Real-world use of topical treatments for atopic eczema in children and young people: Systematic review

Atopic eczema/dermatitis (eczema) is a common inflammatory skin condition affecting up to 30% of children and young people worldwide. Our knowledge of the real-world use of topical treatments is limited.

We undertook a systematic review with a search of 6 databases identifying 22 studies. Primary studies were included if they were quantitative studies of real-world patterns of topical treatment use for eczema.

There were 17 cohort (5 high, 9 moderate and 3 low quality) and 5 cross-sectional (4 high, 1 moderate quality) studies. Methodological shortcomings included study population descriptions, how and which patterns of use were collected, and/or how they were reported. Use of topical treatments varied significantly across countries, populations and care settings. Creams and ointments were the most common type of emollient, with use varying widely (any use 16.9-99.2%, daily use 38.0-82.1%). Exposure to any TCS ranged 0.85-95.8%, with mild 8.2-83.3%, moderate 11.6-64.6%, potent 7.0-54.3%, and very potent 0.2-15.3%. Exposure to TCI ranged 1.1-51.2%. In general, use of all treatment types was higher in specialist than generalist settings, with adherence declining over time.

This systematic review highlights gaps in our understanding of real-world use of common topical treatments for eczema in children and young people. Use tends to decline over time, differs between generalist and specialist care and is influenced by patient and provider-level factors. Further research should provide more complete data on frequency, quantity and duration of topical treatment use and how this relates to effectiveness, safety and adherence outcomes.