Seasonal Variation of the Burden of Atopic Dermatitis in Finnish Primary Care: A Database Study on Effects of Weather and Air Quality
DOI:
https://doi.org/10.2340/actadv.v105.43041Keywords:
Atopic dermatitis, Seasonal variation, Effects of weather, Air qualityAbstract
The burden of atopic dermatitis has been increasing in Finland during recent decades and seems to vary seasonally. The aim was to investigate the effect of season and weather factors on patient numbers of primary care. Data bank information of the Finnish Institute for Health and Welfare was analysed for frequency of atopic dermatitis patients in the primary care of Helsinki during 2018–2023. In addition, the seasonal burden was compared with weather data from the Finnish Meteorological Institute. Patient numbers varied significantly during the year (p = 0.028). There was a recurrent seasonal variation with most atopic dermatitis diagnoses in January, February, March, and November and the least in July and August. A significant inverse association was observed between atopic dermatitis patients and outside temperature (p = 0.004) and UV Index (p = 0.008). Low air quality was associated with a higher burden in primary care (p = 0.013). There was no significant association regarding rain (p = 0.103) or relative air humidity (p = 0.392). The burden of atopic dermatitis in primary care shows a significant seasonal variation. There are specific weather parameters that follow similar patterns and likely comprise important extrinsic pathogenetic factors. It is reasonable to address the changing burden of atopic dermatitis with seasonally directed medical measures, education, and resources.
Downloads
References
Kiiski V, Salava A, Susitaival P, Barnhill S, Remitz A, Heliovaara M. Atopic dermatitis in adults: a population-based study in Finland. Int J Dermatol 2022; 61: 324–330.
https://doi.org/10.1111/ijd.15912 DOI: https://doi.org/10.1111/ijd.15912
Salava A, Rieppo R, Lauerma A, Salo V. Age-dependent distribution of atopic dermatitis in primary care: a nationwide population-based study from Finland. Acta Derm Venereol 2022; 102: adv00738.
https://doi.org/10.2340/actadv.v102.2287 DOI: https://doi.org/10.2340/actadv.v102.2287
Tian J, Zhang D, Yang Y, Huang Y, Wang L, Yao X, et al. Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study. Br J Dermatol 2023; 190: 55–61.
https://doi.org/10.1093/bjd/ljad339 DOI: https://doi.org/10.1093/bjd/ljad339
Kim J, Kim BE, Leung DYM. Pathophysiology of atopic dermatitis: clinical implications. Allergy Asthma Proc 2019; 40: 84–92.
https://doi.org/10.2500/aap.2019.40.4202 DOI: https://doi.org/10.2500/aap.2019.40.4202
Hui-Beckman JW, Goleva E, Leung DYM, Kim BE. The impact of temperature on the skin barrier and atopic dermatitis. Ann Allergy Asthma Immunol 2023; 131: 713–719.
https://doi.org/10.1016/j.anai.2023.08.007 DOI: https://doi.org/10.1016/j.anai.2023.08.007
Zeldin J, Ratley G, Shobnam N, Myles IA. The clinical, mechanistic, and social impacts of air pollution on atopic dermatitis. J Allergy Clin Immunol 2024; 154: 861–873.
https://doi.org/10.1016/j.jaci.2024.07.027 DOI: https://doi.org/10.1016/j.jaci.2024.07.027
Salava A, Oker-Blom A, Remitz A. The spectrum of skin-related conditions in primary care during 2015–2019: a Finnish nationwide database study. Skin Health Dis 2021; 1: e53.
https://doi.org/10.1002/ski2.53 DOI: https://doi.org/10.1002/ski2.53
Antti A, Salava A, Perälä M, Pelkonen AS, Mäkelä MJ, Remitz A. Are infants and toddlers with moderate-to-severe atopic dermatitis undertreated? Experiences of a Finnish tertiary care hospital. Acta Derm Venereol 2021; 101: adv00368.
https://doi.org/10.2340/00015555-3739 DOI: https://doi.org/10.2340/00015555-3739
Salava A, Perälä M, Juppo M, Pelkonen AS, Mäkelä MJ, Remitz A. Effective treatment of atopic dermatitis in small children significantly improves the quality of life of patients and their families. Eur J Dermatol 2021; 31: 791–797.
https://doi.org/10.1684/ejd.2021.4169 DOI: https://doi.org/10.1684/ejd.2021.4169
Database of the Finnish Institute for Health and Welfare (THL), Avohilmo: ICD-10. (database search conducted in April 2024). Availabel from: https://sampo.thl.fi/pivot/prod/fi/avo/perus06/summary_icd1001
Database of the Finnish Meteorological Institute (database search conducted in April 2024). Available from https://en.ilmatieteenlaitos.fi/download-observations
Weiland SK, Hüsing A, Strachan DP, Rzehak P, Pearce N; ISAAC Phase One Study Group. Climate and the prevalence of symptoms of asthma, allergic rhinitis, and atopic eczema in children. Occup Environ Med 2004; 61: 609–615.
