Topical treatment use and under-use in childhood eczema: secondary analysis of RCTs and cohort data in the UK and the Netherlands

Background Underuse of emollients and topical corticosteroids (TCS) contributes to uncontrolled atopic eczema, but variations between countries remain unclear.

Aim To compare the actual use of emollient and TCS use in childhood eczema in the UK and The Netherlands (NL) and examine treatment adherence in relation to guidelines.

Design & setting A secondary analysis of data from the Rotterdam Eczema cohort study (n=367) (NL), the BATHE trial (n=482) (UK) and BEE trial (n=520) (UK).Methods: Frequency of emollient and TCS use were compared at baseline and after 12-16 weeks of follow-up by age, sex and disease severity. Treatment adherence was defined as: 1 a) not using an emollient at all, 1b) not using an emollient when a TCS was used, 2) not using a TCS when eczema is mild or worse. Overall undertreatment was defined as category 1 and 2 combined.

Results In total, questionnaire data from 1312 children (aged 3 months-17 years) with mostly mild (26-37%) or moderate (45-48%) eczema were analysed. Not using an emollient was significantly more prevalent in NL at baseline (14%) and follow-up (19%) than in the UK (4% and 7.6%, respectively). Not using a TCS when eczema is mild or worse differed significantly (P<0.05) between countries. The overall undertreatment rate was high and did not differ significantly between countries at baseline (UK 52.0%-NL 48.2%) and follow-up (UK 45.0%-NL 49.8%).

Conclusion Undertreatment with emollients and TCS are common and a reminder for clinicians to explain treatment rationale and check treatment adherence. Differences in treatment practices between countries warrant further exploration.