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Dellavalle et al1 reported a higher nevus count in 3-year-old children with atopic eczema (AE) and a light skin pigmentation. This is in contrast to a previous observation that adults with long-standing AE had a lower nevus count.2 To provide further evidence, we analyzed data from a cross-sectional study involving 6-year-old children assessed during a mandatory medical examination prior to school enrollment in Erlangen and Salzgitter, Germany.
Of the 2189 participating children (there was a 94.8% response), 1925 were included in this analysis because they were white, had their nevi counted, and contributed data for all the variables considered. Study methods have partly been described.3 The skin color of the upper inner arm was used to construct a 3-point ordinal variable, a method similar to that described by Dellavalle et al.1 Furthermore, we asked parents for any AE history in their children since birth using the UK Working Party's Diagnostic Criteria for Atopic Dermatitis.4 Additional variables are listed in the Table, which also shows their distribution in children with and without AE. Nevus counts in the 6 subgroups defined by AE status and skin color are depicted as box plots (Figure). A significant difference in nevus count between children with and without AE was found only in the subgroup with “dark” skin in a bivariate analysis (Wilcoxon–Mann-Whitney test). However, because some of the variables determining UV sensitivity and known to be associated with nevus density3 are unevenly distributed, the relationship between nevus count and AE may be confounded. Therefore, a Poisson regression analysis was performed with nevus count as the dependent variable, AE as the variable of interest, and the potential confounders listed in the Table. As this analysis yielded evidence of overdispersion, the confidence intervals were adjusted with a suitable scaling factor to provide a conservative precision estimate. This analysis confirmed the association between nevus count and several constitutional variables as well as 1 UV exposure–related variable, but no significant association with AE was found.
Distribution of nevus counts in children with and without atopic eczema (AE) in 3 subgroups defined by skin color (light, medium, and dark). Eight children with more than 25 nevi, 1 with AE and 7 without AE, are not represented in the box plot.
The lower nevus counts found in highly selected AE patients2 may be due to differences related to severe chronic AE, eg, variables related to lifestyle or treatment. In contrast, Dellavalle et al1 examined a nonselected sample similar to ours. Possible reasons for the discrepant results could be as follows:
Atopic eczema was probably a more recent condition in the sample of younger children,1 with a greater impact than in our sample of older children.
The pattern and overall intensity of UV exposure might have been different in our older, more active sample of children.
Residual confounding may have influenced the logistic regression analysis in the study by Dellavalle et al,1 as the authors did not adjust for several of the variables that we identified as confounders (Table)—presumably, because their study did not have sufficient power to detect confounding.
In conclusion, there seems to be no evidence of a major impact of AE on the development of melanocytic nevi in white children; however, the immunological alterations or exposures associated with severe chronic AE may play a modifying role.
Correspondence: Dr Uter, Department of Medical Informatics, Biometry and Epidemiology (IMBE), Friedrich Alexander-Universität Erlangen-Nürnberg, Waldstr 6, 91054 Erlangen, Germany (wolfgang.uter@rzmail.uni-erlangen.de).
Financial Disclosure: None.
Group Members: The authors of this study wrote on behalf of the Naevi, Vaccination, and Infection (NAEVAC) study Group. Members are Klaus F. Kölmel, MD, University Skin Hospital, Göttingen; Peter Lederer, MD, Regional Health Authority, Erlangen; Stefan Mueller-Dechent, MD, Regional Health Authority, Salzgitter; Jasmin Ecke, Sabine Billmann, Udo Reulbach, Yurdagül Öztürk, and Annette Wicovsky, IMBE, Erlangen, Germany.
Funding/Support: This study was supported by grant 2000.093.1 of the Wilhelm Sander Foundation, Munich, Germany.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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