Adult height in patients with childhood onset atopic dermatitis

Cyclosporin A-loaded dissolving microneedles for dermatitis therapy: Development, characterisation and efficacy in a delayed-type hypersensitivity in vivo model

Several drugs can be used for treating inflammatory skin pathologies like dermatitis and psoriasis. However, for the management of chronic and long-term cases, topical administration is preferred over oral delivery since it prevents certain issues due to systemic side effects from occurring. Cyclosporin A (CsA) has been used for this purpose; however, its high molecular weight (1202 Da) restricts the diffusion through the skin structure. Here, we developed a nano-in-micro device combining lipid vesicles (LVs) and dissolving microneedle array patches (DMAPs) for targeted skin delivery. CsA-LVs allowed the effective incorporation of CsA in the hydrophilic DMAP matrix despite the hydrophobicity of the drug. Polymeric matrix composed of poly (vinyl alcohol) (5% w/v), poly (vinyl pyrrolidine) (15% w/v) and CsA-LV dispersion (10% v/v) led to the formation of CsA-LVs@DMAPs with adequate mechanical properties to penetrate the stratum corneum barrier. The safety and biocompatibility were ensured in an in vitro viability test using HaCaT keratinocytes and L929 fibroblast cell lines. Ex vivo permeability studies in a Franz-diffusion cell setup showed effective drug retention in the skin structure. Finally, CsA-LVs@DMAPs were challenged in an in vivo murine model of delayed-type hypersensitivity to corroborate their potential to ameliorate skin inflammatory conditions. Different findings like photon emission reduction in bioluminescence study, normalisation of histological damage and decrease of inflammatory cytokines point out the effectivity of CsA-LVs@DMAPs to treat these conditions. Overall, our study demonstrates that CsA-LVs@DMAPs can downregulate the skin inflammatory environment which paves the way for their clinical translation and their use as an alternative to corticosteroid-based therapies.

The effect of atopic dermatitis in pediatric patients on height: Reflections triggered by a real-life case report

RATIONALE

Atopic dermatitis (AD) is a burdensome skin disorder, especially in children. The prevalence of children with AD is increasing year by year in China. Typical symptoms like eczema-like lesions and severe pruritus can seriously affect the sleep quality and the growth and development of pediatric patients.

PATIENT CONCERNS

We observed a pair of fraternal twins, in which the younger sister had AD, while the elder one had no relevant medical history. At present, the height of the 2 individuals is significantly inconsistent, with a difference of about 10 cm.

DIAGNOSES

Based on the little patient's medical history and clinical manifestations, the diagnosis of AD was made.

INTERVENTIONS

This little patient was treated with oral routine antihistamines, topical glucocorticoids and Dupilumab.

OUTCOMES

At present, her rash and xerosis have significant improvement. She also have relief of generalized itching and improved sleep quality.

LESSONS

Previous studies have indeed shown that AD has a negative impact on children's height. This case leads us to consider the association between AD and height. It also gave us the opportunity to observe subsequent height changes after the intervention was carried out.

Association Between Atopic Dermatitis and Height, Body Mass Index, and Weight in Children

Importance

Atopic dermatitis may be associated with short stature and obesity in children, but most previous studies have been either small or cross-sectional.

Objective

To evaluate the association between atopic dermatitis and height, body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), and weight throughout childhood.

Design, Setting, and Participants

TARGet Kids! (The Applied Research Group for Kids) is an ongoing prospective longitudinal cohort study that collects data at routine physician visits throughout childhood. In this cohort, children aged 5 or younger were followed up into adolescence at regular physician visits at general pediatric and family practices in Toronto, Canada, from June 2008 to February 2021.

Exposure

Parental report of atopic dermatitis.

Main Outcomes and Measures

Primary outcomes were length-for-age and BMI-for-age z scores. The secondary outcome was weight-for-age z score. Linear mixed effects models were used to estimate associations between atopic dermatitis and each outcome. In secondary analyses, interaction terms were included between atopic dermatitis and age.

