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