Topical treatments in atopic dermatitis

unexpectedly low use of emollients; use of topical corticosteroid is higher in juvenile patients, higher in male vs females, and shows independent associations with asthma and depression

J.y. Choi, R. Dawe, S. Ibbotson, C. Fleming, A. Doney, J. Foerster

Research output: Contribution to journalArticle

Abstract

Background Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate‐to‐severe atopic dermatitis (AD) under real‐world conditions are unknown. Thus, it remains unclear if inadequate use is widespread. OBJECTIVE: To quantify the use of TCS and emollients in moderate‐to‐severe AD. METHODS: Double‐blinded drug prescribing recorded prospectively at the point of drug dispensing within a catchment of approx. 450,000 over a 31‐year period in a population‐based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over 12‐month to minimize fluctuations. RESULTS: The resulting dataset was near‐complete, and essentially free of reporting‐ and recording bias. Atopic co‐morbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile (age < 16) compared to adult patients (49·2 vs. 38·1 gram / month), in males vs. females (46·8 vs. 29·7), and in patients receiving concurrent asthma treatment (40·4 vs. 26·7). TCS use was strongly associated with anti‐depressant treatment. Emollient use was unexpectedly low at median of 9·6 gram/day (range 1·4 ‐ 30·1). Results replicated in an independent validation cohort. Conclusions Deficient use of emollients may be a factor contributing to AD severity. TCS use does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure real‐world impact of novel AD treatments.
Original languageEnglish
JournalBritish Journal of Dermatology
DOIs
Publication statusE-pub ahead of print - 30 Jun 2019

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Emollients
Atopic Dermatitis
Adrenal Cortex Hormones
Asthma
Therapeutics
Drug Prescriptions
Antidepressive Agents
Comorbidity
Primary Health Care
Guidelines
Pharmaceutical Preparations

Keywords

  • atopic dermatitis
  • corticosteroid
  • comorbidity
  • database

Cite this

@article{951382ecf6d74ff5b4b270874f07703d,
title = "Topical treatments in atopic dermatitis: unexpectedly low use of emollients; use of topical corticosteroid is higher in juvenile patients, higher in male vs females, and shows independent associations with asthma and depression",
abstract = "Background Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate‐to‐severe atopic dermatitis (AD) under real‐world conditions are unknown. Thus, it remains unclear if inadequate use is widespread. OBJECTIVE: To quantify the use of TCS and emollients in moderate‐to‐severe AD. METHODS: Double‐blinded drug prescribing recorded prospectively at the point of drug dispensing within a catchment of approx. 450,000 over a 31‐year period in a population‐based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over 12‐month to minimize fluctuations. RESULTS: The resulting dataset was near‐complete, and essentially free of reporting‐ and recording bias. Atopic co‐morbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile (age < 16) compared to adult patients (49·2 vs. 38·1 gram / month), in males vs. females (46·8 vs. 29·7), and in patients receiving concurrent asthma treatment (40·4 vs. 26·7). TCS use was strongly associated with anti‐depressant treatment. Emollient use was unexpectedly low at median of 9·6 gram/day (range 1·4 ‐ 30·1). Results replicated in an independent validation cohort. Conclusions Deficient use of emollients may be a factor contributing to AD severity. TCS use does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure real‐world impact of novel AD treatments.",
keywords = "atopic dermatitis, corticosteroid, comorbidity, database",
author = "J.y. Choi and R. Dawe and S. Ibbotson and C. Fleming and A. Doney and J. Foerster",
year = "2019",
month = "6",
day = "30",
doi = "10.1111/bjd.18265",
language = "English",
journal = "British Journal of Dermatology",
issn = "0007-0963",
publisher = "Wiley",

}

TY - JOUR

T1 - Topical treatments in atopic dermatitis

T2 - unexpectedly low use of emollients; use of topical corticosteroid is higher in juvenile patients, higher in male vs females, and shows independent associations with asthma and depression

AU - Choi, J.y.

AU - Dawe, R.

AU - Ibbotson, S.

AU - Fleming, C.

AU - Doney, A.

AU - Foerster, J.

PY - 2019/6/30

Y1 - 2019/6/30

N2 - Background Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate‐to‐severe atopic dermatitis (AD) under real‐world conditions are unknown. Thus, it remains unclear if inadequate use is widespread. OBJECTIVE: To quantify the use of TCS and emollients in moderate‐to‐severe AD. METHODS: Double‐blinded drug prescribing recorded prospectively at the point of drug dispensing within a catchment of approx. 450,000 over a 31‐year period in a population‐based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over 12‐month to minimize fluctuations. RESULTS: The resulting dataset was near‐complete, and essentially free of reporting‐ and recording bias. Atopic co‐morbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile (age < 16) compared to adult patients (49·2 vs. 38·1 gram / month), in males vs. females (46·8 vs. 29·7), and in patients receiving concurrent asthma treatment (40·4 vs. 26·7). TCS use was strongly associated with anti‐depressant treatment. Emollient use was unexpectedly low at median of 9·6 gram/day (range 1·4 ‐ 30·1). Results replicated in an independent validation cohort. Conclusions Deficient use of emollients may be a factor contributing to AD severity. TCS use does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure real‐world impact of novel AD treatments.

AB - Background Despite decades of use,the actual amounts of topical corticosteroids (TCS) and emollients used in moderate‐to‐severe atopic dermatitis (AD) under real‐world conditions are unknown. Thus, it remains unclear if inadequate use is widespread. OBJECTIVE: To quantify the use of TCS and emollients in moderate‐to‐severe AD. METHODS: Double‐blinded drug prescribing recorded prospectively at the point of drug dispensing within a catchment of approx. 450,000 over a 31‐year period in a population‐based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over 12‐month to minimize fluctuations. RESULTS: The resulting dataset was near‐complete, and essentially free of reporting‐ and recording bias. Atopic co‐morbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile (age < 16) compared to adult patients (49·2 vs. 38·1 gram / month), in males vs. females (46·8 vs. 29·7), and in patients receiving concurrent asthma treatment (40·4 vs. 26·7). TCS use was strongly associated with anti‐depressant treatment. Emollient use was unexpectedly low at median of 9·6 gram/day (range 1·4 ‐ 30·1). Results replicated in an independent validation cohort. Conclusions Deficient use of emollients may be a factor contributing to AD severity. TCS use does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure real‐world impact of novel AD treatments.

KW - atopic dermatitis

KW - corticosteroid

KW - comorbidity

KW - database

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DO - 10.1111/bjd.18265

M3 - Article

JO - British Journal of Dermatology

JF - British Journal of Dermatology

SN - 0007-0963

ER -