Prescribing Patterns for Atopic Dermatitis in the United States

October 2019 | Volume 18 | Issue 10 | Original Article | 987 | Copyright © October 2019

Adrian Pona MD,a Abigail Cline MD PhD,a Sree S. Kolli BA,a Steven R. Feldman MD PhD, a,b,c Alan B. Fleischer Jr. MDd

ªCenter for Dermatology Research, Department of Dermatology, Wake Forest School of Medicine, Winston-Salem, NC

BDepartment of Pathology, Wake Forest School of Medicine, Winston-Salem, NC

cDepartment of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC

dDepartment of Dermatology, College of Medicine, Cincinnati, OH

Abstract
Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD.

Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment.

Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years.

Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD.

J Drugs Dermatol. 2019;18(10):987-990.

INTRODUCTION

Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting about 10% of children and adults in the United States.1-5 Atopic dermatitis is the most common skin condition in children under 11 years of age.6 Atopic dermatitis is the most common chief complaint at a pediatric dermatology clinic, disproportionally affecting African Americans.7 Although AD appears in childhood, AD often persists until adulthood.8

Management of AD is difficult due to relapse and high rates of treatment failure. These pitfalls cause children and their families to suffer somatically, psychologically, and financially.9-12 Atopic dermatitis can cause disfigurement and disability impacting social relationships and quality of life for the child, parent, and adult.13,14

Since future research in AD is focused on improving standard-of-care treatment, how AD patients are currently managed is not well characterized. The purpose of this study was to gather insight into the most common treatment regimens prescribed for AD across age group and specialties.15 Establishing the current standards of treatment may act as a reference for future AD clinical research.

METHODS

Data were obtained from the National Ambulatory Medical Care Survey (NAMCS). The Division of Health Care Statistics of the National Center for Health Statistics conducts the NAMCS to provide data on ambulatory physician office visits in the USA. The NAMCS uses healthcare visits as the base of analysis and reports prescription and nonprescription treatments discussed during the visit. The data are then weighted to obtain nationally representative estimates of ambulatory medical care in the United States.