A study found significant differences in the therapeutic and diagnostic approaches to atopic dermatitis used by allergists, dermatologists and pediatricians, and those recommended by guidelines.
Therapeutic and diagnostic approaches to atopic dermatitis (AD) can vary significantly by type of clinic, with care also differing from that recommended in established guidelines. Findings were reported in Dermatology Research and Practice.
With a wide range of therapies available and different medical specialties dedicated to the delivery of care, AD management consists of managing the physical and psychosocial burden of disease. While published guidelines exist on providing symptom relief and improving patients’ quality of life, researchers note that adherence to these guidelines does not guarantee successful treatment in every situation.
“But it can help doctors make decisions based on evidence-based medicine in everyday clinical practice,” she added. “Advances have been made in understanding the pathophysiology of AD and in developing better targeted therapies; however, little is known about the therapeutic decision-making of specialist physicians.”
With the aim of assessing the therapeutic and diagnostic approaches to AD used by medical specialties involved in care, including allergists, dermatologists and pediatricians, and to determine whether these approaches were in line with guidelines, the authors conducted The survey conducted a cross-sectional study of medical associations and their medical partners who participated in an electronic questionnaire administered through the SurveyMonkey platform.
The questionnaire was based on the updated guidelines of Brazilian and international medical associations, with questions divided into 2 sections:
Socio-demographics: gender, age, occupational status, academic background, title of specialist or specialist registration with the Regional Medical Council, length of professional experience and place of occupational activity Treatment of AD in adult and pediatric patients: use of moisturizing agents, emollients, wet wrap therapy, corticosteroids, calcineurin inhibitors, antihistamines, phototherapy, immunomodulatory agents; the role of superantigens; type of research conducted; and food and environmental guidelines
Of the 1473 eligible questionnaires collected, 1179 were answered by pediatricians (80%), 245 by dermatologists (16.7%) and 49 (3.3%) by allergists. The respondents were mainly active female professionals between the ages of 30 and 60 in private practices.
Across all specialties, the use of moisturizers as part of AD treatment was observed in pediatricians (91.9%), dermatologists (97.5%) and allergists (100%; p = 0.07). With regard to preference for the use of new emollients, pediatricians (57%) reported their use less often than dermatologists (75.9%) and allergists (71.4%; P < .001). In addition, the prevalence of wet wrap therapy was lower among dermatologists (16.3%) than among allergists (51%; P < 0.001).
When considering recommendations, proactive topical corticosteroid treatment was reported more frequently by allergists (65.3%) than pediatricians (43.3%) and dermatologists (40.8%; P < 0.001) - a trend also observed for proactive treatment with calcineurin inhibitors.
The use of oral antihistamines to control pruritus was also primarily considered by pediatricians (69.2%) and dermatologists (59.2%) and less commonly prescribed by allergists (34.7%; P < .001).
Further findings indicated that clinical experience with systemic immunomodulatory agents was greater in allergists (77.5%) and dermatologists (60.8%) than in pediatricians (16.7%; P < 0.001), with ciclosporin being the most commonly cited systemic was an immunomodulatory agent.
Environmental control of aeroallergens was most recommended by allergists (100%), followed by pediatricians (89.8%) and dermatologists (86.9%; p = 0.01).
“Such differences may be related to the fact that AD management should be individualized, adjusted based on clinical variability, and performed with the primary goal of providing patients with adequate disease control,” researchers concluded.
de Bortoli SPZ, Neto HJC, Filho NAR. Different approaches to atopic dermatitis by allergists, dermatologists and pediatricians. Dermatol Res Pract. Published online Dec 3, 2021. doi: 10.1155/2021/6050091