Patterns of Clinical Management of Atopic Dermatitis in Infants and Toddlers: A Survey of Three Physician Specialties in the United States

Objective To describe atopic dermatitis (AD) management patterns in children ≤36 months old as reported by pediatricians, dermatologists, and allergists in the US. Study design A nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 26), and allergists (n...

Full description

Saved in:
Bibliographic Details
Published in:The Journal of pediatrics 2013-12, Vol.163 (6), p.1747-1753
Main Authors: Saavedra, José M., MD, Boguniewicz, Mark, MD, Chamlin, Sarah, MD, Lake, Alan, MD, Nedorost, Susan, MD, Czerkies, Laura A., MS, RD, Patel, Vardhaman, MS, Botteman, Marc F., MSc, MS, Horodniceanu, Erica G., BS
Format: Article
Language:English
Subjects:
adrenal cortex hormones
Allergy and Immunology
atopic dermatitis
Child, Preschool
children
Dermatitis, Atopic - therapy
Dermatology
Female
Humans
Infant
infant formulas
infants
laboratory techniques
Male
medical equipment
patients
pediatricians
Pediatrics
Practice Patterns, Physicians
surveys
therapeutics
toddlers
United States
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Objective To describe atopic dermatitis (AD) management patterns in children ≤36 months old as reported by pediatricians, dermatologists, and allergists in the US. Study design A nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 26), and allergists (n = 26). Main outcomes included referrals to health care professionals, suggested/ordered laboratory tests, management approach (dietary, pharmacologic, or combination of both) by age, AD location, and severity. Results Significant differences were observed in referrals to healthcare professionals ( P < .001). Pediatricians more frequently referred to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred to allergists less frequently for mild (9.1%) than moderate/severe (40.7%) AD cases. Pediatricians (59%), allergists (61.5%), and dermatologists (26.9%) reported treating at least some of their patients with AD with dietary management (infant formula change) alone (with or without emollients). Soy-based formulas were often used. For mild AD, the most commonly reported first-line pharmacologic treatments included topical emollients, topical corticosteroids, and barrier repair topical therapy/medical devices. Over 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. AD lesion location influenced pharmacologic treatment in >80% of physicians. Conclusions Significant and distinct differences in AD treatment approach exist among physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach. This diversity may result from inadequate evidence for a standard approach. Consistent methods for managing AD are needed.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2013.06.073