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NICE accused of overstepping the mark on eczema steroids

A furious row has blown up over the new NICE recommendations on use of topical steroids in eczema, with GPs and patients accusing the

institute of overstepping its


Dermatology groups inflamed by the decision are appealing against the controversial advice.

The institute's recommendations appear to fall outside the initial scope of the appraisal – which was set up to advise on the frequency of application of steroids. NICE has been accused of limiting clinician and patient choice by advising on which steroids to use.

In its final appraisal determination, NICE recommended choosing the 'drug with lowest acquisition price, taking into account pack size and frequency of application'.

The Primary Care Dermatology Society is appealing against the appraisal.

Chair of the group Dr Stephen Kownacki, a GP in Wellingborough, Northamptonshire, said NICE should have abandoned any attempt to advise on choice of topical steroids as soon as the dearth of evidence on the issue became clear.

'The conclusion is extremely limiting for patients and their doctors who are trying to help them,' he said.

'There seems to be a sense that eczema is not regarded as important and we're not given the right tools because the patients don't die or wait on trolleys in A&E.'

Dr John Adams, a GP in Cheadle, Cheshire, who has worked as a clinical assistant in dermatology, said: 'NICE is supposed to go on clinical evidence and there is little evidence from randomised controlled trials comparing ster- oids in eczema.'

He added: 'Clinicians need the flexibility to choose the right treatment for different patients – either they can magic 100 dermatologists out of somewhere or they can let GPs do it.'

Patient groups are also angered by the recommendations.

Peter Lapsley, chief executive of the Skin Care Campaign, described the ruling as 'a blatant infringement of clinician and patient choice'.

The deadline for appeals against the determination was last Friday. An in-house panel and the institute's lawyers will scrutinise the appeals.

Dr Kownacki said he was not optimistic about the appeal's chance of success.

'The big concern is that we end up with NICE guidelines being discredited and people being advised to ignore their advice,' he added.

NICE has ruled that topical steroids should be applied once or twice daily.

By Rob Finch

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