[Oral therapy for atopic dermatitis in year 2000. Questionnaire Study to Boarding Members of Japanese Society for Allergology].
Questionnaires were sent to boarding members of Japanese Society for Allergology (response rate 65.2%; 49 dermatologists [Derma] and 101 pediatricians [Pedia] ) to ask the order of choice in therapy attitudes, in the oral in comparison to the local therapy and in the oral therapy only. As for therapy attitudes, "suppress inflammation" (Infla), "reduce staphylococcal colonization" (Staph), "inhibit scratching" (Scrat), "guard skin from irritation" (Guard), "avoid allergen" (Avoid), and "support psychologically" (Psych) were presented. The order of choice was Guard, Infla, Scrat and Avoid for the first four in both Derma and Pedia. The last 2 were Psych and Staph in Derma and vice versa in Pedia. However, the lowest adoption rate was 76.2% in Derma and 85.8% in Pedia. This suggests that wide therapy attitudes were taken in mind in the therapy of atopic dermatitis in the both specialites. The adoption rate was significantly (P>0.05) higher in Pedia than Derma with Staph, Avoid, Scrat and Psych. As for the oral versus local therapy, "antihistamine" (A-hist), "antiallergy" (A-aller), "sedative" (Sedat), "hypnotic" (Hypno), "corticosteroid hormone" (O-steroid) and "antibacterial drug" (A-bact) were presented for the oral therapy, and "skin care medicine" (SkinC), "NSAID" (t-NSAID), "corticosteroid ointment" (S-oint) and "disinfectant" (Disinf) were for the topical therapy. The adoption rate was in the order of SkinC as well as S-oint followed by A-aller and A-hist both in Derma and Pediat. These choices were over 60% in Derma and over 75% in Pediat. Disinf and t-NSAID followed these with over 50% of adoption rate in Pediat, while all others were 30.6% or less in Derma. Thus, in Derma 4 therapies (2 local and 2 oral) were thought to be the first rank therapy but in Pediat additional 2 therapies (Disinf, t-NSAID) were comparable to the first rank therapy in Derma. As for the oral therapy only, A-aller and A-hist were adopted at high rates both in Derma and Pediat, but all other therapies that included 5 additional therapies; "kampo drug", "antimycotic drug", "vitamine", "arachidonic acid cascade controlling drug" and "immunosuppressant" were adopted in only low rates. Experience of oral corticosteroid therapy was about three quarters in Derma but a quarter in Pediat. Conditions for prescribing oral corticosteroid were mostly "extreme severity" and "acute generalized aggravation" both in Derma and Pediat. About 40% of doctors both in Derma and Pediat who ever prescribed oral corticosteroid were afraid that corticosteroid might not be stopped when starting the therapy. However, only short-term oral corticosteroid therapy is described in the guidelines of this society for the treatment of atopic dermatitis (1995). It is hoped to standardized oral corticosteroid therapy for long-lasting extremely severe atopic dermatitis.
Aoki
Toshiyuki
T
Aoki Skin and Allergy Clinic and Itch Laboratory. toshiyuki.aoki@nifty.ne.jp
Kono
Takeshi
T
D000284:Administration, Oral; D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D018926:Anti-Allergic Agents / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D005938:Glucocorticoids; D006634:Histamine H1 Antagonists / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D011795:Surveys and Questionnaires / Q000592:standards*
D000305:Adrenal Cortex Hormones; D018926:Anti-Allergic Agents; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D006634:Histamine H1 Antagonists