How are eczema 'flares' defined? A systematic review and recommendation for future studies

Area of Science:

• Dermatology
• Clinical Trials
• Public Health

Background:

• Eczema (atopic dermatitis) is a prevalent chronic skin condition with significant morbidity.
• Accurate assessment of disease flares is essential for evaluating treatment efficacy in eczema.
• Current methods for defining and measuring eczema flares in clinical research are inconsistent.

Purpose of the Study:

• To systematically review and critically appraise existing literature on eczema flare definitions.
• To explore methodological and practical aspects of using eczema flares as outcome measures in intervention studies.
• To inform the development of an international consensus definition for eczema flares.

Main Methods:

• Systematic review of prospective intervention studies on eczema published up to February 14, 2013.
• Double-extraction of data from identified studies.
• Evaluation of flare definitions based on pre-specified criteria for feasibility and timely recording.

Main Results:

• 26 out of 314 identified papers described eczema flares, using 22 different definitions.
• Eczema flares were the primary outcome in 65% of studies, but only 15% used patient-reported definitions.
• No studies met all essential criteria for a good flare definition, and no validation studies were found.

Conclusions:

• The wide variation and lack of validation in current eczema flare definitions impede the comparison of research findings.
• Existing definitions are not fit for purpose, highlighting a critical gap in eczema research methodology.
• Further research is needed to identify patient-important worsening aspects and develop valid, reliable, and feasible data capture methods.