2 => "B. Björkstén" 3 => "C.K.W. Lai" 4 => "D.P. Strachan" 5 => "S.K. Weiland" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Lancet." "fecha" => "2006" "volumen" => "26" "paginaInicial" => "733" "paginaFinal" => "743" "itemHostRev" => array:3 [ "pii" => "S0140673618318804" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic Features of Atopic Dermatitis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J.M. Hanifin" 1 => "G. Rajka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Dermatovener (Stockholm)." "fecha" => "1980" "volumen" => "92" "paginaInicial" => "44" "paginaFinal" => "47" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of atopic dermatitis in adults: Results from an international survey" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Barbarot" 1 => "S. Auziere" 2 => "A. Gadkari" 3 => "G. Girolomoni" 4 => "L. Puig" 5 => "E.L. Simpson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/all.13401" "Revista" => array:6 [ "tituloSerie" => "Allergy." 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Estatísticas

Research Letter

Prevalence of atopic dermatitis in adults

Maria Valeria Anglesa,

Autor para correspondência

maria.angles@hospitalitaliano.org.ar

Corresponding author.

, Carolina Andrea Antoniettib, Ana Clara Torrea, Estefanía Juszkiewicz Franzéb, Luis Daniel Mazzuoccoloa, Claudio Alberto Salvador Parisib

a Department of Dermatology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

b Adults and Pediatrics Allergy Units, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina

