title: An exploratory prospective observational study of environmental factors exacerbating atopic eczema in children.
abstract: BACKGROUND
  Possible exacerbating factors are a major concern of parents of children with atopic eczema (AE). However, there is minimal evidence for their direct role in leading to disease flares.
  
  
  OBJECTIVE
  To assess the association between 'trigger factors' and disease flares in AE.
  
  
  METHODS
  Twenty-five children with AE were recruited. Participants completed diaries, recording severity and exposure to potential exacerbating factors (18 variables) over 28 days. Severity was assessed at baseline and study completion. The relationship between severity and exposures was assessed.
  
  
  RESULTS
  At episode level, on the day of exposure (lag 0), hot weather correlated to increased scratch scores (P=0.043). At a lag of 2 days after exposure, damp weather was associated with raised scratch scores (P=0.027). At lag 3 days, elevated scratch scores were associated with sweating and stress (P=0.029 and 0.019, respectively). Outside damp was associated with elevated scores (P=0.001) at lag 4. Multivariate analysis of all significant variables showed that only damp at lag 4 was significantly associated with flares (P=0.039).
  
  
  CONCLUSIONS
  This study suggests association between stress, damp and heat and disease flares. These findings need to be studied over a longer period, using objective exposure measures.
authors.affiliation: Department of Dermatology, South Infirmary-Victoria Hospital, Old Blackrock Road, Cork, Ireland, and Trent Research and Development Support Unit, University of Nottingham Medical School, UK. sinead.langan@nottingham.ac.uk
authors.forename: S M
authors.initials: SM
authors.lastname: Langan
authors.forename: J F
authors.initials: JF
authors.lastname: Bourke
authors.forename: P
authors.initials: P
authors.lastname: Silcocks
authors.forename: H C
authors.initials: HC
authors.lastname: Williams
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000209:etiology*; D005260:Female; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D006813:Humidity; D007223:Infant; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications; D013696:Temperature