Results

A total of 10 611 children were included in the analysis, with mean (SD) baseline age of 23 (20) months; 5070 (47.8%) participants were female. Participants were followed for a median (range) of 28.5 (0.0-158.0) months. A total of 1834 (17.3%) children had atopic dermatitis during follow-up. Atopic dermatitis was associated with lower length-for-age z score (-0.13; 95% CI, -0.17 to -0.09; P < .001), higher BMI z score (0.05; 95% CI, 0.01 to 0.09; P = .008), and lower weight-for-age z score (-0.07; 95% CI, -0.10 to -0.04; P < .001) compared with children without atopic dermatitis. The associations between atopic dermatitis and height and BMI changed with age, diminishing by age 14 years and 5.5 years, respectively. Based on World Health Organization growth tables, children with atopic dermatitis were on average 0.5 cm shorter with 0.2 more BMI units at age 2 years and 0.6 cm shorter with no difference in BMI at age 5 years than children without atopic dermatitis after adjusting for covariates. There was no evidence of interaction between atopic dermatitis and age with respect to weight.

Conclusions and Relevance

In this cohort study, atopic dermatitis was associated with shorter stature, higher BMI, and lower weight in early childhood, but these associations were small and, for height and BMI, attenuated with age and resolved by adolescence.

Approach to the Assessment and Management of Pediatric Patients with Atopic Dermatitis: A Consensus Document. Section II: Comorbid Disease in Pediatric Atopic Dermatitis

Pediatric atopic dermatitis (AD) is one of the most common skin conditions encountered by health-care providers caring for infants, children, and adolescents. Pediatric patients with AD may present with other allergic and nonallergic comorbidities that require appropriate treatment and referral. They may also experience a trajectory of allergic diseases known as the atopic march, which depends on a complex interaction between genetic and environmental factors and likely involves early epidermal barrier dysfunction. Here we provide a review and clinical recommendations on the assessment and referral of comorbidities in pediatric AD.

Systematic review of published trials: long-term safety of topical corticosteroids and topical calcineurin inhibitors in pediatric patients with atopic dermatitis

BACKGROUND

Many clinicians have concerns about the safety of atopic dermatitis (AD) treatments, particularly in children requiring long-term daily maintenance therapy. Topical corticosteroids (TCS) have been widely used for >5 decades. Long-term TCS monotherapy has been associated with adverse cutaneous effects including atrophy, rebound flares, and increased percutaneous absorption with potential for adverse systemic effects. Topical calcineurin inhibitors (TCIs), tacrolimus and pimecrolimus, available for 1-2 decades, are not associated with atrophy or increased percutaneous absorption after prolonged use and have much lower potential for systemic effects. However, since 2006 TCIs have carried a controversial Boxed Warning based on a theoretical risk of malignancy (eg, skin and lymphoma) that has limited TCI use for standard-of-care maintenance therapy.

METHODS

A comparative systematic search of PubMed was done for long-term (≥12 week) clinical trials of TCS or TCI treatment in patients <12 years with AD. Citations were reviewed for inclusion based on MeSH terms, abstracts, and relevant article text. Studies were excluded if they did not encompass subjects <12 years, or were <12 weeks' duration, retrospective, meta-analyses, or limited to anecdotal case reports.

RESULTS

Of 27 trials meeting criteria, 21 included 5825 pediatric patients treated with TCIs, and 6 included 1999 patients treated with TCS. TCS studies were limited to low- to mid-potency products, and all but one study lacked a vehicle control. Eight TCI studies were vehicle-controlled, and safety data were well reported, with ≤5 % of patients reporting discontinuation due to adverse effects (DAEs). Cutaneous and systemic adverse events (AEs) were similar in TCI and vehicle groups, with no reports of lymphoma. Safety data in TCS trials were less well reported. DAE incidence was addressed in just 2 trials, and systemic and cutaneous AEs were mostly unreported.

CONCLUSIONS

Data supporting long-term use of TCIs are robust, documenting safety and efficacy, while data supporting long-term TCS use are limited to low- to mid-potency products. Our review identifies a lack of information on the safety of commonly prescribed, long-term monotherapy with mid- to high-potency TCS in pediatric AD, and supports standard-of-care maintenance therapy with TCIs and intermittent use of low- to mid-potency TCS for flares.

Dietary restriction causing iodine-deficient goitre

Iodine-deficient goitre was common in some parts of the UK prior to the introduction of salt iodisation. Many contemporary salt preparations do not contain much iodine, and there are renewed concerns about the iodine status of the population. We present a boy with severe allergy who developed goitre and significant thyroid dysfunction in association with an iodine-deficient 'food-restricted' diet. The case highlights the importance of a comprehensive nutritional assessment in all children on multiple food restrictions.

