1. Use of emollients and topical glucocorticoids among adolescents with eczema: data from the population-based birth cohort BAMSE
S. Lundin,1,2 C.F. Wahlgren,3,4 A. Bergström,5,6 E.K. Johansson,2,3,7 E. Dahlén,8 N. Andersson5 and I. Kull1,2
1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
2Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
3Dermatology and Venerology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
4Department of Dermatology, Karolinska University Hospital, Stockholm, Sweden
5Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
6Centre of Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
7Dermatological and Venereal Clinic, Södersjukhuset, Stockholm, Sweden
8Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
British Journal of Dermatology. DOI: /bjd.16484

2. Susanne Lundin, first author

3. Introduction - What’s already known?
Knowledge on topical treatment with emollients and glucocorticoids in adolescents with eczema, at a population-based level, is insufficient

4. Objective
To explore the use of emollients and topical glucocorticoids in adolescents with eczema in relation to sex and disease severity
In addition study dispensing patterns of topical glucocorticoids (TGS)

5. Methods Questionnaire-based data (n=3108) at 16 years
Symptoms of eczema and severity
Treatment with emollients and topical glucocorticoids the preceding 12 month
Severity was assessed with the BAMSE Eczema Severity Score (BESS)

6. Methods - Clinical examination:
Skin was examined by a trained nurse
Severity of current eczema was self-assessed by adolescents with ongoing eczema - using the Patient- Oriented Eczema Measure (POEM)
Questions were asked about treatment and blood samples were obtained

7. Linkage to the Swedish Prescribed Drug Register
Data on dispensed TGCs were obtained for the preceding 12-months, with expanded time windows up to 24-months
Compare the use of TGCs reported in the questionnaire and at the clinical examination

8. Results Proportions with self-reported treatment with topical glucocorticoids in relation to eczema severity based on the BAMSE Eczema Severity Score.

9. Treatment with emollients, topical glucocorticoid or both
Multi-regression model analyzing factors affecting the likelihood of treatment with emollients, topical glucocorticoids or both among adolescents with current eczema (n=104).
Treatment with emollients, topical glucocorticoid or both
Adj OR
95% CI
Severity based on POEM
Clear or almost clear eczema
1.0
Ref
Mild, moderate, severe/very severe eczema 1
5.97
Male sex
1.32
Family history of allergic disease and/or eczema2
1.79
IgE sensitization3
0.68
Socioeconomic status4
1.18
Parental smoking at 16 years5
2.23
Smoking at 16 years of age
0.15

10. Eczema according to the questionnaire (n=297)
Dispensed topical glucocorticoids in adolescents with eczema in relation to severity of the disease measured by BESS and POEM
Eczema according to the questionnaire
(n=297)
Moderate, severe/very severe eczema according to POEM (n=45) n %
Glucocorticoid, any 70
23.6 17
37.8
Glucocorticoid, potent 35
11.8 11
24.4

11. Discussion
These findings indicate that adolescents treat themselves inadequately
Few studies illustrate this
Possible explanations:
Concern about side-effects
Insufficient knowledge about treatment principles (amount of cream, length of treatment and when to apply TGCs etc.)

12. Discussion
Misleading information from health care professionals and pharmacists
In Sweden is it possible to buy small packages (30 g) of mild TGCs without a prescription, over the counter
Mild TGCs is not enough treatment if your eczema is moderate to very severe

13. Discussion
Transition into adulthood is a challenge for the individual, the family and health care providers
It seems to be a discrepancy between reported treatment with TGCs (55 %) and dispensed TGCs (24 %) the preceding 12 months

14. Conclusions- What does this study add?
Almost all adolescents with eczema use emollients, but only half use topical glucocorticoids, with no difference between sexes.
Only one of four with moderate to very severe eczema has a potent topical glucocorticoid dispensed.
Symptoms of more severe eczema were not associated with increased likelihood to treat with a topical glucocorticoid.

15. The research team

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