CHAPTER ONE

INTRODUCTION

Atopic dermatitis (AD) is defined as a chronic inflammatory pruritic skin disease which occurs most frequently in children but can occur in adults and follows a relapsing course1. It is often associated with elevated serum IgE levels and a personal or family history of type I allergies, allergic rhinitis, and asthma1.

 The disease occurs in all age groups but is commoner in children2. It is slightly commoner in females than males though the difference has not been consistent3. It also occurs in all races. The disease is commoner in people living in urban areas and also in dry and cold areas4. Parental history of atopy or eczema is one of the strongest risk factors of the disease. Atopic dermatitis and atopy in general seem to be diseases of the advantaged classes5 with the prevalence being inversely related to the number of siblings6. The true prevalence of AD in the general population is imprecise as it varies between 10%-30%7. Infrequent remission, unpredictable course, newer treatment options, lack of uniform diagnostic criteria and nomenclature have been identified as strong limitations to determining its true prevalence. However studies from different parts of the world indicate that the prevalence of AD is rising. In Europe, there is a two-three fold increase in the disease over the past fifty years8 while about 10% of children are affected by this disease in the United States of America9. A similar picture was reported in Asia where in Japan there was a two-fold increase in childhood AD cases and a five-fold increase in adolescents10. The situation is not different in Australia with a current prevalence of 9.7%4. A rising prevalence was also reported in Africa for example in Nigeria, figures of 3, 3.5, 6.1 and 17% were reported4, 11-13. In 2004, Nnoruka in south-eastern Nigeria concluded that AD is currently on the increase particularly amongst infants and has created a cost burden for families with a prevalence of 8.5%14. The reason for the rising prevalence is unknown but environmental factors are thought to be responsible.

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