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Initial Management of Infantile Atopic Dermatitis in Primary Care Settings and Predictors of Topical Steroid Potency
Moira Shea1, Carter Haag1, Emile Latour1,2
1Department of Dermatology, Oregon Health & Science University, Portland, Oregon, USA.
Insights
Fewer than half of infants with atopic dermatitis (AD) received anti-inflammatory prescriptions initially. Children with allergic conditions were more likely to need stronger topical corticosteroids (TCS).
Area of Science:
- Pediatric Dermatology
- Allergy and Immunology
- Primary Care Medicine
Background:
- Atopic dermatitis (AD) is a common childhood condition, affecting 15%-20% globally.
- Most pediatric AD cases are managed in primary care settings.
- The initial management strategies for new-onset infantile AD are not well-documented.
Purpose of the Study:
- To characterize the initial management of new-onset infantile atopic dermatitis.
- To identify common treatments and comorbidities in infants diagnosed with AD.
- To explore factors associated with treatment escalation.
Main Methods:
- Retrospective cohort study of 3053 patients aged 0-2 years diagnosed with AD.
- Data collected included demographics, comorbidities, and initial treatments.
- Treatment patterns and changes in topical corticosteroid (TCS) potency were analyzed.
Main Results:
- 66.8% of infants received prescription therapy at initial diagnosis, primarily topical treatments.
- Topical corticosteroids (TCS) were the most common prescription (48.4%), predominantly low potency.
- Children with allergic comorbidities were significantly more likely to escalate TCS potency (OR 3.15).
Conclusions:
- Less than half of infants with AD received anti-inflammatory prescriptions at their first visit.
- Further research is needed to determine if this reflects mild disease or undertreatment.
- The association between allergic comorbidities and the need for stronger TCS warrants further investigation.
Background/Objectives:
Atopic dermatitis (AD) affects 15%-20% of children worldwide, with most treatment in primary care. Initial management of new-onset infantile AD remains poorly characterized.
Methods:
This retrospective cohort study included 3053 patients aged 0-2 years diagnosed with AD at pediatric and family medicine clinics at a single institution. Demographic, comorbidities, and treatment information were collected.
Results:
The mean age was 0.6 years at initial diagnosis; 54.4% were male. Of 3053 patients, 1015 (33.2%) had ≥ 1 additional atopic comorbidity or complication, most commonly asthma (28.8%), allergy (33.4%), allergic rhinitis (34.7%), conjunctivitis (41.8%), and bacterial infection (6.7%). At diagnosis, 66.8% (2038/3053) received prescription therapy, mostly topical (57.3%, 1743/3043 initial prescriptions). Common treatments at visit 1 (V1) included topical corticosteroid (TCS, 48.4%, 1472/3043 prescriptions), topical antifungal (4.4%, 134/3043), oral antihistamine (4.0%, 121/3043), while only 0.2% (7/3043) received topical calcineurin inhibitors. TCS potency was predominantly low (71.5%, 1053/1472), with medium (27.3%, 402/1472) and high (1.2%, 17/1472) less frequent. 78/1261 children (6.2%) changed potency of TCS between V1 and visit 2 (V2), with 5.2% escalating and 1.0% de-escalating therapy. Escalation was significantly associated with existing atopic comorbidities/complications (OR 3.15, p < 0.001).
Conclusions:
Fewer than half of children received anti-inflammatory prescriptions at their initial AD visit. More research is needed to investigate whether this finding represents mild cases or undertreatment. Children with allergic comorbidities were more likely to require escalation to stronger TCS, warranting future exploration of the relationship between initial therapies and disease severity or comorbidity development.
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