Healthcare Utilization in Danish Children With Atopic Dermatitis and Parental Topical Corticosteroid Phobia

Abstract

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin condition. One foundational component of AD treatment is topical corticosteroids (TCS). With this study, researchers sought to evaluate the association among parental-reported health care use, parental TCS phobia, medication use to treat AD, and AD severity in pediatric patients.In the study, researchers included 1343 children with AD in Denmark.Children were recruited from the Danish National Patient Registry from January 2014 through December 2018 for this cross-sectional study. Children with a chief complaint and diagnosis of AD on the basis of International Classification of Diseases, 10th Revision, codes registered by a dermatology department within the Danish health care system were included. A questionnaire including 158 items assessing family structure, residence, parental education, AD severity (assessed by the Patient-Oriented Eczema Measure [POEM] score), TCS phobia (assessed by validated Topical Corticosteroid Phobia [TOPICOP] score), and AD treatment were sent to parents of eligible children.A total of 3437 children met inclusion criteria, and the parents of 1343 (43%) responded to the questionnaire; the mean age of the children was 8.9 years, and 52.8% were male. Mean POEM scores were significantly higher for girls (8.2 ± 6.3) than for boys (7.3 ± 6.2; P = .009), with scores between 8 and 16, indicating moderate eczema. On the basis of POEM scores, 23.4% had clear or almost clear AD, 29.5% had mild AD, 37% had moderate AD, and 10% had severe AD. With regards to treatment, 95% of all children had received TCS in the past. Severe AD was associated with increased health care visits. With regards to TCS phobia, there was no difference in TOPICOP scores on the basis of AD severity or child age. Higher TOPICOP scores were significantly associated with lower parental educational level as well as delayed TCS application for AD flares but were not associated with increased primary care visits when adjusted for AD severity and parental educational level.Increased TOPICOP scores were associated with lower parental educational levels leading to delayed treatment of AD flares. There was no association between TOPICOP scores and AD severity or the child’s age. Increased health care use was demonstrated in children with severe AD, compared with milder forms of AD, but was not associated directly with increased TOPICOP scores.Although there are no cutoff values for TOPICOP scores to define TCS phobia, in this study, it is suggested that TCS phobia is prevalent and associated with lower parental educational levels and delayed TCS treatment of AD flares. Further study is needed to define the impact of TCS phobia and evidence-based interventions to address this.