What we do
About our project
Background
Topical corticosteroids (TCS) of different potencies are the main treatment to control atopic dermatitis (AD). The Dutch guideline on AD for general practitioners (GPs) recommends a stepwise approach in which treatment steps are tailored to the severity of the disease, starting with the lowest possible potency of TCS. However, it remains unclear whether the recommended stepwise approach is most efficient.
Hypothesis
We hypothesize that a potent TCS is more effective than a low-potency TCS in the initial treatment of children with a moderate flare-up of atopic dermatitis in primary care
Methods
Children with eczema will be identified in GP Information Systems, and approached for participation in this study. A cohort with children with eczema will be formed. At a flare-up of the eczema, the children will be randomized into the trial-part of the study. This is designed as an open-label, pragmatic trial. The intervention group will start with a potent CS, the usual care group will receive treatment according to the Dutch GP-guideline. After 1, 4 and 24 weeks scores and questionnaires will be collected. The primary outcome is changes in disease severity after a period of 24 weeks.
Topical corticosteroids (TCS) of different potencies are the main treatment to control atopic dermatitis (AD). The Dutch guideline on AD for general practitioners (GPs) recommends a stepwise approach in which treatment steps are tailored to the severity of the disease, starting with the lowest possible potency of TCS. However, it remains unclear whether the recommended stepwise approach is most efficient.
Hypothesis
We hypothesize that a potent TCS is more effective than a low-potency TCS in the initial treatment of children with a moderate flare-up of atopic dermatitis in primary care
Methods
Children with eczema will be identified in GP Information Systems, and approached for participation in this study. A cohort with children with eczema will be formed. At a flare-up of the eczema, the children will be randomized into the trial-part of the study. This is designed as an open-label, pragmatic trial. The intervention group will start with a potent CS, the usual care group will receive treatment according to the Dutch GP-guideline. After 1, 4 and 24 weeks scores and questionnaires will be collected. The primary outcome is changes in disease severity after a period of 24 weeks.
Our research focus
Primary outcome
The primary outcome will be changed in disease severity over 24 weeks follow-up in the trial, as measured by the average score of the patient-oriented eczema measure (POEM).
Secondary outcomes
Other secondary outcomes in the trial part include: (1) changes in disease severity after 1 week and 4 weeks using POEM, (2) quality of life, (3) medication compliance, (4) local side effect, (5) time to recovery, (6) frequency of flare-ups, (7) medication use, (8) patient global assessment and investigator global assessment, (9) itch intensity score and (10) healthcare use.
Secondary outcomes concerning the cohort includes disease severity at inclusion, and at 26 weeks and 52 weeks follow-up using POEM and Eczema Area and Severity Index, quality of life, frequency of flare-ups, medication use and healthcare use.
The primary outcome will be changed in disease severity over 24 weeks follow-up in the trial, as measured by the average score of the patient-oriented eczema measure (POEM).
Secondary outcomes
Other secondary outcomes in the trial part include: (1) changes in disease severity after 1 week and 4 weeks using POEM, (2) quality of life, (3) medication compliance, (4) local side effect, (5) time to recovery, (6) frequency of flare-ups, (7) medication use, (8) patient global assessment and investigator global assessment, (9) itch intensity score and (10) healthcare use.
Secondary outcomes concerning the cohort includes disease severity at inclusion, and at 26 weeks and 52 weeks follow-up using POEM and Eczema Area and Severity Index, quality of life, frequency of flare-ups, medication use and healthcare use.
Funds & Grants
SBOH
Collaborations
Department of Dermatology
Publications
van Halewijn KF, Bohnen AM, van den Berg PJ, et al. Different potencies of topical corticosteroids for a better treatment strategy in children with atopic dermatitis (the Rotterdam Eczema study): protocol for an observational cohort study with an embedded randomised open-label controlled trial. BMJ Open 2019;9:e027239. doi: 10.1136/bmjopen-2018-027239.
Our team
Dr. G. Elshout (co-promotor), g.elshout@erasmusmc.nl
Dr. A.M. Bohnen, a.bohnen@erasmusmc.nl
Dr. P.J. van den Berg, p.j.vandenberg@erasmusmc.nl
Prof. Dr. S.G.M.A. Pasmans, s.pasmans@erasmusmc.nl
Prof. Dr. P.J.E. Bindels (promotor), p.bindels@erasmusmc.nl
Contact address for the project: k.vanhalewijn@erasmusmc.nl.