Dietary pattern and nutrient intake of korean children with atopic dermatitis

BACKGROUND

Atopic dermatitis (AD) is characterized by itching and eczema-like skin lesions, and its symptoms alleviate with age. Recently, the prevalence of AD has increased among adolescents and adults. The increasing prevalence of AD seems to be related to westernized lifestyles and dietary patterns.

OBJECTIVE

The aim of this study was to evaluate the dietary patterns and nutrient intake of patients with AD.

METHODS

The study population consisted of 50 children with AD who visited the Department of Dermatology at Kangnam Sacred Heart Hospital, Seoul, Korea from May 2008 to May 2009. Physical condition and calorie intake were evaluated using the Eczema Area and Severity Index score and Food Record Questionnaire completed by the subjects, and the data were analyzed using the Nutritional Assessment Program Can-pro 3.0 (The Korean Nutrition Society, 2005) program to determine the gap between the actual ingestion and average requirements of 3 major nutrients (i.e. carbohydrates, proteins, and lipids), vitamins (i.e. A, B, C, and E), niacin, folic acid, calcium, iron, phosphorus, and zinc in all subjects.

RESULTS

The intake rate of proteins was 18.02% (recommended dietary allowance [RDA], 7%~20%), of carbohydrates was 67.7% (RDA, 55%~70%), and of lipids was 14.24% (RDA, 15%~30%). Thirty-one subjects (62%) showed deficiency of folic acid, and 21 subjects (42%), of iron supplements.

CONCLUSION

Essential nutrient intake tends to be lower in AD patients than in healthy subjects, and this low intake is closely related to the severity of AD.

Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies

Atopic dermatitis is a common and chronic, pruritic inflammatory skin condition that can affect all age groups. This evidence-based guideline addresses important clinical questions that arise in its management. In this second of 4 sections, treatment of atopic dermatitis with nonpharmacologic interventions and pharmacologic topical therapies are reviewed. Where possible, suggestions on dosing and monitoring are given based on available evidence.

The short stature in atopic dermatitis patients: are atopic children really small for their age?

Background

Short stature is sometimes seen in children with atopic dermatitis (AD); however, the topic has never been studied systematically. Objective: The aim of this study was to show whether AD itself affects stature in children and to evaluate the influence of other relevant factors such as genetic background, diet restrictions, and sleep disturbance on the stature of children with AD.

Objective

The aim of this study was to show whether AD itself affects stature in children and to evaluate the influence of other relevant factors such as genetic background, diet restrictions, and sleep disturbance on the stature of children with AD.

Methods

The study population included Korean children 7 to 8 years of age who live in one district of Seoul, Korea. We used a questionnaire as an investigating tool to survey genetic backgrounds, environmental factors, and comorbidities. Student's t-test and linear regression were employed for statistical analysis.

Results

In univariate analysis, the average stature in the AD group was short compared with the normal control group. Parental stature, dietary habit, and sleep patterns were also relevant factors with respect to stature. However, in multivariate analysis, AD itself had no influence on stature. Significant correlations were found for such factors as parental height, sleep disturbance, presence of asthma, and dietary restrictions, in decreasing magnitude.

Conclusion

These results suggest that AD itself may not be the causative factor for short stature in children with AD. Therefore, consideration of other relevant factors related to short stature in patients with AD will be important for the proper management of the disease.

Nutritional aspects in diagnosis and management of food hypersensitivity-the dietitians role

Many common foods including cow's milk, hen's egg, soya, peanut, tree nuts, fish, shellfish, and wheat may cause food allergies. The prevalence of these immune-mediated adverse reactions to foods ranges from 0.5% to 9% in different populations. In simple terms, the cornerstone of managing food allergy is to avoid consumption of foods causing symptoms and to replace them with nutritionally equivalent foods. If poorly managed, food allergy impairs quality of life more than necessary, affects normal growth in children, and causes an additional economic burden to society. Delay in diagnosis may be a further incremental factor. Thus, an increased awareness of the appropriate procedures for both diagnosis and management is of importance. This paper sets out to present principles for taking an allergy-focused diet history as part of the diagnostic work-up of food allergy. A short overview of guidelines and principles for dietary management of food allergy is discussed focusing on the nutritional management of food allergies and the particular role of the dietitian in this process.

