Diagnosis, assessment and treatment of childhood eczema in primary care: cross-sectional study

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Background: The majority of children with eczema in the UK are looked after in primary care yet we know little about their care in this setting.
Aim: To compare the diagnosis, assessment and treatment of eczema in primary care with published diagnostic criteria and management guidelines.
Design: Cross-sectional study using data from a randomised controlled feasibility study
Setting: General Practices, UK
Method: Baseline data from children aged one month to five years recruited ‘in-consultation’ for the COMET feasibility study were used: clinician diagnosis and global severity assessment; parent-completed POEM (Patient Orientated Eczema Measure) and questionnaire about eczema treatments (including use of topical corticosteroid, TCS); and EASI (Eczema Area Severity Index) done by researchers. Descriptive analyses were undertaken to compare diagnoses with UK diagnostic criteria, severity assessments, and treatment with NICE guidance.

Results: Data were available on 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 TCS were under-used with 44% of participants not using any emollient and 46% using one or more TCS. The ‘match’ between eczema severity and TCS potency was poor.
Conclusion: We found discrepancies between the diagnosis, assessment and treatment of children with eczema in primary care and UK diagnostic criteria/guidelines. Further investigation to explore the reasons for this discordance, and whether it matters, is needed.
Original languageEnglish
Article number00821
Number of pages12
JournalBritish Journal of General Practice Open
Issue number2
Early online date2 May 2017
Publication statusPublished - Jul 2017

Structured keywords

  • BTC (Bristol Trials Centre)
  • BRTC


  • Atopic dermatitis
  • eczema
  • childhood
  • diagnostic criteria
  • disease management
  • treatment


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