Dermatologists and allergists have far more experience and use more complex treatment regimens in the treatment of atopic dermatitis than other physicians.
BACKGROUND
Atopic dermatitis (AD) is a prevalent skin condition, especially in the pediatric population. Whereas it has been shown that dermatologists prefer using more intensive therapy for AD than generalists, actual drug utilization has not been quantified.


OBJECTIVE
The purpose of this study is to characterize visits for and treatment of AD in the office-based setting.


METHODS
National Ambulatory Medical Care Survey data from 1990 to 1997 was analyzed to determine the use of topical corticosteroids (including their relative potencies), oral antibiotics, and oral antihistamines in the treatment of AD.


RESULTS
There were an estimated 900,000 outpatient visits per year for AD. If in some visits to generalists the diagnosis for AD was miscoded as contact dermatitis, there may have been as many as 3 million outpatient visits per year for AD. Topical corticosteroids were used in 67% of visits with a mean potency rank of 4.5 (4.3, 4.8 95% CI). Dermatologists saw 48% of all visits for AD (63 yearly visits/physician) and allergists saw 10% of visits (30 yearly visits/physician). Other physicians saw from 0.1 to 2 yearly visits per physician. Dermatologists were the most likely to use topical corticosteroids (81% of visits) and high-potency corticosteroid agents (22% of visits). Dermatologists and allergists were the only physicians to prescribe ultrahigh-potent corticosteroid agents (12% and 9% of visits, respectively) and were more likely than other physicians to use multiple-agent regimens (21% and 27% of visits treated with a corticosteroid agent, respectively).


CONCLUSIONS
Dermatologists and allergists have more expertise in the management of AD than other physicians, as suggested by their higher per capita visits and greater use of complex topical corticosteroid regimens.
Henderson
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RL
Bristol-Myers Squibb Center for Dermatology Research and Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA.
Fleischer
A B
AB
Feldman
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SR
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000486:Allergy and Immunology / Q000193:education / Q000706:statistics & numerical data; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000628:therapy*; D003879:Dermatologic Agents / Q000627:therapeutic use; D003880:Dermatology / Q000193:education / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005194:Family Practice / Q000706:statistics & numerical data; D005938:Glucocorticoids; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009819:Office Visits / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*
D000893:Anti-Inflammatory Agents; D003879:Dermatologic Agents; D005938:Glucocorticoids