From the Departments of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Dermatology-Center of Pediatric Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Dermatitis. 2024 Jan-Feb;35(1):61-69. doi: 10.1089/derm.2022.0040. Epub 2023 Apr 4.
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, = 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.
需要真实世界的数据来评估特应性皮炎（AD）患儿的自我管理情况，了解其严重程度和治疗方法。本研究旨在评估一般人群中 AD 患儿的严重程度和外用治疗方法，并确定客观和主观 AD 严重程度评估方法之间的一致性和相关性。研究数据来自鹿特丹特应性皮炎研究，这是一项观察性前瞻性队列研究，其中嵌入了一项实用的开放性随机对照试验。使用描述性统计方法分析基线特征、药物使用和严重程度。采用 Kappa 分析和 Pearson 相关系数来评估一致性和相关性。共纳入 367 名儿童（平均年龄 5.7 岁）。平均湿疹面积和严重程度指数（EASI）评分为 2.1（±3.2），平均患者导向的湿疹测量（POEM）评分为 10.3（±6.1）。大多数儿童每天使用保湿剂（54.9%），过去一周未使用外用皮质类固醇（TCS）（51%）。根据 POEM 和 EASI 的严重程度分级，分别有 49.9%和 24.9%的儿童治疗不足。EASI 和 POEM 之间没有发现一致性证据（Kappa 0.028，n=178，r=0.451）。POEM 与 EASI、婴儿特应性皮炎生活质量指数和儿童皮肤病生活质量指数之间存在中度相关性。与 EASI 相比，POEM 与 QoL 的相关性更高。研究人群中保湿剂的使用足够。根据体征或症状，分别有 24.9%和 49.9%的儿童治疗不足。POEM 评分与 QoL 的相关性优于 EASI 评分。我们认为 EASI 低估了 AD 的严重程度，基于 EASI 评分的治疗可能导致 AD 治疗不足。治疗医生应注意 TCS 的不合理使用。
