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STUDIES
Year : 2005  |  Volume : 50  |  Issue : 3  |  Page : 125-128
Correlation of the severity of atopic dermatitis with growth retardation in pediatric age group


1 Paediatric Dermatology and Growth Clinics, Indian Statistical Institute, Kolkata, India
2 Department Of Biophysics, Indian Statistical Institute, Kolkata, India

Correspondence Address:
Sandipan Dhar
Paediatric Dermatology and Growth Clinics, Indian Statistical Institute, Kolkata
India
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Source of Support: None, Conflict of Interest: None


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   Abstract 

Evidence of growth retardation was recorded in cases of severe atopic dermatitis before the advent of corticosteroid therapy and can therefore be attributed to the disease. The present study is an attempt to confirm the validity of such claims in Indian scenario. A total of 100 children with atopic dermatitis and 100 age and sex matched controls were evaluated for growth status and compared at the department of pediatric dermatology, Institute of c0 hild h0 ealth. Significant proportion of children with atopic dermatitis showed growth retardation with respect to their weight and height as compared to the controls. Statistically significant association was observed to exist between growth retardation with both the surface area of involvement of the disease and the severity of atopic dermatitis while no such association was found to exist with either sex or personal history of atopy .Our study shows that growth retardation occurs more frequently in patients with atopic dermatitis as compared to nonatopic children from the same population. This shows that there may be an association between growth and the disease process. In our study we also found that the growth retardation occurring in cases of atopic dermatitis is associated with the severity of the disease as well as the surface area of involvement.


Keywords: Atopic dermatitis, Growth


How to cite this article:
Dhar S, Mondal B, Malakar R, Ghosh A, Gupta AB. Correlation of the severity of atopic dermatitis with growth retardation in pediatric age group. Indian J Dermatol 2005;50:125-8

How to cite this URL:
Dhar S, Mondal B, Malakar R, Ghosh A, Gupta AB. Correlation of the severity of atopic dermatitis with growth retardation in pediatric age group. Indian J Dermatol [serial online] 2005 [cited 2019 Oct 20];50:125-8. Available from: http://www.e-ijd.org/text.asp?2005/50/3/125/18923



   Introduction Top


Atopic dermatitis (AD) is an itchy, chronic or chronically relapsing inflammatory skin condition. The rash is characterized by itchy papules (occasionally vesicles in infants) which become excoriated and lichenified and typically have a flexural distribution. The eruption is frequently associated with other atopic conditions in individual or other family members. [1],[2],[3],[4] Growth impairment can be associated with atopic dermatitis.5 Evidence of growth retardation was recorded in cases of severe atopic dermatitis before the advent of corticosteroid therapy and can therefore be attributed to the disease. The present study is an attempt to find out the association, if any, of growth patterns in patients of atopic dermatitis with their disease.


   Materials and methods Top


The study was carried out in the Pediatric Dermatology and Growth clinics of the Institute of Child Health, Kolkata. A total of one hundred children attending the outpatient department of the Institute, who were diagnosed to have atopic dermatitis, were enrolled in the study. Patients having atopic dermatitis along with other systemic diseases which, could cause growth retardation were excluded from the study. One hundred age and sex matched children without any personal or family history of atopy were taken as controls.

For every patient a detailed history was taken regarding the age at onset, duration of present illness, personal and/or family history of atopic disorder(s) and recorded in a special proforma.

A thorough clinical examination was carried out to obtain the surface area of involvement of the disease (using Wallace's rule of nine) and the severity of the disease (using "SCORAD" index).

SCORAD index is a scoring system designed by the European Task Force on atopic dermatitis to measure the severity of atopic dermatitis. SCORAD index has five clinical signs viz., erythema, vesiculation, excoriation, crusting and edema. Each of these signs has four scoring points ranging from 0 to 3; O=absent; 1=mild; 2=moderate; 3=severe.

For recording growth status of the child "cross sectional method" was adapted where the child was evaluated only once at a given age. Only weight and height was recorded and those were matched with weight and height percentile of the "National centre of health statistics" (NCHS), USA.

Weight was recorded using a spring weighing machine. In children below 2 years of age length was recorded using an infantometer while in children above 2 years standing height was recorded using a stadiometer.


   Results Top


Of the one hundred patients with atopic dermatitis included in our study, the baseline demographic analysis showed an age distribution ranging from 1 month 1 day to 13years, with the mean and the median ages being 4.94years and 3.5 years respectively. Sexwise distribution showed 57 males and 43 females with the male to female ratio being 1.3:1.

When the weight and height of the patients and the controls were matched with that of the NCHS for their respective age and sex, 42% of the patients had weight below the 3rd percentile and 34% had height below 3rd percentile for age and sex while none of the controls had weight or height below the 3rd percentile mark. This clearly showed a significant occurrence of growth retardation as depicted by height and weight in our present study in cases of children with atopic dermatitis.

The association between sex, personal history of atopy, surface area of involvement and severity of atopic dermatitis (SCORAD Index) with growth retardation was calculated by using contingency Chi-squared test. For this, each of the above parameter is used as row variable and compared to both the proportion of cases with weight below 3rd percentile and that of height below 3rd percentile separately. The probability for each of the Chi-square value was calculated.

The results showed that there was no significant association between sex and personal history of atopy with the proportion of cases with weight below 3rd percentile or that of the cases with height below the 3rd percentile. Statistically significant association was observed to exist between the surface area of involvement and the severity of atopic dermatitis with both the proportion of cases with weight below 3rd percentile and that of the cases with height below 3rd percentile.

Thus the results showed the existence of a significant association of growth retardation with both the surface area of involvement of the disease and the severity of atopic dermatitis while no such association was found to exist with either sex or personal history of atopy.


