Measuring the impact of childhood atopic dermatitis
In this issue Dr Sue Lewis-Jones
explores in some detail the ways in
which atopic dermatitis (eczema)
(AD) affects the lives of children, their
parents and other family members,
and how this can be assessed (1). She
reports that the effects are dramatic,
may be severe, and can be measured
using validated instruments that are
reliable, reproducible and capable of
providing comparisons between differ-
ent conditions.
This will come as no surprise to
dermatologists, community paediatric
nurses and families with affected
members, because they will have seen
the problem face to face and day to
day; they will have had to try and
address the challenges faced by chil-
dren with AD. It really should not be
news to anyone who sees and treats
children in any number, including
general practitioners, paediatricians
and pharmacists, although I suspect it
will be to many, if not most. The fact
that the impact of AD has been
shown, scientifically, to be as severe
as, or worse than, that of childhood
diabetes or asthma ought to raise an
eyebrow even further.
This effect is compounded by the
fact that AD affects so many children.
AD is now a very common disorder
in ‘western’ societies, perhaps affecting
an even higher number of individuals
than Dr Lewis-Jones mentions in her
article: perhaps 25% of UK children
by the time they have reached their
fourth birthday according to the
results of a relatively recent birth
cohort study from the English Mid-
lands (2). Also of great interest must
be the suggestion that AD may have a
greater impact among children in eth-
nic minority families – a finding in
keeping with observations made about
understanding of the problem in a
study also from our department in
Leicester some years ago (3).
If a disease has significant implica-
tions for large numbers of people,
surely it has to be taken seriously, and
investment in effective treatment must
be considered worthwhile? Sadly, this
is not necessarily the case. All health-
care systems struggle to balance the
needs of competing priorities and skin
diseases are rarely fatal. Patients with
AD often simply ‘suffer in silence’
when those responsible for trying to
help them are provided with inad-
equate time to explain the complexit-
ies of management and/or prescribe
quantities of creams and ointments
that are nowhere near what are really
required. The same patients wait
hopefully for news of research and for
therapeutic agents to be made avail-
able that safely offer additional bene-
fit. What they often get, though, are
false dawns and unsubstantiated
claims. They also find that prices lev-
ied on new products, while relatively
modest in overall terms item for item,
may make them difficult to accommo-
date in restricted budgets, especially in
primary care.
All of this makes it even more
important that health-related quality
of life measures are included in the
assessment of therapeutic interventions
in future. The increasing ability to
measure life quality and to judge treat-
ments against their ability to change
those things that really matter to
patients should allow clinical research-
ers to demonstrate to ‘the paymasters’
(whether they be in the pharmaceuti-
cal industry, government, medical
insurance, or just plain patients and
parents) that investment in AD is
worth it.
Surely we owe it to our patients to
follow this approach to the investiga-
tion of all disease and its manage-
ment?
R. Graham-Brown
Department of Dermatology,
Leicester Royal Infirmary,
Leicester, UK
R E F E RE N C E S
1 Lewis-Jones MS. Quality of life and
childhood atopic dermatitis: the misery
of living with childhood eczema. Int J
Clin Pract 2006; 60: 984–92.
2 Bleiker TO, Shahidullah H, Dutton E
et al. The prevalence and incidence of
atopic dermatitis in a birth cohort: the
importance of a family history of atopy.
Arch Dermatol 2000; 136: 274.
3 George S, Berth-Jones J, Graham-
Brown RAC. A possible explanation for
the increased referral of atopic dermati-
tis from the Asian community in
Leicester. Br J Dermatol 1997; 136:
494–7.
EDITORIAL 895
ª 2006 The AuthorsJournal compilation ª 2006 Blackwell Publishing Ltd Int J Clin Pract, August 2006, 60, 8, 891–895