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Background The pathophysiology of seborrhoeic dermatitis (SebD) is complex and is likely to be related to an interplay of the microbial colonization of the skin and local immunity. There are also genetic components to the illness. At least two forms of SebD exist, infantile (ISebD), which has onset early in life, and SebD with later onset. Objectives We aimed to improve our understanding of SebD by evaluating whether maternal history of SebD is associated with increased risk of ISebD or childhood-onset SebD (CSebD, with onset after 5 years of life). Methods We performed a prospective cohort study of mother–child pairs using data from a large UK primary care electronic medical records database. Results We analysed 1 023 140 children with linked maternal data. The mean (SD) time of follow-up for the children was 10.2 (7.9) years for a total follow-up of more than 10 million person-years. Proportional hazards models [HRs (95% confidence intervals)] were used to examine the association between presence of SebD in mothers and SebD in the child. Maternal history of SebD was associated with development of SebD [1.99 (1.91–2.09)], ISebD [1.86 (1.74–1.99)] and CSebD [2.12 (1.97–2.29)] in their children. However, ISebD in a child was not associated with that child later developing CSebD [0.91 (0.82–1.01)]. Conclusions Maternal history of SebD is a risk factor for the development of SebD in children. While we cannot fully differentiate SebD risk due to mother's genetics (inheritance) from a newborn's environment, our results lend credence to the possible role of genetics in SebD. A child with ISebD does not appear to be at risk for developing CSebD. [ABSTRACT FROM AUTHOR]

Electronic health records hold great promise for clinical and epidemiologic research. Undertaking atopic eczema (AE) research using such data is challenging because of its episodic and heterogeneous nature. We sought to develop and validate a diagnostic algorithm that identifies AE cases based on codes used for electronic records used in the UK Health Improvement Network. We found that at least one of five diagnosis codes plus two treatment codes for any skin-directed therapy were likely to accurately identify patients with AE. To validate this algorithm, a questionnaire was sent to the physicians of 200 randomly selected children and adults. The primary outcome, positive predictive value for a physician-confirmed diagnosis of AE, was 86% (95% confidence interval = 80-91). Additional criteria increased the PPV up to 95% but would miss up to 89% of individuals with physician-confirmed AE. The first and last entered diagnosis codes for individuals showed good agreement with the physician-confirmed age at onset and last disease activity; the mean difference was 0.8 years (95% confidence interval = -0.3 to 1.9) and -1.3 years (95% confidence interval = -2.5 to -0.1), respectively. A combination of diagnostic and prescription codes can be used to reliably estimate the diagnosis and duration of AE from The Health Improvement Network primary care electronic health records in the UK.

BackgroundCase reports and cross-sectional studies suggest increased risks of cutaneous and non-cutaneous infections in eczema; this relationship needs to be assessed in large population-based studies with diagnostic confirmation. The objective was to examine associations between eczema and common childhood infections.MethodsIndividuals registered prior to age 18 in the Health Improvement Network, a UK general practice database, from 2003 to 2013 were included in this cohort study. We determined the association between eczema and selected infectious outcomes, including cutaneous (dermatophyte, herpes simplex virus, impetigo, molluscum contagiosum and warts), and non-cutaneous infections (otitis media, streptococcal throat infections, and pneumonia).ResultsEczema was diagnosed in 14.4% (95% confidence interval 14.4, 14.4), and the average age of eczema diagnosis was 7.94 years (7.91, 7.98). All of the infectious illnesses were more prevalent in those with eczema compared to those without, with adjusted odds ratios (95% confidence intervals) as follows: dermatophyte 2.54 (2.47-2.61), herpes simplex virus, 2.08 (2.04-2.12), impetigo 2.61 (2.53-2.68), molluscum contagiosum 3.11 (3.07-3.14) and warts 1.98 (1.96-2.00). For non-cutaneous outcomes, the odds of otitis media, streptococcal throat infections and pneumonia were 2.24 (2.22-2.25), 1.75 (1.69-1.82) and 1.27 (1.23,1.31). Associations were attenuated in sensitivity analyses.ConclusionSelected infectious illnesses were more prevalent in those with eczema versus those without, with the strength of association varying from 75% increase in streptococcal throat infections to a three-fold increased prevalence for molluscum contagiosum. Findings suggest there may be generalized immune dysfunction in eczema predisposing to increased risk of various infections, which is important for clinical management

Background Atopic dermatitis (AD) is a common inflammatory disease of the skin that begins early in life and can be lifelong. The purpose of our study was to evaluate whether fetal exposure and/or early-life exposure of a child to antibiotics increases the risk of early-onset AD. Objectives We hypothesize that antibiotic exposure in utero or early in life (e.g. first 90 days) increases the likelihood that children develop AD. Methods Utilizing a large, prospectively collected electronic medical records database, we studied the association of antibiotic exposure received in utero or very early in life and the relative risk of onset of AD in a population-based cohort study. Associations were estimated using proportional hazards models as hazard ratios (HRs) with 95% confidence intervals (CIs). Results The risk of AD in childhood was increased after in utero or early-life antibiotic exposure. For any in utero antibiotic exposure the HR (CI) was 1.38 (1.36–1.39). However, penicillin demonstrated the strongest association with AD for both in utero exposure [1.43 (1.41–1.44)] and for childhood exposure [1.81 (1.79–1.82)]. HRs were higher in children born to mothers without AD than in those with AD pointing to effect modification by maternal AD status. Conclusions Children born to mothers exposed to antibiotics while in utero had, depending on the mother's history of AD, approximately a 20–40% increased risk of developing AD. Depending on the antibiotic, children who received antibiotics early in life had a 40–80% increased risk of developing AD. Our study supports and refines the association between incident AD and antibiotic administration. It also adds population-based support to therapeutic attempts to treat AD by modifying the skin microbiome. [ABSTRACT FROM AUTHOR]

The goal of this multicentre study was to evaluate whether circulating endothelial precursor cells and microparticles can predict diabetic foot ulcer healing by the 16th week of care. We enrolled 207 subjects, and 40.0% (28.4, 41.5) healed by the 16th week of care. Using flow cytometry analysis, several circulating endothelial precursor cells measured at the first week of care were associated with healing after adjustment for wound area and wound duration. For example, CD34+CD45dim, the univariate odds ratio was 1.19 (95% confidence interval: 0.88, 1.61) and after adjustment for wound area and wound duration, the odds ratio was (1.67 (1.16, 2.42) p = 0.006). A prognostic model using CD34+ CD45dim, wound area, and wound duration had an area under the curve of 0.75 (0.67, 0.82) and CD34+ CD45dim per initial wound area, an area under the curve of 0.72 (0.64, 0.79). Microparticles were not associated with a healed wound. Previous studies have indicated that circulating endothelial precursor cells measured at the first office visit are associated with a healed diabetic foot ulcer. In this multicentred prospective study, we confirm this finding, show the importance of adjusting circulating endothelial precursor cells measurements by wound area, and show circulating endothelial precursor cells per wound area is highly predictive of a healed diabetic foot ulcer by 16th week of care. [ABSTRACT FROM AUTHOR]