Abstract
Objectives Atopic dermatitis (AD) is the most prevalent chronic inflammatory skin disease, with a vast drug arsenal and guidelines available for its management and diagnosis and different medical specialties engaged in providing care. This study aimed to outline the therapeutic and diagnostic approaches to the AD of allergists, dermatologists, and pediatricians and verify whether they are compliant with the guidelines. Methods A cross-sectional study using an electronic questionnaire administered through the SurveyMonkey® platform was disclosed by participating medical societies to their medical associates. Results Of the 1,473 participating physicians, the use of moisturizers as part of AD treatment was observed among pediatricians (91.9%), dermatologists (97.5%), and allergists (100%; p=0.07). The preference for the use of new emollients was lower among pediatricians (57%) than dermatologists (75.9%) and allergists (71.4%; p < 0.001). The prevalence of wet-wrap therapy was lower among dermatologists (16.3%) than allergists (51%; p < 0.001). The recommendation of proactive treatment with topical corticosteroids was more frequently reported by allergists (65.3%) than pediatricians (43.3%) and dermatologists (40.8%; p < 0.001), and the same trend was observed in relation to proactive treatment using calcineurin inhibitors. The use of oral anti-histamines to control pruritus was mainly considered by pediatricians (69.2%) and dermatologists (59.2% p < 0.001). Clinical experience with systemic immunomodulating agents was greater among allergists (77.5%) and dermatologists (60.8%; p < 0.001), with cyclosporine being the most cited systemic immunomodulating agent. Environmental control of aeroallergens was recommended by pediatricians (89.8%), dermatologists (86.9%), and allergists (100%; p=0.01). Conclusion There were differences in the therapeutic and diagnostic approaches to AD used by allergists, dermatologists, and pediatricians and those recommended by the guidelines, especially regarding the use of wet-wrap therapy, proactive treatment with topical corticosteroids or calcineurin inhibitors, prescription of anti-histamines, recommendation of phototherapy, and control of aeroallergens.
Highlights
Atopic dermatitis (AD) or atopic eczema is the most prevalent chronic inflammatory skin disease worldwide [1,2,3], and it is estimated that 20% to 30% of children and 7% to 10% of adults are affected [4]
Regarding the use of moisturizers, 1,167 of the pediatricians (99%), 244 of the dermatologists (99.6%), and 49 of the allergists (100%) indicated that the use of moisturizers can reduce the severity of AD (p 0.96), and 1,083 (91.9%), 239 (97.5%), and 49 (100%), respectively, reported prescribing moisturizers as an integral part of AD treatment (p 0.07). e preference for the use of new emollients, which influence the skin microbiome, was lowest among pediatricians (672 (57%) vs. 186 dermatologists (75.9%) and 35 allergists (71.4%); p < 0.001)
Regarding the prescription of wet-wrap therapy, namely, moist compresses with and without topical corticosteroids for moderate or severe AD, a lower frequency was observed among pediatricians (319 (27%)) and dermatologists (40 (16.3%)), but 25 allergists reported prescribing this treatment (51%; p < 0.001)
Summary
Atopic dermatitis (AD) or atopic eczema is the most prevalent chronic inflammatory skin disease worldwide [1,2,3], and it is estimated that 20% to 30% of children and 7% to 10% of adults are affected [4]. Its most striking symptom in addition to skin xerosis, skin redness and inflammation [11], and consequent sleep disorders [12], has a strong negative impact on the quality of life. Dermatology Research and Practice of its bearers, affecting their physical appearance and causing psychological, psychosocial, and occupational disorders [10, 11, 13]. E main objective of therapeutic management is to control these signs and symptoms to provide relief and ensure a better quality of life [14,15,16]. Adherence to the guidelines does not ensure successful treatment in every situation [21], but it can help physicians make decisions grounded in evidence-based medicine in daily clinical practice
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