Patterns of clinical management of atopic dermatitis in infants and toddlers: A survey of three physician specialties in the united states

José M. Saavedra, Mark Boguniewicz, Sarah Chamlin, Alan Lake, Susan Nedorost, Laura A. Czerkies, Vardhaman Patel, Marc F. Botteman, Erica G. Horodniceanu

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1747-1753
Number of pages7
JournalJournal of Pediatrics
Volume163
Issue number6
DOIs
StatePublished - Dec 1 2013

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Saavedra, J. M., Boguniewicz, M., Chamlin, S., Lake, A., Nedorost, S., Czerkies, L. A., Patel, V., Botteman, M. F., & Horodniceanu, E. G. (2013). Patterns of clinical management of atopic dermatitis in infants and toddlers: A survey of three physician specialties in the united states. Journal of Pediatrics, 163(6), 1747-1753. https://doi.org/10.1016/j.jpeds.2013.06.073