A comparison of emollient prescribing guidelines for atopic eczema and other dry skin conditions across Clinical Commissioning Groups in England.

Problem

Atopic eczema is an inflammatory skin condition characterised by a breakdown in the skin barrier leading to dry and itchy skin, affecting up to one in five British children. The majority of cases can be managed in primary care with emollients and corticosteroids. Emollients, which come in different formulations, are the mainstay of treatment.The NHS has an annual emollient spend of approximately £116.2 million, with emollients ranging from £132.29 to £2084.16 for a year’s treatment. However, there is a lack of evidence as to which emollients are the most effective and consequently little to guide clinical commissioning groups (CCGs) in what to recommend to prescribers. Emollient guidelines have never been compared before, so we sought to identify and examine emollient guidelines/formularies across all CCGs in England.

Approach

First, all English CCGs and websites were identified. All available emollient guidelines/formularies were then retrieved, via CCG websites or Google search.Data were extracted from the guidelines/formularies, looking for: which emollients were recommended and the rationale behind the recommendations made. Primary data extraction is being carried out by JC, with a second researcher PQ independently conducting a 10% quality control data extraction, to check for consistency/discrepancies. Data are being analysed using STATA.

Findings

184/209 CCGs have an emollient guideline/formulary. From the first 51 guidelines/formularies examined, 110 different emollients were identified from across all of the guidelines/formularies. Ointments were 4 out of the top 5 most recommended and ‘Zero’ products were 4 out of the top 5 most recommended first choice emollients. 28 (55%) cited cost, 4 (8%) gave other reasoning and 19 (37%) gave no rationale behind emollient recommendations. 38 (75%) recommended using bath emollients.

Consequences

Preliminary findings suggest that emollient guidelines vary widely across English CCGs, both in their recommendations but also the rationale for their content. Data extraction/analysis is on-going and will be complete by the time of the conference. This study further highlights the need for high quality RCTs to establish which emollients are most clinically and cost effective. This study will provide a snapshot of emollient prescribing across England, so that any effect that the results of on-going relevant trials (e.g. Bath Additives for treatment of childHood Eczema, Best Emollient for Eczema) may have on policy, can be examined through follow up studies.