PURPOSE OF THE STUDY.
The goal of this study was to describe atopic dermatitis (AD) management patterns in children aged ≤36 months as reported by pediatricians, dermatologists, and allergists in the United States.
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, and management approaches (dietary, pharmacologic, or combination of both) according to age, AD location, and severity.
Significant differences were observed in referrals to health care professionals (P < .001). Pediatricians more frequently referred children to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred children 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 by using 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. More than 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. Location of the AD lesion influenced pharmacologic treatment in >80% of physicians.
Significant and distinct differences in AD treatment approach exist among the physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach.
This survey highlights the need for a more unified approach to the diagnosis and treatment of this chronic disease, which affects 10% to 20% of children. The investigators concluded that pediatricians and allergists were more likely to use formula change as a management strategy, with allergists specifically more likely to use laboratory tests (eg, IgE, skin prick) or an elimination diet with a food challenge test, and that dermatologists favor a pharmacologic approach to treatment and are less likely to consider food allergy as a cause of AD. A unified approach should be based on the possible etiologies of AD in affected children. This approach requires an understanding of the mechanisms of hypersensitivity to food and some environmental allergens that are frequent causes of the most severe forms of AD in infants and small children. It also requires knowledge of the benefits and pitfalls of testing for allergies, because not all patients who test positive for a food protein actually have an allergic reaction to that food. Erroneous interpretation of allergy tests can lead to extensive elimination diets that can further complicate the patient’s life and may lead to nutritional problems. Comprehensive management of AD requires a multifaceted approach, including avoidance of allergens and irritants, skin moisturization, topical anti-inflammatory agents, and anti-itch and anti-infection measures.
- Copyright © 2014 by the American Academy of Pediatrics