Effectiveness of different strenghts of topical steroids in children with eczema in general practice.

Rationale:

Atopic dermatitis (AD) or eczema is a chronic, highly pruritic inflammatory skin disease, and is the most common chronic skin disorder in children. Eczema is in the top 10 of highest prevalence disorders in general practice in children up to 18 years

The aim of treatment is to keep the skin condition optimal, prevent flare-ups and treat symptoms as soon as they occur. Treatment is initially started by the general practitioner. According to the recently revised guideline of the Dutch College of General Practitioners (NHG) for AD, a stepwise approach is advocated; when AD is mild to moderate, a mild (class I) to moderate potent (class II) topical corticosteroid (CS) is preferred, while potent (class III) CS is used only when AD is severe. It may be that during a flare up, AD can be best treated intermittent with a potent CS (pulse treatment) in terms of time to recovery, patient satisfaction, amount of CS used, and reconsultations.

Objective:

To determine whether a potent topical corticosteroid (CS) is more effective than a mild topical CS in the treatment of children with a moderate flare-up of atopic dermatitis (AD) in primary care on short and long term.

Study design:

Prospective cohort study with an embedded open-label randomized controlled trial.

Study population:

Patients with the diagnosis AD, aged between 12 weeks and 18 years, who visited the GP for AD or received repeated prescription for AD in previous 12 months.

Intervention:

The intervention group will start with a potent CS (class III) at a flare-up of the AD.

Main study endpoints:

Changes in subjective disease severity after24 weeks follow-up in the trial, measured with a recommended and validated questionnaire for patients with AD (POEM).

Class III corticosteroid is more effective than a class I corticosteroid for treating a moderate flare-up of atopic dermatis in children.

Subjects will be asked to complete a weekly questionnaire (POEM) for 24 weeks.

At baseline, 1, week, 4 weeks and 24 weeks of follow-up Eczema Area and Severity Index (EASI) will be scoired.

The intervention group will start with a potent corticosteroid (class III) when having a flare-up of the atopic dermatitis. The GP-guideline group will receive treatment according to the Dutch GP-guideline (start with mild CS class I).