Introduction: prevalence and prognosis

Atopic eczema has been defined as ‘an inflammatory disease, characterized by an itchy, erythmatous, poorly demarcated skin eruption, which has a predilection for the skin creases’ (Williams, 1994, cited in Charman, 1999). Symptoms include intractable itching, skin damage and soreness. Where it lasts into adulthood it becomes a lifelong disease where the typical pattern is of a labile course resulting in some uncertainty and insecurity. Eczema or atopic dermatitis (AD) is a common childhood condition. It usually presents during the first year of life (Barnetson & Rogers, 2002) and in 60–70% of cases clears up during teenage years, although relapses may occur (Charman, 1999). The remaining sufferers are older children, adolescents and adults with a chronic skin condition. Symptoms can be mild or severe, and if severe can have both physical and psychological repercussions for the sufferer and the whole family.

Eczema is probably the most common of the atopy diseases to come to the attention of psychologists and psychiatrists for treatment and may co-exist with other atopy disorders in up to 48% of cases (Diepgen & Fartasch, 1992). Eczema affects 15–20% of children in the United Kingdom and 2–3% of adults (Charman, 1999), with a rising trend of incidence of twofold to threefold over the past three decades (Barnetson & Rogers, 2002). A large cross-sectional survey of 715 033 children and adolescents, in 56 countries, revealed a range of prevalence rates from less than 2% in Iran to over 17% in Nigeria.