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Treatment Patterns Vary in Pediatric Patients With Atopic Dermatitis

Despite known risks, systemic corticosteroids (SCS) and other medications with disproven efficacy in atopic dermatitis (AD) are frequently prescribed in pediatric patients with AD, a new study found. The retrospective observational analysis of pediatric patients with AD was stratified by age and provider type. The analytic sample comprised 607,258 pediatric patients with AD. Median observation period was 30.0 months. Among the findings:

  • 78.6% of patients were prescribed ≥1 AD medication, 86.7% were prescribed topical corticosteroids (TCS), 5.4% were prescribed a calcinuerin inhibitor.
  • SCS were prescribed for 24.4% of patients, of whom 51.8% had no asthma/allergic comorbidities.
  • Of the 46.6% and 16.2% prescribed an antihistamine or montelukast, respectively, 62.0% and 41.3% had no asthma/allergic comorbidities.
  • Treatment patterns varied by provide type.

Citation:

Paller AS, et al. Treatment patterns of pediatric patients with atopic dermatitis: A claims data analysis. [Published online ahead of print August 7, 2019]. J Am Acad Dermatol. doi:10.1016/j.jaad.2019.07.105.

Commentary:

This is a survey of a large pediatric AD population over a duration of 2.5 years, thus providing an excellent view into prescribing and referral practices. Not surprisingly, almost all were prescribed a topical corticosteroid and/or calcineurin inhibitor. It is unclear whether the few who did not receive prescription treatments were unable or unwilling to use prescription medications. Of more interest is the use of systemic corticosteroids (SCs), antihistamines, and montelukast. About half of the patients who received SCs did not have respiratory disease, so presumably these were used for the treatment of AD. Most AD experts frown on use of SCs except for short term "rescue" on severe patients. Also a significant number of AD patients without respiratory disease received antihistamines or montelukast, despite the lack of evidence that these drugs are useful in controlling AD. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY