Comparison between parent versus clinician assessment of disease severity in childhood atopic dermatitis

Background: Atopic dermatitis is a common paediatric dermatological condition with 90% of cases presenting before five years of age. Children with atopic dermatitis can live relatively symptom-free with adequate management. However, despite highly effective treatment regimens with minimal side-effect profiles [1] patients often suffer from poorly controlled disease. Possible reasons for this include non-compliance with treatment due to corticosteroid phobia and inconsistency between caregiver and clinician perceptions of disease severity.
Objectives: To determine if there is a difference between clinician and caregiver perception of severity of childhood atopic dermatitis and to understand the impact of any such difference on adherence to treatment.
Methods: A prospective cohort study recruited fifty paediatric patients and their caregivers from an outpatient dermatology clinic. Two clinicians completed Eczema Area and Severity Index (EASI) scores and caregivers completed Self-Administered EASI and Dermatology Quality of Life Index (DLQI). Data was analysed using a paired T-test in statistical analysis software SPSS.
Results: Paired T-test showed a significant difference between clinician assessed EASI score (M= 8.87, SD = 11.99) and caregiver assessed SA-EASI score (M= 6.78, SD = 9.86), t = 3.86 (df=49), p = <0.001.
Conclusion: Caregivers significantly underestimated disease severity of childhood atopic dermatitis. Improvement in patient education on the safety, efficacy and importance of disease control may improve patient outcomes.
1. Smith, S.D., et al., Treatment failure in atopic dermatitis as a result of parental health belief. Med J Aust, 2013. 199(7): p. 467-9.

Ms Julia Stone