Atopic dermatitis in children in the United States, 1997-2004: visit trends, patient and provider characteristics, and prescribing patterns.
OBJECTIVE
Atopic dermatitis is the most common chronic inflammatory skin disease of childhood and is increasing in prevalence throughout the world. Morbidity and resource use for atopic dermatitis are comparable to other chronic diseases. Topical corticosteroids are first-line therapeutic agents for atopic dermatitis; topical calcineurin inhibitors are considered second-line agents for patients who are older than 2 years. The aims of this study were to examine trends in visits for atopic dermatitis in children in the United States between 1997 and 2004, identify factors that were associated with a pediatric visit for atopic dermatitis, and assess changes in the treatment of atopic dermatitis over time.


METHODS
Visits for atopic dermatitis by children (0-18 years) to office-based physicians and hospital outpatient departments using 1997-2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey databases were analyzed. Medication prescribing rates during 2 time periods (1997-2000 and 2001-2004) were also analyzed.


RESULTS
There were an estimated 7.4 million visits for atopic dermatitis. Statistically significant differences in patients with atopic dermatitis included age 2 to 5 years, black race, Asian race, and specialist or hospital outpatient clinic evaluation. The increase in atopic dermatitis visits per year was statistically significant. No statistical differences in prescribing rates were identified between the 2 time periods. Between 1997 and 2000, topical corticosteroids were prescribed in 34% of visits, decreasing to 25% between 2001 and 2004. Between 2001 and 2004, topical calcineurin inhibitors were prescribed in 23% of visits. In the same period, topical corticosteroids were prescribed in 24% of visits by children who were younger than 2 years; topical calcineurin inhibitors were prescribed in 22% of visits.


CONCLUSIONS
Visits for atopic dermatitis in children are increasing. A recommended first-line treatment was prescribed in a minority of the visits.
Horii
Kimberly A
KA
Section of Dermatology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108, USA. kahorii@cmh.edu
Simon
Stephen D
SD
Liu
Deede Y
DY
Sharma
Vidya
V
D000287:Administration, Topical; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D017677:Age Distribution; D065095:Calcineurin Inhibitors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019992:Databases as Topic; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000453:epidemiology*; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D019538:Health Care Surveys; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D009819:Office Visits / Q000706:statistics & numerical data / Q000639:trends*; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017678:Sex Distribution; D013038:Specialization; D016559:Tacrolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
D000305:Adrenal Cortex Hormones; D065095:Calcineurin Inhibitors; D006634:Histamine H1 Antagonists; D007166:Immunosuppressive Agents; C117268:pimecrolimus; D016559:Tacrolimus