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Published on: September 27, 2017
Atopic Dermatitis in Children in the General Population: Baseline Characteristics, Medication Use, and Severity
Karlijn F van Halewijn1, Floor van der Most1, Arthur M Bohnen1
1From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Insights
Real-world data show many children with atopic dermatitis (AD) are undertreated. The Patient-Oriented Eczema Measure (POEM) better reflects quality of life than the Eczema Area and Severity Index (EASI), which may underestimate AD severity.
Area of Science:
- Pediatric Dermatology
- Clinical Research
- Atopic Dermatitis Management
Background:
- Real-life data on atopic dermatitis (AD) severity and treatment in children are crucial for evaluating self-management strategies.
- Understanding the current landscape of AD management in the general pediatric population is needed.
Purpose of the Study:
- To assess the severity and topical treatment use in children with AD within the general population.
- To evaluate the agreement and correlation between objective (EASI) and subjective (POEM) measures of AD severity.
- To identify potential undertreatment based on established severity indices.
Main Methods:
- Utilized data from the Rotterdam Eczema Study, a prospective observational cohort with an embedded pragmatic trial.
- Employed descriptive statistics for baseline characteristics, medication use, and severity.
- Assessed agreement and correlation using kappa analysis and Pearson correlation.
Main Results:
- 367 children (mean age 5.7 years) were included. Mean EASI score was 2.1, mean POEM score was 10.3.
- 54.9% used emollients daily; 51% had not used topical corticosteroids (TCSs) in the past week.
- Based on POEM and EASI severity banding, 49.9% and 24.9% of children, respectively, were undertreated.
- No significant agreement was found between EASI and POEM (kappa=0.028, P=0.451).
- Moderate correlation found between POEM, EASI, and quality of life (QoL) measures; POEM correlated better with QoL than EASI.
Conclusions:
- Emollient use was adequate, but a significant proportion of children were undertreated based on POEM and EASI scores.
- The Eczema Area and Severity Index (EASI) may underestimate AD severity, potentially leading to undertreatment.
- Physicians should be aware of the potential for suboptimal topical corticosteroid (TCS) use and consider POEM for a better reflection of patient QoL in AD management.
Abstract:
Real-life data on severity and treatments in children with atopic dermatitis (AD) are needed to evaluate self-management. To determine severity and use of topical treatments in children with AD in the general population. Furthermore, we aim to determine agreement and correlation between objective and subjective AD severity measures. Data were used from the Rotterdam Eczema Study, an observational prospective cohort study with an embedded pragmatic open-label randomized controlled trial. Descriptive statistics were used for baseline characteristics, medication use, and severity. Strength of agreement and correlation were determined using kappa analysis and Pearson correlation. In total, 367 children (mean age 5.7 years) were recruited. The mean eczema area and severity index (EASI) score was 2.1 (±3.2) and mean patient-oriented eczema measure (POEM) score was 10.3 (±6.1). The majority applied emollients on a daily basis (54.9%) and had not used topical corticosteroids (TCSs) over the past week (51%). Based on severity banding of POEM and EASI, 49.9% and 24.9% of the children were undertreated, respectively. No evidence was found for an agreement between EASI and POEM (kappa 0.028, n = 178, P = 0.451). A moderate correlation between POEM, EASI, infants' dermatitis quality of life index, and children's dermatology life quality index was found. POEM showed higher correlation with quality of life (QoL) than EASI. Emollients were used sufficiently in the study population. Based on signs or symptoms, 24.9% and 49.9% of children are undertreated, respectively. POEM scores correlated better with QoL than with EASI scores. We argue that EASI underestimates severity of AD, and treatment based on EASI scores may lead to undertreatment of AD. Treating physicians should be aware of suboptimal use of TCSs.