Comorbidity in Atopic Dermatitis

The negative impact of atopic dermatitis (AD) often extends beyond the skin. Children with AD experience increased rates of infectious, mental health, and allergic diseases compared to their non-atopic peers. The mechanisms underlying these associations remain elusive. New insights from genetic and epidermal research pinpoint the skin barrier as a primary initiator of AD. Epicutaneous sensitization represents an intriguing new model which links a disrupted skin barrier to the later development of IgE-mediated diseases in patients with AD. Recent epidemiological studies have identified new comorbidities linked to AD as well, including several mental health disorders and obesity. This manuscript reviews the recent literature regarding both classic and newly described AD comorbidities.

Corticosteroids' effect on the height of atopic dermatitis patients: a controlled questionnaire study

To investigate if children treated with topical corticosteroids have a significantly shorter height than the height of children not treated with corticosteroids and to see if corticosteroids affect the ability for treated children to meet growth potential defined as midparental height. Parents of patients attending the UNC's Dermatology clinic completed the survey. The patient's height and siblings' heights were measured by staff. Parents' heights were self reported as were the child's diagnosis of atopic dermatitis, and duration of use of corticosteroids. The patient's height was standardized using CDC charts. Additionally, the midparental height was calculated and standardized. The difference between present and predicted standardized heights was calculated; 151 surveys yielded data on 83 girls and 63 boys (ages 2-21 yrs). The standing height and the difference in standing height and midparental scores were not significantly different among: (i) children with and without atopic dermatitis; and (ii) children treated and not treated with corticosteroids. The overall height of children examined in this survey who were treated with topical corticosteroids appears to be unaffected.

A systematic review of the safety of topical therapies for atopic dermatitis

BACKGROUND

The safety of topical therapies for atopic dermatitis (AD), a common and morbid disease, has recently been the focus of increased scrutiny, adding confusion as how best to manage these patients.

OBJECTIVES

The objective of these systematic reviews was to determine the safety of topical therapies for AD.

METHODS

Databases searched included: OVID Medline, Medline In-Process and Other Non-Indexed Citations, Embase, and the Cochrane Central Register of Controlled Trials. In addition to the articles identified by this search, investigators were also referred to a list of links (most recently updated 25 September 2005) to recent Food and Drug Administration (FDA) studies, reports and meetings regarding the topical calcineurin inhibitors for further potential references. Only fully published papers available in English and data obtained from FDA sites were included. Furthermore, the criteria for inclusion and exclusion for each systematic review were further evaluated at a meeting of all of the content and evidence-based medicine experts participating in this process and alteration of the inclusion criteria was done at that time when it was felt necessary to avoid inclusion of lower-quality data in the review. Qualitative review of the abstracted data was performed and reviewed at a meeting of all of the content and evidence-based medicine experts.

RESULTS

While systemic exposure to these topical agents does occur, physiological changes appear to be uncommon and systemic complications rare and have only been found with use of topical corticosteroids.

CONCLUSIONS

Based on the data that are available the overall safety of AD therapies appears to be good with the only documented systemic side-effects of therapy those occasionally seen with use of topical corticosteroids.

Evaluation of diet and growth in children with and without atopic eczema: follow-up study from birth to 4 years

Current research into dietary factors contributing to the development of allergic diseases is directed towards new active approaches instead of passive elimination diets. The present study aimed to investigate the explanatory role of the diet in a probiotic intervention study on the appearance of atopic eczema (AE) in childhood and the safety of perinatal supplementation with probiotics (Lactobacillus rhamnosus strain GG; ATCC 53 103). A prospective follow-up study from birth to 48 months of children (n 159) with a family history of allergic disease was carried out. Outcome measures included growth, dietary intake assessed with 4 d food diaries and their association with AE by logistic regression models. Increased intakes of retinol, Ca and Zn, with perinatal administration of probiotics, reduced the risk of AE, whilst an increase in intake of ascorbic acid increased the likelihood of AE. Perinatal administration of probiotics was safe, as it did not influence the height (mean difference 0·04 (95 % CI −0·33, 0·40) sd scores, P=0·852) or the weight-for-height (mean difference −3·35 (95 % CI −7·07, 0·37)%, P=0·077) of the children at 48 months with and without perinatal administration of probiotics. Up to 48 months, AE did not affect height (mean difference −0·05 (95 % CI −0·42, 0·33) sd scores, P=0·815), but mean weight-for-height in children with AE was −5·1 % (95 % CI −8·9, −1·2 %) lower compared with children without (P=0·010). The joint effects of nutrients and probiotics need to be considered in active prevention and management schemes for allergic diseases.

