Severity of pediatric atopic dermatitis underestimated by doctors

Only half of pediatric patients with atopic dermatitis meeting criteria for severe disease were identified as such by treating physicians.

A gap in severe physician-identified atopic dermatitis according to criteria has been reported in pediatric patients, with approximately 2 in 5 physicians expressing dissatisfaction with current treatment options for severe AD. The results were recently published in Dermatology and Therapy.

As a common condition affecting up to 30% of people under the age of 18, AD has been shown to significantly reduce the quality of life of pediatric patients and their families. Adverse effects associated with severe AD in children and adolescents include problems regulating sleep and attention, as well as an increased risk of fracture.

Due to differences in disease presentation and treatment tolerance between adults and younger patients, the researchers note that the current management of pediatric AD is challenging with limited availability of treatment options.

“Inconsistencies among healthcare professionals when recommending therapies for pediatric patients may lead to suboptimal treatment,” they added. “Relatively little is understood about how doctors determine whether the disease is mild, moderate or severe and what they consider to be the best treatment options for patients.”

They conducted a questionnaire-based study among 574 physicians responsible for the care of 1,719 children (6-11 years) and adolescents (12-17 years) with moderate to severe AD in 11 emerging economy countries, including Argentina. , Brazil, China, Colombia. , Israel, Mexico, Russia, Saudi Arabia, Taiwan, Turkey and United Arab Emirates.

Physicians were asked for an initial assessment of the patient’s disease severity and control, which was then compared to patient records and predefined criteria to assess concordance and discordance between the physician’s perception and the presentation. recorded from the patient.

Among the cohort of patients cared for by physicians, a majority had a family history of AD and an average of 2.4 comorbidities, with allergic rhinitis, dust allergy and asthma being cited as the most common. Physicians primarily used the SCORing AD (SCORAD) criteria for their assessments.

In their findings, physicians in all countries except Mexico and Turkey were shown to underestimate the severity of Alzheimer’s disease when initially assessing patients. Overall, 51% of patients whose disease criteria met “severe disease” on predefined criteria and SCORAD scores were also initially identified by physicians as having severe disease.

Disease severity was underestimated by physicians in 78% of children and 68% of adolescents with severe disease and overestimated in 19% of adolescents with moderate disease.

In terms of disease control, patients with moderate to severe AD experienced flares for an average of 263 days in the previous year, during which 90% and 74% of patients experienced flares chronic and unpredictable flare-ups, respectively. Relapse control could only be achieved within 7 days in 14% of patients (n=153).

When discussing treatment goals and satisfaction, a majority of physicians indicated complete elimination of itching and skin symptoms as their primary treatment goal. For moderate and severe cases, 59% and 33% of physicians said they were able to achieve this goal, respectively. About 24% and 40% of physicians were slightly dissatisfied (or worse) with treatment options for moderate and severe disease, respectively.

The most commonly used therapeutic interventions were emollients (92% to 93% of patients), as well as potent or super potent topical corticosteroids (83% of children with severe disease; 91% of adolescents with severe disease). severe; 87% of adolescents with moderate disease). Physicians reported being “moderately” to “very concerned” about exposure to corticosteroids and immunosuppressants in 68% and 73% of their patients, respectively.

“These findings suggest that there are many unmet needs in the treatment of children and adolescents with Alzheimer’s disease in emerging economies, whose treatment could be further optimized,” the study authors concluded. . “Practical, easy-to-use, and validated objective measures for the assessment of disease severity and control, as well as the effective use of new therapies, are essential to ensure appropriate patient management.”

Reference

Tang MBY, Fatani M, Wiggins S, Maspero J. Physicians’ perception of disease severity and treatment outcomes for children and adolescents with atopic dermatitis in emerging economies. Dermatol Ther (Heidelb). Published online March 26, 2022. doi:10.1007/s13555-022-00708-y

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