Journal of the American Academy of Dermatology
Volume 61, Issue 5 , Pages 806-812, November 2009

Prevalence of adult atopic dermatitis among nursing staff in a Taiwanese medical center: A pilot study on validation of diagnostic questionnaires

  • Cheng-Che E. Lan, MD, PhD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Chien-Hung Lee, PhD

      Affiliations

    • Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Yi-Wei Lu, MS

      Affiliations

    • Graduate Institute of Healthcare Administration, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Chi-Ling Lin, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Hsiu-Hui Chiu, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Department of Dermatology, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
    • ,
  • Tsai-Ching Chou, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Stephen Chu-Shung Hu, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Ching-Ying Wu, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Yi-Ying Kim, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Hui-Ju Yang, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Yin-Chun Chen, MD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Ching-Shuang Wu, PhD

      Affiliations

    • Department of Medical Laboratory Science and Biotechnology, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Hui-Yu Hsu, MS

      Affiliations

    • Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Sheng-Lan Shieh, BS

      Affiliations

    • Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • ,
  • Hsin-Su Yu, MD, PhD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • ,
  • Ying-Chin Ko, MD, PhD

      Affiliations

    • Department of Public Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Division of Environmental Health and Occupational Medicine, National Health Research Institutes, Zhunan, Taiwan
    • ,
  • Gwo-Shing Chen, MD, PhD

      Affiliations

    • Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
    • Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Center of Excellence for Environmental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
    • Corresponding Author InformationReprint requests: Gwo-Shing Chen, MD, PhD, Department of Dermatology, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd, Kaohsiung, Taiwan.

Accepted 25 March 2009. published online 13 July 2009.

Background

Atopic dermatitis (AD) is a chronic, relapsing dermatosis. Previous studies have focused mostly on pediatric patients, and investigations emphasizing adult AD have been limited.

Objective

We set out to determine the 1-year prevalence and evaluate the validity of the International Study of Asthma and Allergies in Childhood (ISAAC) and United Kingdom Working Party (UKWP) AD questionnaires of adult AD in Taiwan.

Methods

We conducted a cross-sectional study among nursing staff at a university hospital. The 1-year prevalence of AD was assessed by ISAAC and UKWP questionnaires. Subsequently, the dermatologists' diagnosis based on Hanifin and Rajka criteria was used as a reference for validation.

Results

The overall response rate was 92.9%, equivalent to 1131 complete questionnaires. Ninety adult patients with AD (8%) were identified by dermatologists' diagnosis whereas ISAAC identified 107 (9.5%); sensitivity and specificity were 36.7% and 92.9%, respectively. UKWP identified 42 (3.7%) patients with AD; sensitivity and specificity were 42.2% and 99.6%, respectively. Using the receiver operating characteristic curve analysis, the UKWP criteria performed significantly better than its ISAAC counterpart. Further analysis indicated that modification of these criteria resulted in significant improvement in their diagnostic efficacy. More specifically, modified ISAAC showed 90.0% and 55.2% sensitivity and specificity, respectively, whereas modified UKWP demonstrated 82.2% and 94.2% sensitivity and specificity, respectively.

Limitation

Most of the study subjects were female with a high educational background.

Conclusion

Currently available questionnaire instruments do not perform well in the identification of adult patients with AD. Modification of the original questionnaires may allow for future large-scale epidemiologic studies.

Key words: adult atopic dermatitis, diagnostic criteria, prevalence

Abbreviations used: AD, atopic dermatitis, AUC, area under curve, ISAAC, International Study of Asthma and Allergies in Childhood, NPV, negative predictive value, PPV, positive predictive value, ROC, receiver operating characteristic, RV, relative value, UKWP, United Kingdom Working Party

 

 Drs. Lan and Lee contributed equally to this work

 Supported by National Health Research Institute, Taiwan, NHRI-CN-PD9611P.

 Conflicts of interest: None declared.

PII: S0190-9622(09)00381-8

doi:10.1016/j.jaad.2009.03.035

Journal of the American Academy of Dermatology
Volume 61, Issue 5 , Pages 806-812, November 2009

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