Pattern of growth and adiposity from infancy to adulthood in atopic dermatitis

BACKGROUND

Impaired linear growth has been reported in children with atopic dermatitis (AD) but the pattern of growth in height and weight through childhood and adolescence has not been described.

OBJECTIVES

To define the pattern of linear growth and adiposity in AD from early childhood through to adult life.

PATIENTS AND METHODS

Growth measurements of 70 male and 40 female patients with AD followed through childhood and adolescence were studied retrospectively and compared with the 1990 U.K. normal values. Height, weight and body mass index (BMI) were converted to standard deviation scores (SDS). Regression analysis examined whether the mean trend was different from zero.

RESULTS

While dermatitis was the predominant atopic problem in all 110 patients, 92 had a history of asthma which was mild in 85 of 92. Regression analyses showed that the trends in height, weight and BMI SDS for AD patients were significantly different from zero and also different between males and females. Both sexes were short and relatively overweight from early childhood, a trend that was more pronounced in males than females. At 5 years (school entry), the 50th centile BMI of male (but not female) patients was 0.44 kg m(-2) higher than the reference population but height and weight were lower. The age at adiposity rebound in AD males and females was 0.8 year and 0.7 year later than the U.K. population (6.2 years vs. 5.4 years and 6.2 years vs. 5.3 years, respectively). AD patients attained peak height velocity later than the 1990 U.K. population (males 16.0 years vs. 13.5 years, P = 0.0002; females 13.4 years vs. 11.0 years, P = 0.008). In addition, males had greater mean gain in height during late adolescence (12.2 vs. 8.8 cm, P = 0.03) and were shorter as young adults (170.9 vs. 177.6 cm, P = 0.0005).

CONCLUSIONS

Our patients with AD were relatively overweight very early but had a later adiposity rebound, were short in childhood and had a delayed adolescent growth spurt. Serial growth measurements should be done on all children with troublesome AD and can be helpful in counselling about the growth prognosis.

Study of growth in prepubertal asthmatics

OBJECTIVE

The aim of this pilot study was to assess whether long standing asthma affects growth in prepubertal Egyptian children before initiation of long-term corticosteroid therapy.

METHODS

Children with asthma were divided into two groups according to asthma severity, moderate (n=24) and severe (n=14) and were compared for their physical and skeletal growth with a control group (n=15) using standard deviation score (SDS) and one-way ANOVA (analysis of variance) test.

RESULTS

No statistically significant differences were found between various growth parameters (weight, height, BMI, upper segment lower segment ratio, and skin fold thickness in asthmatic and normal children, although a positive correlation was found between the age at which the asthma presented and the height in all asthmatic children, r= 0.288, p= 0.036. The bone age standard deviation scores (SDS) were 0.97 mean, -0.165 and -0.572 for controls, moderate and severe asthmatics respectively (P< 0.05), and significant inter group difference between the 2 asthmatic groups (moderate and severe) and the controls was found.

CONCLUSION

The authors conclude that there was no significant major effect of asthma per se on growth parameters in children, but that skeletal maturation was influenced by long standing asthma.

Management of food allergy: vitamins, fatty acids or probiotics?

The dietary approach to allergic disease in infancy is evolving from passive allergen avoidance to active stimulation of the immature immune system, the aim of which is to support the establishment of tolerance. This may include probiotics providing maturational signals for the gut-associated lymphoid tissue and by balancing the generation of pro and anti-inflammatory cytokines in addition to their capacity to reduce the dietary antigen load by degrading and modifying macromolecules. Probiotics have also been shown to reverse the increased intestinal permeability characteristic of children with food allergy and to enhance specific IgA responses frequently defective in children with food allergy. The promotion of gut barrier functions by probiotics also includes the normalization of the gut microecology, alterations in which have been demonstrated in allergic individuals. Dietary lipids, especially long-chain polyunsaturated fatty acids, regulate immune function and may modify the adherence of microbes in the mucosa thereby contributing to host-microbe interactions. The properties of specific dietary compounds in optimal combinations and the joint effects of nutrients can be exploited in the development of specific prophylactic and therapeutic interventions. To meet these targets, rigorous scientific effort is required to elucidate how the food matrix and the dietary content impacts on the complex cascade of interrelated immunological mechanisms in food allergy.

