Treatment of Atopic Dermatitis in the United States: Analysis of Data from the National Ambulatory Medical Care Survey
March 2017 | Volume 16 | Issue 3 | Original Article | 250 | Copyright © 2017
Sean P. McGregor DO PharmD, Michael E. Farhangian MD, Karen E. Huang MS, and Steven R. Feldman MD PhD
Wake Forest School of Medicine, Winston-Salem, NC
Introduction: Atopic dermatitis (AD) affects both adult and pediatric patients, and multiple practitioners encounter and manage AD. However, differences with regard to the treatment of AD between specialties are not well characterized. Objective: The primary objective of this study was to determine if there is a difference between dermatologists and non-dermatology specialties with regard to treatment strategies for AD and to describe those differences. Methods: Data from the 1993-2010 National Ambulatory Medical Care (NAMCS) and National Hospital Ambulatory Care (NHAMCS) Surveys were used to characterize outpatient visits made for AD. Differences in demographic, geographic and seasonal characteristics were obtained and compared. Additionally, the frequency of medications prescribed at dermatologist visits were compared to other specialties. Primary Outcome Measures: Frequency of modalities used in the treatment of atopic dermatitis between dermatologists and non-dermatology specialties. Results: An estimated 3.7 million visits for AD were made to outpatient offices and hospital departments from 1993 to 2010. The rates per capita of visits for atopic dermatitis were similar when evaluated by gender and season. However, Caucasians were almost 50% less likely than African Americans or individuals of other minority races to have visits for AD. Topical corticosteroids (TCS) were mentioned at 52% of visits, and dermatologists were more likely than non-dermatologists to prescribe TCS, emollients, and topical calcineurin inhibitors. Conclusions: Dermatologists were more likely to recommend TCS, emollients, and topical calciuneurin inhibitors for the treatment of AD. Dermatologists were also more likely to prescribe higher potency TCS in comparison to non-dermatology specialties, and these differences may ultimately affect patient care. As a result, there remains a disparity between dermatologists and non-dermatology specialties with regard to evidence-based approaches to the treatment of AD.
J Drugs Dermatol. 2017;16(3):250-255.
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Atopic dermatitis (AD) is a common inflammatory disease of the skin that affects both adult and pediatric patients. While it primarily begins in childhood, AD persists into adulthood more than previously thought, and its prevalence among pediatric and adult patients in the United States is 10.7% and 10.2%, respectively.1-3 The prevalence of childhood AD is highest amongst those living in metropolitan areas, with higher household education levels, and of Black race.2 In comparison, the prevalence of adult AD is higher in females, those with higher household education levels, and those of Hispanic descent.3Patients with AD often suffer from both symptomatic and psychosocial complications of the disease. Pruritus, excoriation, and lichenification are tactile and visual reminders of the discomfort and progressive nature of the disease. Additionally, xerosis, as a result of abnormal epidermal barrier function and increased transepidermal water loss, is a hallmark feature of AD and increases the propensity for cutaneous infections.4 Although the exact cause is unknown, AD is associated with a number of aggravating factors, including irritants, allergens cold weather, heat, and stress.5 AD is primarily managed with topical agents that restore the epidermal barrier and inhibit the inflammatory cascade. Topical corticosteroids have been the mainstay of therapy for over 60 years.4 However, correction of epidermal barrier dysfunction and preservation of skin hydration with topical emollients is also considered central to AD treatment, regardless of severity.4 Dermatologists, pediatricians, and primary care practitioners play a role in the management of AD. A number of factors including, but not limited to, topical corticosteroid (TCS) and emollient usage may influence the therapeutic outcomes achieved in each patient. In one survey, dermatologists indicated greater preference for more intensive therapy with higher potency topical corticosteroids in comparison to pediatricians and family practitioners.6 However, differences in regard to the treatment of AD between these specialties are not well characterized. The present study aimed to determine if there is a difference between dermatologists and non-dermatology specialties with regard to treatment strategies for AD and whether those treatments are in line with current guideline recommendations.