https://doi.org/10.1136/oem.2002.006809 DOI: https://doi.org/10.1136/oem.2002.006809
Hamann CR, Andersen YMF, Engebretsen KA, Skov L, Silverberg JI, Egeberg A, et al. The effects of season and weather on healthcare utilization among patients with atopic dermatitis. J Eur Acad Dermatol Venereol 2018; 32: 1745–1753.
https://doi.org/10.1111/jdv.15023 DOI: https://doi.org/10.1111/jdv.15023
Khodaei B, Seyedpour S, Gholami B, Garmarudi G, Nasimi M. Seasonal and gender variation in skin disease: a cross-sectional study of 3120 patients at Razi hospital. Int J Womens Dermatol 2021; 7: 799–802.
https://doi.org/10.1016/j.ijwd.2021.09.014 DOI: https://doi.org/10.1016/j.ijwd.2021.09.014
Fleischer AB Jr. Atopic dermatitis: the relationship to temperature and seasonality in the United States. Int J Dermatol 2019; 58: 465–471.
https://doi.org/10.1111/ijd.14289 DOI: https://doi.org/10.1111/ijd.14289
Hancox JG, Sheridan SC, Feldman SR, Fleischer AB Jr. Seasonal variation of dermatologic disease in the USA: a study of office visits from 1990 to 1998. Int J Dermatol 2004; 43: 6–11.
https://doi.org/10.1111/j.1365-4632.2004.01828.x DOI: https://doi.org/10.1111/j.1365-4632.2004.01828.x
Uenishi T, Sugiura H, Uehara M. Changes in the seasonal dependence of atopic dermatitis in Japan. J Dermatol 2001; 28: 244–247.
https://doi.org/10.1111/j.1346-8138.2001.tb00125.x DOI: https://doi.org/10.1111/j.1346-8138.2001.tb00125.x
Aoki T, Kojima M, Adachi J, Fukuzumi T, Endo K, Sumitsuji H, et al. Seasonal variation in the month of first visit for atopic dermatitis patients. Allergol Int 1998; 47: 137–142.
https://doi.org/10.2332/allergolint.47.137 DOI: https://doi.org/10.2332/allergolint.47.137
Young E. Seasonal factors in atopic dermatitis and their relationship to allergy. Acta Derm Venereol 1980; 60: 111–112.
https://doi.org/10.2340/0001555592111112 DOI: https://doi.org/10.2340/0001555592111112
Morita K, Yasudo H, Chiba T, Kitazawa H, Narita M, Yamamoto-Hanada K, et al. Seasonal variability of epidermal Bleomycin Hydrolase activity in healthy children and pediatric patients with atopic dermatitis. J Dermatol Sci 2021; 102: 137–139.
https://doi.org/10.1016/j.jdermsci.2021.03.007 DOI: https://doi.org/10.1016/j.jdermsci.2021.03.007
Furue M, Yamazaki S, Jimbow K, Tsuchida T, Amagai M, Tanaka T, et al. Prevalence of dermatological disorders in Japan: a nationwide, cross-sectional, seasonal, multicenter, hospital-based study. J Dermatol 2011; 38: 310–320.
https://doi.org/10.1111/j.1346-8138.2011.01209.x DOI: https://doi.org/10.1111/j.1346-8138.2011.01209.x
Silverberg JI, Hanifin J, Simpson EL. Climatic factors are associated with childhood eczema prevalence in the United States. J Invest Dermatol 2013; 133: 1752–1759.
https://doi.org/10.1038/jid.2013.19 DOI: https://doi.org/10.1038/jid.2013.19
Suárez-Varela MM, García-Marcos Alvarez L, Kogan MD, González AL, Gimeno AM, Aguinaga Ontoso I, et al. Climate and prevalence of atopic eczema in 6- to 7-year-old school children in Spain. ISAAC phase III. Int J Biometeorol 2008; 52: 833–840.
https://doi.org/10.1007/s00484-008-0177-0 DOI: https://doi.org/10.1007/s00484-008-0177-0
Sargen MR, Hoffstad O, Margolis DJ. Warm, humid, and high sun exposure climates are associated with poorly controlled eczema: PEER (Pediatric Eczema Elective Registry) cohort, 2004–2012. J Invest Dermatol 2014; 134: 51–57.
https://doi.org/10.1038/jid.2013.274 DOI: https://doi.org/10.1038/jid.2013.274
Kim YM, Kim J, Lee JY, Kim M, Kim H, Jung K, et al. Impact of solar ultraviolet radiation on atopic dermatitis symptoms in young children: a longitudinal study. Pediatr Allergy Immunol 2017; 28: 551–556.
https://doi.org/10.1111/pai.12746 DOI: https://doi.org/10.1111/pai.12746
Osborne NJ, Ukoumunne OC, Wake M, Allen KJ. Prevalence of eczema and food allergy is associated with latitude in Australia. J Allergy Clin Immunol 2012; 129: 865–867.
