Published online August 31, 2007
PEDIATRICS Vol. 120 No. 3 September 2007, pp. e527-e534 (doi:10.1542/10.1542/peds.2007-0289)
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ARTICLE

Atopic Dermatitis in Children in the United States, 1997–2004: Visit Trends, Patient and Provider Characteristics, and Prescribing Patterns

Kimberly A. Horii, MDa, Stephen D. Simon, PhDb, Deede Y. Liu, MDc and Vidya Sharma, MBBS, MPHa

a Section of Dermatology
b Office of Medical Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
c Department of Internal Medicine, University of Kansas School of Medicine, Kansas City, Kansas

OBJECTIVE. Atopic dermatitis is the most common chronic inflammatory skin disease of childhood and is increasing in prevalence throughout the world. Morbidity and resource use for atopic dermatitis are comparable to other chronic diseases. Topical corticosteroids are first-line therapeutic agents for atopic dermatitis; topical calcineurin inhibitors are considered second-line agents for patients who are older than 2 years. The aims of this study were to examine trends in visits for atopic dermatitis in children in the United States between 1997 and 2004, identify factors that were associated with a pediatric visit for atopic dermatitis, and assess changes in the treatment of atopic dermatitis over time.

METHODS. Visits for atopic dermatitis by children (0–18 years) to office-based physicians and hospital outpatient departments using 1997–2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey databases were analyzed. Medication prescribing rates during 2 time periods (1997–2000 and 2001–2004) were also analyzed.

RESULTS. There were an estimated 7.4 million visits for atopic dermatitis. Statistically significant differences in patients with atopic dermatitis included age 2 to 5 years, black race, Asian race, and specialist or hospital outpatient clinic evaluation. The increase in atopic dermatitis visits per year was statistically significant. No statistical differences in prescribing rates were identified between the 2 time periods. Between 1997 and 2000, topical corticosteroids were prescribed in 34% of visits, decreasing to 25% between 2001 and 2004. Between 2001 and 2004, topical calcineurin inhibitors were prescribed in 23% of visits. In the same period, topical corticosteroids were prescribed in 24% of visits by children who were younger than 2 years; topical calcineurin inhibitors were prescribed in 22% of visits.

CONCLUSIONS. Visits for atopic dermatitis in children are increasing. A recommended first-line treatment was prescribed in a minority of the visits.

Key Words: atopic dermatitis • topical corticosteroids • topical calcineurin inhibitors • NAMCS • NHAMCS

Abbreviations: AD—atopic dermatitis • NAMCS—National Ambulatory Medical Care Survey • NHAMCS—National Hospital Ambulatory Medical Care Survey • NCHS—National Center for Health Statistics • ICD-9-CM—International Classification of Diseases, Ninth Revision, Clinical Modification • ED—emergency department • CI—confidence interval • OR—odds ratio • FDA—Food and Drug Administration

Accepted Mar 7, 2007.


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