25442 Relationship between topical corticosteroid utilization and atopic dermatitis severity and burden: A population-based cross-sectional study

Abstract

Treatment of atopic dermatitis (AD) includes the use of emollients, topical corticosteroids (TCS), topical calcineurin inhibitors, phototherapy, and systemic therapy in severe or persistent cases. We analyzed the cumulative amount of TCS use over a 12-month period among a cohort of Danish adults with AD. Data were presented as the total TCS anti-inflammatory activity (TTAA) exposure. To calculate the TTAA exposure, all TCS prescribed over the previous 12 months were converted into equipotent doses of grams (g) of momethasone based on their anti-inflammatory potency. We included 2341 AD patients. Of these, 11 patients were currently asymptomatic (PO-SCORAD = 0), 952 had mild AD (PO-SCORAD >0 and 50). There was a strong female predominance (68.2-73.4%), and the median age was 45.1 (IQR 35.6-55.2) years. We observed a considerable undertreatment; 65.3% of the total population did not receive any prescription topical or systemic treatment, and 31.4% of severe AD patients were treated with topical therapy alone. Among those filling at least one TCS prescription within the last 12 months, the overall TTAA was 216 g. The highest use was seen among those that had severe AD (434 g, interquartile range [IQR] 162 g-1296 g), and with current involvement of the face (555 g, IQR 300 g-1545 g) or hands (518 g, IQR 289 g-2086 g). In conclusion, while some patient subgroups displayed a high TCS use, including those with severe AD with involvement of the hands or face, many patients were undertreated even though they presented with severe symptoms.