Abstract
BackgroundThe majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting.AimTo compare the diagnosis, assessment, and treatment of eczema in primary care with published diagnostic criteria and management guidelines.Design & settingCross-sectional study using data from a randomised controlled feasibility study. General practices, UK.MethodBaseline data from children aged 1 month to 5 years recruited ‘in-consultation’ for the Choice of Moisturiser in Eczema Treatment (COMET) feasibility study was used. These included clinician diagnosis and global severity assessment; the parent-completed Patient Orientated Eczema Measure (POEM); a questionnaire about eczema treatments, including use of topical corticosteroid (TCS); and, the Eczema Area Severity Index (EASI) carried out by trained researchers. Descriptive analyses were undertaken to compare diagnoses with UK diagnostic criteria, severity assessments, and treatment with the National Institute for Health and Care Excellent (NICE) guidance.ResultsData were available for 90 participants. Only 46% of participants labelled as having eczema met the UK diagnostic criteria. Agreement between the global severity assessment by a healthcare practitioner with the EASI and POEM measures of eczema severity were 44% and 48% respectively. Emollients and TCSs were underused with 44% of participants not using any emollient and 46% using one or more TCSs. The ‘match’ between eczema severity and TCSs potency was poor.ConclusionDiscrepancies were found between the diagnosis, assessment, and treatment of children with eczema in primary care, and UK diagnostic criteria and guidelines. Further investigation to explore the reasons for this discordance, and whether it matters, is needed.
Highlights
Eczema is one of the most common childhood disorders with high prevalence (0.2–24.6%) worldwide.[1]
Less than half (46%) of the participants recruited met the UK diagnostic criteria for atopic dermatitis
Patient consent All participants in this study have provided consent
Summary
Eczema ( known as atopic eczema/dermatitis) is one of the most common childhood disorders with high prevalence (0.2–24.6%) worldwide.[1] The burden of the disease falls on pre-school aged children it persists in a significant proportion through to adulthood.[2] It is characterised by dry and itchy skin and can have a significant impact on the quality of life of the patient and their family.[3,4]. In countries like the UK, the majority of children with eczema are managed exclusively by GPs5, yet little is known about their diagnosis, assessment, or treatment in this setting. Emerson et al[6] found that of children with eczema in primary care, the majority (84%) had mild eczema, with 14% moderate, and 2% severe. This study is dated (1998), and assessments were based on a single dermatologist’s clinical opinion, and no patient-reported measures were collected
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