SEVERITY DISTRIBUTION OF ATOPIC-DERMATITIS IN THE COMMUNITY AND ITS RELATIONSHIP TO SECONDARY REFERRAL

Although atopic dermatitis is the most common inflammatory dermatosis affecting children, no previous studies have evaluated the relationshi p between disease severity and the referral pattern to secondary healt h care services. We carried out a cross-sectional survey of 1760 child ren aged 1-5 years selected from the age-sex registers of four urban a nd semiurban general practices in Nottingham. Atopic dermatitis was di agnosed by a dermatologist on the basis of symptoms and signs of a fle xural itchy rash that had been present in the previous 12 months. The severity of atopic dermatitis was assessed clinically by the same derm atologist on the basis of reported symptoms over the previous 12 month s and clinical signs, and was graded on a three-point scale as mild, m oderate or severe. Information on the use of primary and secondary hea lth care services was recorded at the time of the interview, The 1-yea r period prevalence of atopic dermatitis was 16.5% (95% confidence int erval 14.7-18.2%). The severity distribution of atopic dermatitis was: mild 84% (n = 242), moderate 14% (n = 41) and severe 2% (n = 7). Of t hose children with atopic dermatitis, 96% (n = 278) had consulted thei r general practitioner in the previous 12 months and 6% (n = 17) had b een seen in secondary care. Overall, 4% (n = 11) of those children wit h atopic dermatitis had a consultation with a dermatologist. Other sou rces of secondary care referral included the paediatric department (n = 2) and accident and emergency department (n = 6). Referral to second ary care was found to be positively related to disease severity with r eferral occurring in 3% of mild cases, 15% of moderate cases and 43% o f severe cases. Although the relative referral rate of mild and modera tely severe disease was low, these cases were found to represent a sig nificant proportion (82%) of the total numbers of children seen in sec ondary care. This study has shown that: (i) most cases of atopic derma titis in the community are mild in severity; (ii) referral to secondar y health care services by general practitioners is infrequent; (iii) d isease severity is an important determinant of referral to secondary c are; and (iv) any potential change in the referral pattern of mild/mod erate cases of atopic dermatitis to secondary care is likely to produc e a significant increase in workload for dermatology departments.