SATURDAY

November 8

SESSION 2

11:00 – 11:15

OPTIMISING TREATMENT OF ATOPIC DERMATITIS: THE EMOLLIENT TO TOPICAL STEROID PRESCRIBING RATIO

Michael J. Cork,1,2 John Timmins,3 Julie Carr,2 Simon Ward,1 Rachid Tazi-Ahnini,1 Darren Robinson,1 Yiannis Vasilopoulos,1 Catherine Holden,2 Bonnie L. Kuehl4, Ian Landells5

There is increasing evidence that a genetically determined defective epidermal barrier is a primary event in the development of atopic dermatitis. These genetic changes render the skin barrier more vulnerable to breakdown by environmental agents such as soap, detergents and house dust mites. Emollients produce a partial repair of the skin barrier. The optimal regimen is to replace all soaps and detergents with emollient based cleansers and use large quantities of emollient creams or ointments. With education, 25% of children with mild/moderate atopic eczema can be predominantly controlled with emollients.

In this comparative prescribing audit, we have recorded the emollient to topical steroid prescribing ratio in specialist paediatric dermatology
clinics in the UK and Canada. In the UK, emollients, topical steroids and topical immunomodulators are prescribed and are reimbursable. In Canada, emollients are not prescribable or reimbursable, - reimbursement is restricted to topical corticosteroid and topical immunomodulators.

In the UK paediatric eczema clinic, the emollient to topical steroid
prescribing ratio was 14.9 to 1, with the majority of prescriptions being for a moderate potency topical corticosteroid (Eumovate). In contrast, in the paediatric dermatology clinic in Canada, emollients are not prescribed only recommended with the majority of prescriptions being for a potent topical corticosteroids (Elocom). It appears that dermatologists in Canada use potent, rather than moderately potent topical corticosteriods, because emollients are not reimbursable in Canada. Education, combined with affordable and accessible high quality products (emollients, topical corticosteroids and topical immunomodulators), are essential to treat atopic dermatitis. Evidence also strongly indicates that the combination of emollients with topical steroids can have a profound steroid sparing effect.