Lido

5541

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que se leu este artigo

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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients&#44; members of a health insurance program of a Community University Hospital&#44; evaluated in the period between January 1&#44; 2015&#44; and January 1&#44; 2018&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic Dermatitis &#40;AD&#41; is a chronic&#44; recurrent inflammatory skin disease affecting between 15&#37; and 20&#37; of children&#44; and 2&#37; and 3&#37; of adults&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Cases with onset in childhood and persistence of the disease through adulthood &#40;10&#37;&#8211;30&#37;&#41; tend to have a history of atopy&#46; However&#44; when AD first presents at an adult age&#44; there may be no such association and the diagnosis is generally more complex&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In adults&#44; the disease has a significant impact on the quality of life&#44; which is aggravated by the underdiagnoses and is related to a significant increase in healthcare costs&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Little information is available in our country about epidemiology on AD in adults&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">This study aimed to describe the prevalence of AD and its clinical features of our cohort of patients&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">A cross-sectional observational study was conducted between January 1&#44; 2015&#44; and January 1&#44; 2018&#44; in adult patients that were members of a health insurance program of a Community University Hospital in Hospital Italiano&#44; Buenos Aires &#40;IPHI&#41;&#46; This health insurance program covers around 160&#44;000 members who are mainly middle-income class and inhabitants of Buenos Aires&#46; Patient data are centrally recorded in a personal health record&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Patients older than 17 years of age&#44; those who were active members of IPHI between January 1&#44; 2015&#44; and January 1&#44; 2018&#44; and were in follow-up for at least 6 months&#44; were included in the study&#46; A diagnosis of AD was defined as having 3 or more of the major Hanifin and Rajka criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> AD was considered to be severe in the presence of at least one of the following&#58; systemic treatment&#44; phototherapy&#44; complication-related hospital admissions &#40;infections and&#47;or skin or systemic inflammation in which active AD was the point of entry&#41;&#44; and&#47;or erythroderma&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Specialists in allergy and dermatology reviewed the medical records of the randomly selected patients&#46; For robustness of the data on the features and prevalence of AD during the study period with an expected frequency of 3&#37;&#44;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> a half-width of 0&#37;&#8211;3&#37;&#44; and a 95&#37; Confidence Interval&#44; 350 clinical records had to be evaluated&#46; The sample size was calculated using Power and Precision software&#46; Patients that met the inclusion criteria were selected by random sampling and the prevalence of AD over the study period was calculated using the total number of clinical records evaluated&#44; expressed as a proportion with its confidence intervals&#44; as the denominator&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">The Institutional Ethics Committee approved the study&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Overall&#44; 350 patients with a mean age of 60 years &#40;SD 20&#41; were randomly included in the study &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#59; 59&#37; &#40;207&#41; were female&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">Of the 350 patients&#44; who were active members of the PMHI between January 1&#44; 2015&#44; and January 1&#44; 2018&#44; 11 had AD&#46; The overall prevalence of AD was 3&#37; &#40;95&#37; CI&#44; 1&#46;5&#8211;5&#46;5&#41; and the prevalence of severe AD was 0&#46;3&#37; &#40;1&#41;&#46; Of the total cohort of patients with AD&#44; 9&#37; &#40;1&#41; had severe disease&#46; In <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> characteristics of the patients with AD are described&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">None of the patients required hospital admission due to erythroderma or skin or soft-tissue infection&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the treatments used in this group of patients&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">The overall prevalence of AD in adult patients in our population was 3&#37;&#46; To our knowledge&#44; this is one of the first studies exploring the prevalence of AD in Latin America&#46; <a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">In our study&#44; the onset of AD was observed after the age of 19 in more than 50&#37; of the patients&#46; In a similar way&#44; a recent meta-analysis published by Lee et al&#46; reported that adulthood onset of AD was observed in 24&#37; and 53&#37; of the patients in Europe and America respectively&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">AD prevalence as well as the female preponderance &#40;73&#37;&#41; in our population are in agreement with other reports&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Different studies have evaluated the prevalence of AD mainly based on self-administered surveys and the Working Party criteria&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> A study conducted<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> in 11 European countries and the United States&#44; found a prevalence of AD in adults ranging from 0&#46;3&#37; &#40;Switzerland&#41; to 6&#46;2&#37; &#40;Estonia&#41;&#44; whereas other studies carried out in the United States and Japan observed a prevalence between 2&#46;9&#37;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> and 10&#46;7&#37;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> respectively&#46; These data agree with the overall prevalence of 3&#37; found in our study&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The study conducted in Australia<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> is methodologically similar to ours&#59; nevertheless&#44; it differs in that Chidwick et al&#46; identified patients based on AD diagnosis in the clinical records&#46; Another difference is that in the Australian study&#44; both adult and pediatric patients were included&#46; The overall prevalence found in that study was two-fold higher than in ours within the population of adults older than 20 years&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Regarding disease severity&#44; we observed that 10&#37; of the patients had severe AD&#46; This observation is similar to that of Chidwick et al&#46;&#44; who found that 15&#46;6&#37; of the study population was classified as having severe disease&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">Among the atopic comorbidities&#44; allergic rhinitis &#40;36&#37;&#41; was the most frequently observed such as in other studies&#44;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> while obesity was the most common non-atopic comorbidity &#40;55&#37;&#41;&#46; In our study&#44; psychological disturbances were seen in 18&#37; of the patients&#44; a rate similar to that found in the Australian study &#40;18&#46;9&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The main limitation of our study is that it was conducted in a middle-class population belonging to a Community University Hospital with a high rate of elderly patients&#46; Therefore&#44; the results may not be translatable to other populations&#46; Nevertheless&#44; we believe that one of the important strengths of the study is that the data were collected from electronic records&#44; which are a reliable and safe source&#44; unlike the self-administered surveys&#46; Moreover&#44; experts in AD reviewed patients&#8217; records&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">The overall prevalence of AD in adult patients was 3&#37;&#44; meanwhile&#44; for the severe forms of the disease&#44; it was 0&#46;3&#37;&#46; The most frequent comorbidities were allergic rhinitis and obesity&#46; Availability of reliable statistical data on the prevalence of AD in adults enables visualization of the disease and its impact&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">An unrestricted grant was received from Sanofi Genzyme Argentina for the development of this work&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financial