Eczema Care Online
What it is. Eczema Care Online (ECO, eczemacareonline.org.uk) is a free behavioural web programme for parents and carers of children with eczema. A separate version exists for young people. The University of Southampton and partners built it from qualitative research on why families underuse emollients and Topical Corticosteroids. That research found that families do not see eczema as long-term, are hesitant about treatments, and receive conflicting information (Teasdale 2021). ECO explains how the treatments work. It calls steroids “flare control creams” to match how parents talk, and promotes a “control not cure” message (Sivyer et al. 2022). It also links to a Written Eczema Action Plan. It is one of the few Eczema Education Programmes available to any UK family at no cost and without a clinic place. Eczema Care Online [part-of] Eczema Education Programmes Eczema Care Online [opposes] Steroid Phobia
The trial (Santer 2022, BMJ). Two independent, pragmatic, unmasked RCTs were run in 98 English general practices. Trial 1 randomised 340 parents or carers of children aged 0–12 to usual care or ECO plus usual care, excluding inactive or very mild eczema (POEM ≤5). Mean baseline POEM was 12.8. Over 24 weeks, eczema severity improved more in the ECO group: adjusted mean difference in POEM −1.5 (95% CI −2.5 to −0.6; P=0.002), with a number needed to treat of 6 to achieve a 2.5-point difference. The benefit lasted to 52 weeks, and follow-up was 91.5% at 24 weeks. Parents’ sense of enablement also improved (−0.7, 95% CI −1.0 to −0.4), and no harms were identified. The young-people trial (337 people aged 13–25) found a similar effect (−1.9). Eczema Care Online [treats] Atopic Dermatitis POEM [defines] Eczema Care Online
What it means for toddlers. The average effect is modest. A 1.5-point POEM change is below the roughly 3-point minimal clinically important difference used in the BEE Trial, and outcomes were parent-reported in an unmasked trial, which the protocol acknowledged as a limitation. However, the programme is free, low-effort and harmless, and it targets the main reason toddler eczema stays uncontrolled: under-use of emollients and fear of steroids. The NNT of 6 means about one extra family in six saw a 2.5-point improvement. For parents unsure about steroid safety, it offers an NHS-linked alternative to conflicting advice on forums and in Herbal and Home Remedies for Eczema marketing. Eczema Care Online [supports] Topical Corticosteroids Eczema Care Online [opposes] Herbal and Home Remedies for Eczema
What parents report. On Reddit, parents link to ECO as a reliable alternative to forum advice (“This site may help you … from NHS and some eczema charities”, r/eczema; evidence: anecdotal). UK mothers interviewed about online parenting forums described cross-checking forum tips and sometimes acting on them without consulting clinicians (Treadgold 2023). ECO is designed to fill that information gap. Parent Experiences [relates] Eczema Care Online Online Parenting Forums [relates] Eczema Care Online
Connections
- Parent Experiences — evidence-based resource parents point to, source: r/eczema 158b26y; Sivyer 2022
- Eczema Education Programmes — free online UK education programme, source: Santer 2022
- POEM — primary outcome; −1.5 vs usual care over 24 weeks, source: Santer 2022 BMJ
- Steroid Phobia — reframes steroids as “flare control creams”, source: Sivyer 2022
- Written Eczema Action Plan — ECO links an action plan, source: ECO
- Online Parenting Forums — evidence-based alternative to forum advice, source: Treadgold 2023