Eumovate (clobetasone butyrate 0.05%) cream: a review of clinical efficacy and safety

Topical steroid creams and ointments have been available as over-the-counter (OTC) medications for the self treatment of acute dermatitis and other steroid responsive skin disorders for more than ten years. Despite earlier fears, widespread availability and use of these creams is not associated with clinically significant adverse effects. In dermatological practice, hydrocortisone 1% remains the mainstay of treatment for facial eczema, but it is often not effective in eczema affecting other body areas. Eumovate(TM) (clobetasone butyrate 0.05%) cream has recently been made available as a pharmacy medication for the short-term management of acute eczema and allergic dermatitis by adults and children aged 10 or older, based on evidence derived from clinical trials involving over 3500 patients. This review summarises the key efficacy and safety data derived from 29 clinical trials and the post-licensing pharmacovigilance safety information, which supported the reclassification of this product for OTC use. These data show clobetasone butyrate 0.05% is more effective than 1.0% hydrocortisone in the treatment of eczema and more effective than flurandrenolone 0.0125% (p=0.01%) and a potent topical steroid hydrocortisone butyrate (p<0.05), in the treatment of psoriasis. A review of the effect of topical steroids on skin thickness concluded that, following short term application, there was no clinically significant difference between hydrocortisone 1.0% and clobetasone butyrate 0.05% in terms of potential for skin thinning. Similarly, even under extreme conditions, clobetasone butyrate 0.05% has negligible systemic absorption and has almost no effect on HPA axis function.

Paediatric atopic dermatitis in Perth general practice

Ninety-seven Perth general practitioners completed a self-administered postal questionnaire that aimed to examine their caseload and management practices for childhood atopic dermatitis (AD). General practitioners saw a median of two new cases and three follow-up consultations per month for childhood AD, and referred a median of 10% of cases to a specialist, usually a dermatologist. Most (77%) recommended emollients for all patients, but only 21% specifically reported advising their use immediately after bathing. Sixty-one percent would use topical corticosteroids in all or most patients, but cream preparations were more commonly used (58%) than ointments (40%). Atrophy was rated as a common or very common side-effect of topical corticosteroid therapy by 23% of general practitioners. Twenty-six percent reported using oral corticosteroids in children with AD. Dietary changes would be recommended in at least a few AD patients by 79% of general practitioners, and 31% would recommend a change from cow's milk to soy in the absence of a history of dietary triggers. We conclude that general practitioners appeared generally well informed about AD management. However, dermatologists, through targeted education, may be in a position to help general practitioners further improve outcomes for these patients.

Prospective, controlled, multi-center study on the effect of an amino-acid-based formula in infants with cow's milk allergy/intolerance and atopic dermatitis

Cow's milk allergy/intolerance is treated by complete avoidance of cow's milk proteins. Because cow's milk is an important food for infants, its avoidance may lead to an increased risk of growth impairment. Whilst there is evidence for the beneficial effects of extensively hydrolyzed cow's milk formulate (eHF) in infants with cow's milk allergy/intolerance, little is known about the effects of amino-acid-based formulae (AA) in such infants. We therefore performed a prospective, controlled, multi-center trial to study the efficacy of AA in comparison with eHF, on the growth and clinical symptoms of 73 infants (median age 5.7 months) with cow's milk allergy/intolerance and atopic dermatitis. Cow's milk allergy/intolerance was proven in all infants by double-blind, placebo-controlled food-challenge. We observed a significant improvement in the SCORAD index in both groups, from a mean of 24.6, at entry, to a mean of 10.7 (p < 0.0001) after 6 months. In the AA group there was a significant increase in the length standard deviation score (p < 0.04), whilst there was no difference in the eHF group. The weight-for-length values were stable in both groups. The energy intake during the study was similar in both groups. Both an AA and eHF resulted in a significant clinical improvement in infants with an early onset of symptoms of cow's milk allergy/intolerance. Feeding an AA resulted in improved growth compared with feeding eHF, despite similar dietary intakes, and may therefore be considered as a beneficial alternative in infants with severe cow's milk allergy intolerance.