support</span><p id="par0150" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#39; contributions</span><p id="par0120" class="elsevierStylePara elsevierViewall">Maria Valeria Angles&#58; Conceived the original idea&#44; contributed to the design and implementation of the research&#59; contributed to the implementation of the research and the analysis of the results&#59; discussed the results and contributed to the final manuscript&#59; approved the final manuscript&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Carolina Andrea Antonietti&#58; Conceived the original idea&#44; contributed to the design and implementation of the research&#59; contributed to the implementation of the research and the analysis of the results&#59; discussed the results and contributed to the final manuscript&#59; approved the final manuscript&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Ana Clara Torre&#58; Conceived the original idea&#44; contributed to the design and implementation of the research&#59; contributed to the implementation of the research and the analysis of the results&#59; discussed the results and contributed to the final manuscript&#59; approved the final manuscript&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Estefan&#237;a Juszkiewicz Franz&#233;&#58; Contributed to the implementation of the research and the analysis of the results&#59; discussed the results and contributed to the final manuscript&#59; approved the final manuscript&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Luis Daniel Mazzuoccolo&#58; Conceived the original idea&#44; contributed to the design and implementation of the research&#59; supervised the project&#59; discussed the results&#44; and contributed to the final manuscript&#59; approved the final manuscript&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Claudio Alberto Salvador Parisi&#58; Conceived the original idea&#44; contributed to the design and implementation of the research&#59; supervised the project&#59; discussed the results&#44; and contributed to the final manuscript&#59; approved the final manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0100" class="elsevierStylePara elsevierViewall">Angles MV&#44; Parisi CAS&#44; Mazzuocolo LD&#58; Investigator and speaker for Sanofi and Abbvie&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Torre AC&#58; Speaker for Novartis and investigator for Sanofi&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Antonietti C&#58; Investigator for Abbvie and Sanofi&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Juszkiewicz Franz&#233; E&#58; Investigator for Sanofi&#46;</p></span></span>"
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    "fechaRecibido" => "2020-08-04"
    "fechaAceptado" => "2020-10-26"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patient-related features &#40;&#37;&#41; &#40;n&#8239;&#61;&#8239;11&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Female sex&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">73&#37; &#40;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">54 &#40;24&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
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                  \t\t\t\t">Comorbidities &#40;n&#8239;&#61;&#8239;11&#41;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Asthma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Rhinitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">36&#37; &#40;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hypertension&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55&#37; &#40;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Diabetes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">9&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Ichthyosis vulgaris&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Alopecia areata&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">18&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Down&#8217;s syndrome&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">None&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Contact dermatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">Hand eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">27&#37; &#40;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ocular involvement &#40;allergic conjunctivitis&#44; keratoconus&#44; keratoconjunctivitis&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
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            1 => array:2 [
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                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AD-related features &#40;n&#8239;&#61;&#8239;11&#41;</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
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                  \t\t\t\t">Birth &#8211; 12 years &#40;Childhood&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">9&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t">&#8805;19 years &#40;Adulthood&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at diagnosis unknown&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#37; &#40;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">History of anxiety due to lack of response to treatment and&#47;or AD-related social stigma&#44; and&#47;or abulia&#44; isolation&#44; lack of motivation and&#47;or social integration in the context of AD&#46;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">18&#37; &#40;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Cyclosporine&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">Topical treatment&#58; humectants&#44; emollients&#44; corticosteroids&#44; and&#47;or immunomodulators&nbsp;\t\t\t\t\t\t\n
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                      "titulo" => "Worldwide time trends in the prevalence of symptoms of asthma&#44; allergic rhinoconjunctivitis&#44; and eczema in childhood&#58; ISAAC Phases One and Three repeat multicountry cross-sectional surveys"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;I&#46; Asher"
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                            2 => "B&#46; Bj&#246;rkst&#233;n"
                            3 => "C&#46;K&#46;W&#46; Lai"
                            4 => "D&#46;P&#46; Strachan"
                            5 => "S&#46;K&#46; Weiland"
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                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
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                  "contribucion" => array:1 [
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                      "titulo" => "Diagnostic Features of Atopic Dermatitis"
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                            0 => "J&#46;M&#46; Hanifin"
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                      "titulo" => "Epidemiology of atopic dermatitis in adults&#58; Results from an international survey"
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                          "autores" => array:6 [
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                            2 => "A&#46; Gadkari"
                            3 => "G&#46; Girolomoni"
                            4 => "L&#46; Puig"
                            5 => "E&#46;L&#46; Simpson"
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                      "doi" => "10.1111/all.13401"
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                            3 => "B&#46;C&#46; Archer"
                            4 => "M&#46;J&#46; Shipley"
                            5 => "J&#46;J&#46; Hunter"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.1994.tb08530.x"
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                        "tituloSerie" => "Br J Dermatol&#46;"
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                        "volumen" => "131"
                        "paginaInicial" => "383"
                        "paginaFinal" => "396"
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                            4 => "D&#46; Norb&#228;ck"
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                      "titulo" => "Prevalence&#44; incidence&#44; and management of atopic dermatitis in Australian general practice using routinely collected data from Medicine Insight"
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                        "tituloSerie" => "Australas J Dermatol&#46;"
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Informação do artigo

ISSN: 03650596
Idioma original: Inglês

DOI:10.1016/j.abd.2020.10.016

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