Patterns and trends in eczema management in primary care

Eczema is the most common inflammatory skin condition in children worldwide, and it often persists into adulthood. The condition can be debilitating and patients of all ages can experience psychological impact. Case management is provided by primary care and attendance rates are high: 96% of children with eczema have used primary care in the previous year.

In their study1de Lusignan and colleagues (2021) used a large primary care research database to assess healthcare utilization and treatment regimens among people in England with new onset active eczema (n = 411,931) between 2009 and 2018.

Primary care consultation rates fell from 87.8 per 100 person-years to 112.0 per 100 person-years over this period, while referral rates to specialists rose from 3.8 to 5.0 per 100 person-years. Primary care visits were highest among children under two, but referral rates were highest among those over 50. Socioeconomic differences were observed: referral rates to specialists were lowest among people of lower socioeconomic status despite their higher rate of primary care visits.

The study period saw slight changes in prescribing practice. The prescription of emollients increased for people with active eczema from 48.5% to 51.4%, while there was a decrease in the prescription of topical corticosteroids from 57.3% to 52%. People of non-white ethnicities and lower socioeconomic status were less likely to be prescribed potent topical corticosteroids.

The authors said the disparities in eczema management warrant further study, particularly the lower baseline rates in people from more disadvantaged backgrounds and the higher risk of progression to moderate and severe eczema. severe in children of non-white ethnicity. The main limitation of the study was that inaccuracies in recording dates of diagnosis mean that onset for some patients may have occurred before the study period.

Lucille Kelsall-Knight is a Lecturer in Children’s Nursing at the University of Birmingham School of Nursing

Reference

1 by Lusignan S et al. Patterns and trends in eczema care in UK primary care (2009-2018). Clin Exp Allergy 202;51:483–494. doi.org/10.1111/cea.13783

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