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Long-Term Safety is Chief Concern for Treating Pediatric Eczema

Survey Finds Physicians Report Safety Concerns Influence Prescribing Patterns



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An extensive new survey has found that parents of children with atopic dermatitis and treating physicians desire safer, more effective therapies that would be suitable for managing the chronic condition over the long term.

The survey results, presented tomorrow at the 58th annual meeting of the American Academy of Dermatology, found an overwhelming majority (98 percent) of physicians (n=303) cited long-term use of oral and topical steroids as their major concern in treating children with atopic dermatitis, commonly known as eczema. This concern was reflected in prescribing patterns, with 47 percent of physicians responding that prescribing is influenced "a lot" by their concerns, and 36 percent reporting they were "very much" influenced by the concerns, on a scale that ranged from "not at all" to "very much."

Robert McAlister, Executive Director, National Eczema Association for Science and Education (NEASE), which conducted the survey, explained that the mainstay of current treatment regimens for atopic dermatitis is corticosteroids, but they pose side effects for children and infants, who are most commonly affected by the condition.

"Parents, pediatricians, and dermatologists are tremendously concerned about the risks associated with long-term use of these powerful steroid medications in children, as well as treatment of sensitive areas, such as the face," McAlister said. "It's therefore critical to identify opportunities for improved management."

Side effects of topical corticosteroids range from excessive thinning of the skin to growth retardation, depending on how much is applied to large body areas over a long period of time. In addition, more potent topical corticosteroids, when applied over extended periods of time, can lead to development of cataracts and glaucoma.

Atopic dermatitis is a very common, inherited condition that causes itchy, inflamed skin. During "flare-ups" of the condition, patients may also experience open "weeping" and crusted sores from scratching or infection. Approximately 77 percent of patients (n=961) surveyed said they felt "sometimes," "often" or "almost always" embarrassed or self-conscious in public during flares. "Atopic dermatitis can severely impair the quality of life of pediatric patients, impacting both daily and social activities," McAlister noted.

Physicians, Patients View Efficacy Differently

Fully 58 percent of pediatric patients (n=429) -- or their parents -- said prescription corticosteroids were either "not effective" or just "somewhat" effective, while less than a quarter said the drugs are "fairly" effective, and a scant 19 percent classified them as "very" effective. However, 44 percent of physicians treating atopic dermatitis patients classified the same medications as "very" effective.

"The dilemma with current treatments for eczema is that, in general, the efficacy of topical corticosteroids is related to their potency. However, increased potency also increases the risk of potential side effects. Fortunately, new investigational treatments may address some of these issues," said Amy Paller, M.D., Professor of Pediatrics and Dermatology, Children's Memorial Hospital, Northwestern University Medical School, and an author of the study.

Atopic dermatitis currently affects 10-20 percent of children. Approximately 80 percent of patients with atopic dermatitis are infants and small children, and up to 20 percent of these will experience lifelong disease.

The survey was conducted by the National Eczema Association for Science and Education and supported by a grant from Novartis Pharmaceuticals Corporation. All of the patients surveyed were NEASE members. The National Eczema Association for Science and Education, a private nonprofit association, works to improve the health and the quality of life of persons living with atopic dermatitis/eczema, including those who have the disease as well as their loved ones.

March 10, 2000

CONTACT: For more information about atopic dermatitis/eczema, please visit the NEASE web site at http://www.eczema-assn.org.

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