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GPs attack NICE 'confusion' over steroid use in eczema

GP dermatology experts are lodging major objections to a draft NICE technology appraisal on prescribing steroids for eczema.

The guidance, out for consultation until next week, is 'worrying' and will confuse GPs, the Primary Care Dermatology Society believes.

Dr Tim Mitchell, secretary of the society and a GP in Bristol, identified three key areas where the appraisal could cause confusion in general practice.

The appraisal said that topical steroids should be limited to twice-daily application and that GPs should prescribe 'the drug with the lowest acquisition cost' where there was more than one option.

According to the document, topical steroids should be used intermittently to combat 'flare-ups' of eczema at the lowest possible potency so as to minimise their potentially harmful effects.

But Dr Mitchell said GPs needed a choice of potencies for different circumstances. 'It worries me because PCTs will say the cheap ones are the best,' he added.

A second potential problem with the guidance was that it failed to clear up confusion over whether GPs should follow advice from the British Association of Dermatologists or the NHS National Prescribing Centre on prescribing topical steroids.

The former said the best use of topical steroids was twice daily for 10-14 days while the latter favoured 'short bursts' of three to seven days' treatment.

Third, the appraisal document placed an unwarranted emphasis on treatments of dubious benefit, Dr Mitchell added.

It said systemic steroids should be 'avoided wherever possible' and was likely to recommend emollients continue as first-line treatment, with wet wraps, antihistamines, tar and other remedies as adjuncts to treatment.

'It worries me that they have mentioned old and discredited treatments such as evening primrose oil and Chinese herbs,' Dr Mitchell said.

The guidance also appeared confused over whether patients should discard their ster-oids after flare-ups or receive only one prescription that they re-used each time, he added.

By Rob Finch

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