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The Burden of Childhood Atopic Dermatitis in the Primary Care Setting: A Report from the Meta-LARC Consortium
Jinan Al-Naqeeb1, Sankirtana Danner1, Lyle J Fagnan1
1From Department of Dermatology, Oregon Health and Science University, Portland (JA, JH, ST, ELS); Oregon Rural Practice-based Research Network, Oregon Health and Science University, Portland (SD, LJF, LM, KB, KD); Public Health and Preventive Medicine, Oregon Health and Science University, Portland (KR, KEZ, JL); Oregon Clinical and Translational Research Institute, Oregon Health & Science University, Portland (JM, CM); High Plains Research Network, University of Colorado, Denver (DEN, LZ); Iowa Research Network, University of Iowa, Iowa City (BL, JD); Wisconsin Research and Education Network, University of Wisconsin, Madison (DH); Primary Care Research Consortium, Duke University, Durham, North Carolina (RD); Centre of Evidence-Based Dermatology, University of Nottingham, England (HCW, JRC); Division of General Pediatrics, Oregon Health and Science University, Portland (KEZ); Patient Advocate (KH, MG); National Eczema Association, San Rafael, CA (JB); Mid-Columbia Medical Center, The Dalles, OR (FK); Treasure Valley Pediatric Clinic, Ontario (SD); Winding Waters Clinic, Enterprise (KS); National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institute of Health, Bethesda, MD (RC).
Insights
Atopic dermatitis (AD) affects 24% of young children in US primary care. Many use skincare practices, like frequent bathing and high water:oil ratio moisturizers, that may harm the skin barrier.
Area of Science:
- Pediatric Dermatology
- Primary Care Medicine
- Epidemiology
Background:
- The prevalence and management of atopic dermatitis (AD) in US primary care settings remain understudied.
- Understanding routine skincare practices for children with AD is crucial.
Purpose of the Study:
- To determine the prevalence of atopic dermatitis (AD) in children aged 0-5 years in US primary care.
- To describe common skincare routines employed for this pediatric population.
Main Methods:
- A cross-sectional survey was conducted.
- Data were collected from 652 children under age 5 across 10 primary care practices in 5 US states.
Main Results:
- The estimated prevalence of ever having atopic dermatitis (AD) was 24% (95% CI, 21-28), varying by age.
- Children with AD had a higher prevalence of comorbid asthma (12%) compared to those without AD (4%).
- Skincare practices differed, with ointments used more for AD and lotions for non-AD children.
Conclusions:
- Atopic dermatitis (AD) represents a significant burden in US primary care for young children.
- Many reported skincare practices, including frequent bathing and high water:oil ratio moisturizers, may compromise the skin barrier.
- Further clinical trials are necessary to establish optimal skincare strategies for managing childhood AD.
Background:
Little is known about the burden of atopic dermatitis (AD) encountered in US primary care practices and the frequency and type of skin care practices routinely used in children.
Objective:
To estimate the prevalence of AD in children 0 to 5 years attending primary care practices in the United States and to describe routine skin care practices used in this population.
Design:
A cross-sectional survey study of a convenience sample of children under the age of 5 attending primary care practices for any reason.
Setting:
Ten primary care practices in 5 US states.
Results:
Among 652 children attending primary care practices, the estimated prevalence of ever having AD was 24% (95% CI, 21-28) ranging from 15% among those under the age of 1 to 38% among those aged 4 to 5 years. The prevalence of comorbid asthma was higher among AD participants compared to those with no AD, namely, 12% and 4%, respectively (P < .001). Moisturizers with high water:oil ratios were most commonly used (ie, lotions) in the non-AD population, whereas moisturizers with low water:oil content (ie, ointments) were most common when AD was present.
Conclusions:
Our study found a large burden of AD in the primary care practice setting in the US. The majority of households reported skin care practices that may be detrimental to the skin barrier, such as frequent bathing and the routine use of moisturizers with high water: oil ratios. Clinical trials are needed to identify which skin care practices are optimal for reducing the significant burden of AD in the community.
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