Evaluating Differences in Therapeutic, Diagnostic Approaches to Atopic Dermatitis

A study found significant differences in the therapeutic and diagnostic approaches to atopic dermatitis used by allergists, dermatologists, and pediatricians, and those recommended by guidelines.

Therapeutic and diagnostic approaches to atopic dermatitis (AD) may differ significantly by the type of consulting provider, with care also different from that recommended in established guidelines. Findings were reported in Dermatology Research and Practice.

With a myriad of available therapies and different medical specialties engaged in providing care, AD management consists of managing the physical and psychosocial burden of disease. Although published guidance exists on providing symptom relief and enhancing quality of life in patients, researchers note that adherence to these guidelines does not ensure successful treatment in every situation.

“But it can help physicians make decisions grounded in evidence-based medicine in daily clinical practice,” they added. “Advances have been made in understanding the pathophysiology of AD and in the development of better-targeted therapies; however, little is known about the therapeutic decision-making of specialist physicians.”

Aiming to review the therapeutic and diagnostic approaches to AD used by medical specialties involved in care, including allergists, dermatologists, and pediatricians, as well as determine whether these approaches were in compliance with guidelines, the study authors conducted a cross-sectional study of medical societies and their medical associates who participated in an electronic questionnaire administered through the SurveyMonkey platform.

The questionnaire was based on the updated guidelines of Brazilian and international medical societies, with questions divided into 2 sections:

  • Sociodemographic data: gender, age, state of professional activity, academic background, specialist title or specialist registration with the Regional Medical Council, length of professional experience, and location of professional activity
  • Treatment of AD in adult and pediatric patients: use of moisturizers, emollients, wet-wrap therapy, corticosteroids, calcineurin inhibitors, antihistamines, phototherapy, immunomodulatory agents; the role of superantigens; type of research performed; and dietary and environmental guidelines

Of the 1473 eligible questionnaires collected, 1179 were answered by pediatricians (80%), 245 by dermatologists (16.7%), and 49 (3.3%) by allergists. Respondents were primarily active female professionals aged between 30 and 60 years in private practice offices.

Across all specialties, use of moisturizers as part of AD treatment was observed among pediatricians (91.9%), dermatologists (97.5%), and allergists (100%; P = .07). Regarding preference for the use of new emollients, pediatricians (57%) were less likely to report use than dermatologists (75.9%) and allergists (71.4%; P < .001). Moreover, prevalence of wet-wrap therapy was lower among dermatologists (16.3%) than allergists (51%; P < 0.001).

In considering recommendations, proactive treatment with topical corticosteroids was more frequently reported by allergists (65.3%) than pediatricians (43.3%) and dermatologists (40.8%; P < .001)—a trend that was also observed for proactive treatment using calcineurin inhibitors.

Use of oral antihistamines to control pruritus was also noted to be mainly considered by pediatricians (69.2%) and dermatologists (59.2%), and less frequently prescribed by allergists (34.7%; P < .001).

Further findings indicated that clinical experience with systemic immunomodulating agents was greater among allergists (77.5%) and dermatologists (60.8%) vs pediatricians (16.7%; P < 0.001), with cyclosporine being the most cited systemic immunomodulating agent.

Environmental control of aeroallergens was recommended most prominently by allergists (100%), followed by pediatricians (89.8%) and dermatologists (86.9%; P = .01).

“Such differences may be related to the fact that AD management must be individualized, adapted based on its clinical variability, and delivered with the main purpose of providing patients with adequate disease control,” concluded researchers.

Reference

de Bortoli SPZ, Neto HJC, Filho NAR. Different approaches to atopic dermatitis by allergists, dermatologists, and pediatricians. Dermatol Res Pract. Published online December 3, 2021. doi:10.1155/2021/6050091