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Management of Pediatric Atopic Dermatitis by Primary Care Providers: A Systematic Review
Trevor K Young1, Alexander F Glick2, H Shonna Yin3
1New York University Grossman School of Medicine (TK Young, AM Kolla, and J Nicholson), New York, NY.
Insights
Primary care providers often underprescribe topical calcineurin inhibitors and overprescribe antihistamines for pediatric atopic dermatitis (eczema). Gaps in knowledge and management highlight the need for improved pediatric eczema care guidelines and education.
Area of Science:
- Dermatology
- Pediatrics
- Primary Care Medicine
Background:
- Primary care providers (PCPs) are the first point of contact for children with eczema/atopic dermatitis (AD).
- Current understanding of pediatric AD management by PCPs and adherence to guidelines is limited.
Purpose of the Study:
- To review literature on pediatric AD management components by PCPs.
- Focus on topical corticosteroids (TCS), topical calcineurin inhibitors (TCIs), antihistamines, bathing, emollients, and diet.
Main Methods:
- Systematic literature review of PubMed/Medline and Embase databases.
- Included English-language articles from 2015-2020 focusing on pediatric AD management by PCPs.
- Two authors independently screened and extracted data; disagreements resolved by a third author.
Main Results:
- Twenty articles were included, primarily surveys and national database analyses.
- PCPs commonly prescribed TCS, favoring low-potency agents, and overprescribed antihistamines.
- TCIs were often avoided, while emollient recommendations were inconsistent; nonmedication management data was scarce.
Conclusions:
- Significant knowledge and management gaps exist for PCPs in treating pediatric AD, particularly regarding TCS safety and TCI prescribing.
- Current research is limited by small studies and reliance on self-reported provider behaviors.
- Future research should address these gaps, focusing on nonmedication management and real-world patient encounters.
Background:
Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines.
Objective:
To review existing literature examining management components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs.
Data Sources:
PubMed/Medline and Embase.
Study Eligibility Criteria:
English-language articles dated 2015 to 2020 reporting outcomes addressing management of pediatric AD by PCPs.
Study Appraisal And Synthesis Methods:
Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author.
Results:
Twenty articles were included. Surveys and national database analyses were the most common methodologies (n = 7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed nonsedating antihistamines, and avoided TCIs. PCPs commonly recommended emollients, although this was not universal. Data characterizing nonmedication management were limited.
Limitations:
Most studies did not examine individual patient encounters, but rather relied on providers reporting their general behaviors. Provider behavior may vary based on country of practice.
Conclusions And Implications Of Key Findings:
Knowledge and management gaps exist among PCPs in treating pediatric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing nonmedication management, highlighting the need for future research in this area.
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