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: 10.111/bjd.16484

Susanne Lundin, first author

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

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)

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)

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

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

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

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 1.90-18.8 Male sex 1.32 0.47-3.70 Family history of allergic disease and/or eczema2 1.79 0.65-4.91 IgE sensitization3 0.68 0.22-2.11 Socioeconomic status4 1.18 0.20-6.69 Parental smoking at 16 years5 2.23 0.38-12.9 Smoking at 16 years of age 0.15 0.03-0.75

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

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.)

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

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

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.

The research team

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