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Assessment and Management of Atopic Dermatitis in Primary Care Settings: A Systematic Review
Saad M Alqahtani1, Bassam H Awaji2, Abdulaziz M Mahdi3
1Family Medicine, King Salman Armed Forces Hospital, Tabuk, SAU.
Insights
Primary care providers commonly use topical corticosteroids for atopic dermatitis but avoid topical calcineurin inhibitors. Gaps exist in managing this chronic skin condition, especially regarding newer treatments and non-medication approaches.
Area of Science:
- Dermatology
- Primary Care Medicine
- Evidence-Based Practice
Background:
- Atopic dermatitis is a chronic, relapsing inflammatory skin disease affecting children and adults.
- Evidence-based clinical practice guidelines are essential for effective and safe atopic dermatitis management.
- Understanding primary care provider (PCP) practices for atopic dermatitis is crucial.
Purpose of the Study:
- To systematically review management strategies for adult and pediatric atopic dermatitis by PCPs.
- To examine the use of topical calcineurin inhibitors (TCIs), topical corticosteroids (TCS), emollients, antihistamines, and diet in atopic dermatitis care.
Main Methods:
- Systematic review of English-language articles published between 2014 and 2023.
- Searches conducted in PubMed (MEDLINE) and Embase databases.
- Included 15 articles, with surveys and national database analyses being the most common methods.
Main Results:
- PCPs frequently use topical corticosteroids (TCS) but tend to overprescribe oral antihistamines and avoid topical calcineurin inhibitors (TCIs).
- Low-potency topical corticosteroids were favored, and TCIs were underutilized.
- Most studies assessed self-reported prescribing behaviors rather than direct patient encounters.
Conclusions:
- Significant knowledge gaps exist in PCP management of atopic dermatitis, particularly concerning TCIs and TCS safety profiles.
- There is a need for future research focusing on prescribing behaviors and non-medication management strategies.
- Current understanding is limited by small studies and a focus on prescribing habits.
Abstract:
Atopic dermatitis is a complex, recurrent, chronic inflammatory skin condition. It frequently begins to manifest in early childhood and may last throughout adulthood. The need for clinical practice guidelines that are based on evidence is critical for efficient and secure care. Little is known about how primary care providers (PCPs) should handle pediatric and adult atopic dermatitis cases and whether they should follow national recommendations. Our systemic review aimed to examine management strategies for treating adult and pediatric (family) atopic dermatitis, including topical calcineurin inhibitors (TCIs), topical corticosteroids (TCS), skin emollients, oral antihistamines, and diet. Data sources were PubMed (MEDLINE) and Embase. Our review investigated English-language articles from 2014 to 2023 that studied the management of adult and children atopic dermatitis. Overall, there were 15 articles included. Surveys and analyses of national databases were the most widely used methods (n=7). The use of TCS by PCPs was common, but they also overprescribed nonsedating antihistamines, favored low-potency drugs, and avoided TCIs. Most studies relied on healthcare personnel reporting their typical behaviors rather than looking at specific patient encounters and it is considered a limitation. Finally, there are gaps in knowledge and management of critical topics such as prescribing TCIs and understanding the safety profiles of TCS, when it comes to treating adult and pediatric atopic dermatitis. Future research in this area is urgently needed because the current systemic assessment is mostly restricted to small studies that assess prescribing behaviors with scant information describing nonmedication management.
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