https://doi.org/10.1016/j.jaci.2012.01.037 DOI: https://doi.org/10.1016/j.jaci.2012.01.037
Krutmann J, Morita A. Mechanisms of ultraviolet (UV) B and UVA phototherapy. J Investig Dermatol Symp Proc 1999; 4: 70–72.
https://doi.org/10.1038/sj.jidsp.5640185 DOI: https://doi.org/10.1038/sj.jidsp.5640185
Abeck D, Schmidt T, Fesq H, Strom K, Mempel M, Brockow K, et al. Long-term efficacy of medium-dose UVA1 phototherapy in atopic dermatitis. J Am Acad Dermatol 2000; 42: 254–257.
https://doi.org/10.1016/S0190-9622(00)90134-8 DOI: https://doi.org/10.1016/S0190-9622(00)90134-8
Garritsen FM, Brouwer MW, Limpens J, Spuls PI. Photo(chemo)therapy in the management of atopic dermatitis: an updated systematic review with implications for practice and research. Br J Dermatol 2014; 170: 501–513.
https://doi.org/10.1111/bjd.12645 DOI: https://doi.org/10.1111/bjd.12645
Thyssen JP, Zirwas MJ, Elias PM. Potential role of reduced environmental UV exposure as a driver of the current epidemic of atopic dermatitis. J Allergy Clin Immunol 2015; 136: 1163–1169.
https://doi.org/10.1016/j.jaci.2015.06.042 DOI: https://doi.org/10.1016/j.jaci.2015.06.042
Hong SP, Kim MJ, Jung MY, Jeon H, Goo J, Ahn SK, et al. Biopositive effects of low-dose UVB on epidermis: coordinate upregulation of antimicrobial peptides and permeability barrier reinforcement. J Invest Dermatol 2008; 128: 2880–2887.
https://doi.org/10.1038/jid.2008.169 DOI: https://doi.org/10.1038/jid.2008.169
Vähävihu K, Ala-Houhala M, Peric M, Karisola P, Kautiainen H, Hasan T, et al. Narrowband ultraviolet B treatment improves vitamin D balance and alters antimicrobial peptide expression in skin lesions of psoriasis and atopic dermatitis. Br J Dermatol 2010; 163: 321–328.
https://doi.org/10.1111/j.1365-2133.2010.09767.x DOI: https://doi.org/10.1111/j.1365-2133.2010.09767.x
Peroni DG, Piacentini GL, Cametti E, Chinellato I, Boner AL. Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children. Br J Dermatol 2011; 164: 1078–1082.
https://doi.org/10.1111/j.1365-2133.2010.10147.x DOI: https://doi.org/10.1111/j.1365-2133.2010.10147.x
Kim J, Kim EH, Oh I, Jung K, Han Y, Cheong HK, et al. Symptoms of atopic dermatitis are influenced by outdoor air pollution. J Allergy Clin Immunol 2013; 132: 495–498.e1.
https://doi.org/10.1016/j.jaci.2013.04.019 DOI: https://doi.org/10.1016/j.jaci.2013.04.019
Song S, Lee K, Lee YM, Lee JH, Lee SI, Yu SD, et al. Acute health effects of urban fine and ultrafine particles on children with atopic dermatitis. Environ Res 2011; 111: 394–399.
https://doi.org/10.1016/j.envres.2010.10.010 DOI: https://doi.org/10.1016/j.envres.2010.10.010
Eberlein-König B, Przybilla B, Kühnl P, Pechak J, Gebefügi I, Kleinschmidt J, et al. Influence of airborne nitrogen dioxide or formaldehyde on parameters of skin function and cellular activation in patients with atopic eczema and control subjects. J Allergy Clin Immunol 1998; 101: 141–143.
https://doi.org/10.1016/S0091-6749(98)70212-X DOI: https://doi.org/10.1016/S0091-6749(98)70212-X
Chong AC, Chwa WJ, Ong PY. Aeroallergens in atopic dermatitis and chronic urticaria. Curr Allergy Asthma Rep 2022; 22: 67–75.
https://doi.org/10.1007/s11882-022-01033-2 DOI: https://doi.org/10.1007/s11882-022-01033-2
Engebretsen KA, Johansen JD, Kezic S, Linneberg A, Thyssen JP. The effect of environmental humidity and temperature on skin barrier function and dermatitis. J Eur Acad Dermatol Venereol 2016; 30: 223–249.
https://doi.org/10.1111/jdv.13301 DOI: https://doi.org/10.1111/jdv.13301
Additional Files
Published
How to Cite
License
Copyright (c) 2025 Emilia Räisänen, Anita Remitz, Alexander Salava
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized ActaDV contents is available freely online. The Society for Publication of Acta Dermato-Venereologica owns the copyright for all material published until volume 88 (2008) and as from volume 89 (2009) the journal has been published fully Open Access, meaning the authors retain copyright to their work.
Unless otherwise specified, all Open Access articles are published under CC-BY-NC licences, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
