Management of Atopic Dermatitis in Children Younger Than Two Years of Age by Community Pediatricians: A Survey and Chart Review

• Published in: The Journal of pediatrics Vol. 221; pp. 138 - 144.e3
• Main Authors: Fishbein, Anna B., Hamideh, Noor, Lor, Jennifer, Zhao, Sharon, Kruse, Lacey, Mason, Maryann, Ariza, Adolfo, Bolanos, Liliana, Necheles, Jonathan, Kaye, Bennett
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2020
• Subjects: atopic dermatitis; eczema; physicians' practice patterns; primary healthcare; surveys and questionnaires; PPRG; primary healthcare; IGA; AD; physicians' practice patterns; eczema; IRB; atopic dermatitis; surveys and questionnaires; PCP
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2020.02.015

To characterize primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children <2 years old and determine the need for AD guidelines for PCPs focused on this age group. This is a mixed-methods study consisting of a survey and a retrospective medical record review of PCP practices in the Chicago metropolitan area. The survey was analyzed using both quantitative and qualitative methods. In the survey (n = 52 respondents), PCPs reported management of AD is different in children <2 years compared with older children (88%). They were more likely to refer to a specialist (65%) and less likely to use high-potency topical corticosteroids (64%). In the chart review, PCP visits for children 2-5 years old (n = 50 914) vs those <2 years old (n = 71 913) for AD, older children had medium- and high-potency topical corticosteroids prescribed more frequently than younger children (0.66% vs 0.37%, P < .01 and .15% vs 0.05%, P < .01, respectively). In the subset of children <2 years of age who also were evaluated by a specialist (n = 109), medium- and high-potency topical corticosteroids were prescribed disproportionately at visits to providers in dermatology (57%) vs allergy (30%) vs pediatrics (15%) (P < .01). PCPs suggested that guidelines for this age group should include recommendations for preferred corticosteroids (39%), allergy management (35%), referral criteria (22%), and assessment of disease severity (11%). PCP management of AD in children <2 years is different from older children, with possible underuse of medium/high-potency topical corticosteroids. Clear guidelines for this age group are needed.