Topical corticosteroid phobia in patients with atopic eczema

Topical corticosteroids are widely prescribed by dermatologists caring for patients with atopic eczema. Patients' fears about using topical corticosteroids may have important implications for compliance with treatment. We carried out a questionnaire-based study of 200 dermatology outpatients with atopic eczema (age range 4 months-67.8 years) to assess the prevalence and source of topical corticosteroid phobia. We also questioned patients on their knowledge of the potencies of different topical corticosteroids. Overall, 72.5% of people worried about using topical corticosteroids on their own or their child's skin. Twenty-four per cent of people admitted to having been non-compliant with topical corticosteroid treatment because of these worries. The most frequent cause for concern was the perceived risk of skin thinning (34.5%). In addition, 9.5% of patients worried about systemic absorption leading to effects on growth and development. The most commonly used topical corticosteroid was hydrocortisone, yet 31% of patients who used this preparation classified it as either strong, very strong or did not know the potency. Only 62.5% of the 48 patients who had used both Dermovate (Glaxo) and hydrocortisone in the past were able to correctly grade Dermovate as being more potent than hydrocortisone. The most common source of patient information regarding topical corticosteroid safety was the general practitioner. Although skin thinning and systemic effects can develop very occasionally in people using topical corticosteroids, the concern expressed by people using them seems out of proportion in relation to the evidence of harm. This study highlights the need for provision of better information and education to patients and possibly general practitioners regarding the safety, potency and appropriate use of topical corticosteroids.

Gastrointestinal symptoms in patients with asthma

AIMS

Minor gastrointestinal abnormalities have been reported in children with asthma, but the prevalence of gastrointestinal symptoms in these children has not been studied.

METHODS

75 children with bronchial asthma and an age and sex matched control group were recruited. Parents completed a questionnaire on gastrointestinal symptoms and on asthma. Weight and height were measured; a clinical evaluation of asthma was undertaken and skin prick tests were performed.

RESULTS

Children with asthma had a significantly greater frequency of gastrointestinal symptoms, particularly diarrhoea, vomiting, and abdominal pain, than did controls. Gastrointestinal symptoms were slightly more common in children with atopic symptoms other than asthma, or with positive skin prick tests to foods. There was no association between current gastrointestinal symptoms and medications or attacks of asthma.

CONCLUSIONS

The occurrence of gastrointestinal symptoms appears to be common in children with asthma. These symptoms might be caused by an atopic gastroenteropathy, which might play a part in the pathogenesis of asthma in some cases.

Linear growth in prepubertal children with atopic dermatitis

OBJECTIVE

To define the evolution of prepubertal growth in atopic dermatitis and the factors influencing that growth pattern.

METHODS

Height and height velocity over two years, weight, triceps and subscapular skin fold thickness, and bone age were assessed in 80 prepubertal patients with atopic dermatitis and a control group of 71 healthy prepubertal school children.

RESULTS

Height standard deviation scores (SDS) and height velocity SDS did not differ between patients and controls, and were not influenced by body surface area affected by atopic dermatitis, topical glucocorticoid potency, or coexisting asthma. However, height SDS (r = -0.37) and height velocity SDS (r = -0.31) correlated inversely to age in patients but not in controls. A greater proportion (z = 2.84) of patients than controls had year 2 height velocity SDS less than -1.96. Patients had a mean delay in bone age of 0.22 years and 0.41 years at the beginning of year 1 and year 2 of the study, respectively. The delay in bone age correlated positively with age (r = 0.39) and duration of atopic dermatitis (r = 0.39), and negatively with height SDS (r = -0.51) and height velocity SDS (r = -0.38).

CONCLUSIONS

Prepubertal children with atopic dermatitis are not short compared with controls. However, as they approach the teenage years their height velocity decreases, the proportion of children with extremely low height velocity increases, and the delay in bone age increases. These features are consistent with the pattern of growth seen in people with constitutional growth delay.