title: Patterns of clinical management of atopic dermatitis in infants and toddlers: a survey of three physician specialties in the United States.
abstract: OBJECTIVE
  To describe atopic dermatitis (AD) management patterns in children ≤36 months old as reported by pediatricians, dermatologists, and allergists in the US.
  
  
  METHODS
  A nationally-representative survey was administered to pediatricians (n = 101), dermatologists (n = 26), and allergists (n = 26). Main outcomes included referrals to health care professionals, suggested/ordered laboratory tests, management approach (dietary, pharmacologic, or combination of both) by age, AD location, and severity.
  
  
  RESULTS
  Significant differences were observed in referrals to healthcare professionals (P < .001). Pediatricians more frequently referred to dermatologists than allergists in mild (52.4% vs 32.0%) and moderate/severe (60.6% vs 38.1%) cases. Dermatologists referred to allergists less frequently for mild (9.1%) than moderate/severe (40.7%) AD cases. Pediatricians (59%), allergists (61.5%), and dermatologists (26.9%) reported treating at least some of their patients with AD with dietary management (infant formula change) alone (with or without emollients). Soy-based formulas were often used. For mild AD, the most commonly reported first-line pharmacologic treatments included topical emollients, topical corticosteroids, and barrier repair topical therapy/medical devices. Over 80% of physicians used a dietary and pharmacologic combination approach. Dermatologists were most likely to manage AD symptoms with a pharmacologic-only approach. AD lesion location influenced pharmacologic treatment in >80% of physicians.
  
  
  CONCLUSIONS
  Significant and distinct differences in AD treatment approach exist among physicians surveyed. Most pediatricians and allergists use formula change as a management strategy in some patients, whereas dermatologists favor a pharmacologic approach. This diversity may result from inadequate evidence for a standard approach. Consistent methods for managing AD are needed.
authors: Nestle Nutrition, Florham Park, NJ; Johns Hopkins University, Baltimore, MD. Electronic address: jose.saavedra@us.nestle.com.
authors: José M
authors: JM
authors: Saavedra
authors: Mark
authors: M
authors: Boguniewicz
authors: Sarah
authors: S
authors: Chamlin
authors: Alan
authors: A
authors: Lake
authors: Susan
authors: S
authors: Nedorost
authors: Laura A
authors: LA
authors: Czerkies
authors: Vardhaman
authors: V
authors: Patel
authors: Marc F
authors: MF
authors: Botteman
authors: Erica G
authors: EG
authors: Horodniceanu
mesh_terms: D000486:Allergy and Immunology; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000628:therapy*; D003880:Dermatology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010372:Pediatrics; D010818:Practice Patterns, Physicians'; D014481:United States
keywords: AD; Atopic dermatitis; EHF; Extensively hydrolyzed formula