   Discussion Top


Growth impairment in children with atopic dermatitis has been associated with the disease process in a number of studies.

Kristmundsdottir, et al, studied growth in 89 children with atopic eczema aged 1-16 years. Nine (10%) had a standing height below the 3rd percentile. Both boys and girls had significantly reduced sitting height but normal subischial leg length, and both sexes had significantly delayed skeletal maturity scores. Impaired growth was particularly associated with widespread eczema.[5] In a controlled study by questionnaire in London, the parents of 128 children with atopic eczema and 117 healthy control children responded to a questionnaire that included measurement of their own and their children's heights at home after standardised instructions. When cases and controls were compared, there was no significant difference in parental height but the children with eczema were significantly shorter than the healthy control group. This difference remained significant when children with associated asthma were excluded from the analysis.[6] David T J in Department of Child Health, University of Manchester, England observed that short stature, defined as a standing height below the third percentile when corrected for mid-parental height, was found in 22% of children with atopic eczema troublesome enough to cause regular attendance at hospital. The cause of this short stature is unknown in most cases, but contributory factors comprise topical steroid therapy, co-existing asthma, inhaled or oral steroid therapy, malnutrition due to unsupervised dietary restriction, loss of sleep, and vitamin D deficiency. If the short stature is simply associated with severe disease and not attributable to steroid therapy, and if the disease remits before puberty, then catch-up growth can be expected. If the short stature is caused by steroid therapy. or if severe disease persists into adult life, then permanent growth stunting may occur. These studies reinforce the validity of our observation that a statistically significant association exists between the growth and the disease process in children with atopic dermatitis.

In a study in the Department of Child Health, University of Manchester, Massarano AA found that height SD scores were significantly correlated with the surface area of skin affected by eczema. The mean height of 41 patients with less than 50% of their skin surface affected (group I) was normal (mean SD score 0.11). The 27 children with more than 50% of their skin affected (group II) were significantly shorter (SD score 0.83) and were also short allowing for their parental target height. The predicted heights were also normal in group I but were lower than expected in group II. The growth of children with eczema affecting less than 50% of the skin surface area appears to be normal, and impaired growth is confined to those with more extensive disease [8] Myoshi M, et al, in the department of Pediatrics, Himeji Red Cross Hospital studied the association of growth with the severity of atopic dermatitis. The study deals with the physical growth of 38 infants with atopic dermatitis and 11 controls. The SD scores of height and weight in the severe group was significantly lower than those of mild and moderate groups.[9].These studies reiterate the findings of the present study showing a positive association to exist between the occurrence of growth retardation in children with atopic dermatitis and the severity of the disease and also with the surface area of involvement.

No statistically significant association was found between the occurrence of growth retardation in children with atopic dermatitis and the sex of the child or with any personal history of atopy. In an earlier Indian study by Saraswat, et al growth impairment was found in preschool children (up to 5 years of age) with pure atopic dermatitis, the magnitude of growth impairment being more in boys than girls. However, no clearcut co­rrelation was found between the severity measured by SCORAD index or disease extent in terms of body surface area involved with respect to either height or weight of the children. This probably reflects the difference in severity of AD, growth pattern and other associated factors in the population studied .Therfore a large multicentric study is needed to address the issue of growth pattern and its relation with severity AD in Indian children.

Therefore the present study shows that growth retardation does occur in children with atopic dermatitis much more frequently as compared to the normal population and this growth retardation is associated with the severity of the disease and the surface area involvement.


   Conclusion Top


Our study shows that growth retardation occurs more frequently in patients with atopic dermatitis as compared to nonatopic children from the same population. This shows that there may be an association between growth and the disease process. In our study we also found that the growth retardation occurring in cases of atopic dermatitis is associated with the severity of the disease as well as the surface area involvement. Sex or personal history of other atopic conditions (bronchial asthma or allergic rhinitis) in patients of atopic dermatitis does not have any association with growth retardation



 
   References Top

1.Ohman S, Johansson SGO .Immunoglobins in atopic dermatitis, with special reference to IgE. Acta Derm Venereol (Stockh) 1974; 54:193-202.  Back to cited text no. 1    
2.Ohman S, Johansson SGO. Allergen specific IgE in atopic dermatitis. Acta Derm Venereol (Stockh) 1974; 54:283-90.  Back to cited text no. 2    
3.Jones HE, Inouye JC, McGerity JL, et al. Atopic disease and serum immunoglobin E. Br J Dermatol 1975;92:17-25.  Back to cited text no. 3    
4.Uehara M .Family background of respiratory atopy: a factor of serum IgE elevation in atopic dermatitis. Acta Derm Venereol Suppl (Stockh) 1989; 144:78-82.  Back to cited text no. 4    
5.Kristmundsdottir F, David TJ. Growth impairment in children with atopic eczema. J R Soc Med 1987 (Jan); 80(1):9-12.  Back to cited text no. 5    
6.Pike MG, Chang CL, Atherton DJ, Carpenter RG, Preece MA. Growth in atopic eczema: a controlled study by questionnaire. Arch Dis Child 1989 (Nov); 64(1 1):1566-9.  Back to cited text no. 6    
7.David TJ. Short stature in children with atopic eczema. Acta Derm Venerol Suppl (Stockh).1989; 144:41-4.  Back to cited text no. 7    
8.Massarano AA, Hollis S, Devlin J, David TJ. Growth in atopic eczema.Arch Dis Child1993 (May); 68(5):677-9.   Back to cited text no. 8    
9. Miyoshi M, Sakurai T, Kodama S. Growth impairment in infants with atopic dermatitis. Arerugi 1996;(Jan) 45(1):41-8.  Back to cited text no. 9    




 

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    Abstract
    Introduction
    Materials and me...
    Results
    Discussion
    Conclusion
    References

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