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Severity of Pediatric Atopic Dermatitis Underestimated by Physicians


Only half of pediatric patients with atopic dermatitis who fit the criteria of having severe disease were identified as such by managing physicians.

A gap in physician-identified and criteria-specified severe atopic dermatitis (AD) was reported among pediatric patients, with approximately 2 in 5 physicians expressing dissatisfaction with current therapeutic options for severe AD. Findings were published recently in Dermatology and Therapy.

As a common condition affecting up to 30% of individuals under 18 years of age, AD has been shown to cause considerable reduction in quality of life for pediatric patients and their families. Adverse effects associated with severe AD in children and adolescents include sleep and attention regulation issues, as well as an increased risk of fracture.

Due to the differences in disease presentation and treatment tolerability between adults and younger patients, researchers note that the current management of pediatric AD is challenging with a limited availability of therapeutic options.

“Inconsistencies among health care professionals when recommending therapies for pediatric patients may lead to suboptimal treatment,” they added. “Relatively little is understood about how doctors determine whether the disease is mild, moderate, or severe and what they consider to be the best treatment options for patients.”

They conducted a questionnaire-based study among 574 physicians responsible for the care of 1719 children (6-11 years) and adolescents (12-17 years) with moderate to severe AD in 11 emerging economy countries, including Argentina, Brazil, China, Colombia, Israel, Mexico, Russia, Saudi Arabia, Taiwan, Turkey, and the United Arab Emirates.

Physicians were asked for an initial assessment of patient disease severity and control, which was then compared with patient records and pre-specified criteria to assess concordance and discordance between physician perception and recorded patient presentation.

Among the cohort of patients managed by physicians, a majority had a family history of AD and a mean 2.4 comorbidities, with allergic rhinitis, dust allergy, and asthma cited as the most common. Physicians primarily used the SCORing AD (SCORAD) criteria for their assessments.

In their findings, physicians of every country besides Mexico and Turkey were shown to underestimate the severity of AD during their initial assessment of patients. Overall, 51% of patients whose disease criteria matched ‘severe disease’ to pre-specified criteria and SCORAD scores were also initially identified by physicians as having severe disease.

Disease severity was underestimated by physicians in 78% of children and 68% of adolescents with severe disease and overestimated in 19% of adolescents with moderate disease.

Regarding disease control, patients with moderate to severe AD experienced flares for an average of 263 days in the preceding year, in which 90% and 74% of patients experienced chronic flares and unpredictable flares, respectively. Control of flares could only be achieved within 7 days in 14% of patients (n = 153).

In discussing treatment goals and satisfaction, a majority of physicians listed complete elimination of itching and skin symptoms as their primary treatment goal. For moderate and severe cases, 59% and 33% of physicians reported that they were able to achieve this, respectively. Approximately 24% and 40% of physicians were slightly dissatisfied (or worse) with the treatment options for moderate and severe disease, respectively.

Most commonly used therapeutic interventions were emollients (92% to 93% of patients), along with potent or super-potent topical corticosteroids (83% of children with severe disease; 91% of adolescents with severe disease; 87% of adolescents with moderate disease). Physicians reported being “moderately” to “very concerned” about corticosteroid and immunosuppressant exposure in 68% and 73% of their patients, respectively.

“These results suggest that there are many unmet needs in the treatment of children and adolescents with AD in emerging economies, whose treatment could be further optimized,” concluded the study authors. “Practical, easy-to-use, and validated objective measures for assessment of disease severity and control, as well as effective use of novel therapies, are essential to ensure that patients are appropriately managed.”


Tang MBY, Fatani M, Wiggins S, Maspero J. Physician perception of disease severity and treatment outcomes for children and adolescents with atopic dermatitis in emerging economies. Dermatol Ther (Heidelb). Published online March 26, 2022. doi:10.1007/s13555-022-00708-y

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