Assessment of differences in therapeutic and diagnostic approaches for atopic dermatitis
One study found significant differences in the therapeutic and diagnostic approaches for atopic dermatitis used by allergists, dermatologists and pediatricians, and those recommended by guidelines.
Therapeutic and diagnostic approaches for atopic dermatitis (AD) can differ considerably depending on the type of consultant, with care also different from that recommended in established guidelines. The results were reported in Research and practice in dermatology.
With a myriad of therapies available and different medical specialties engaged in the delivery of care, managing AD involves managing the physical and psychosocial burden of the disease. While there are published guidelines for relieving symptoms and improving patients’ quality of life, the researchers note that following these guidelines does not guarantee successful treatment in all situations.
“But it can help physicians make evidence-based medicine decisions in daily clinical practice,” they added. “Progress has been made in understanding the pathophysiology of AD and in the development of better targeted therapies; However, little is known about the therapeutic decision making of medical specialists.
With the aim of examining the therapeutic and diagnostic approaches for AD used by medical specialties involved in care, including allergists, dermatologists and pediatricians, as well as to determine if these approaches conformed to the guidelines, the authors The study conducted a cross-sectional study of medicine companies and their medical associates who participated in an electronic questionnaire administered through the SurveyMonkey platform.
The questionnaire was based on updated guidelines from Brazilian and international medical societies, with questions divided into 2 sections:
- Sociodemographic data: sex, age, professional activity status, academic background, specialist title or specialist registration with the Regional Council of Physicians, length of professional experience, and place of professional activity
- Treatment of AD in adult and pediatric patients: use of moisturizers, emollients, wet wraps, corticosteroids, calcineurin inhibitors, antihistamines, phototherapy, immunomodulatory agents; the role of superantigens; type of research carried out; and dietary 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 people interviewed were mainly active professionals aged 30 to 60 in private practices.
In all specialties, the use of moisturizers as part of the treatment of AD was observed among pediatricians (91.9%), dermatologists (97.5%) and allergists (100%; P = .07). Regarding the preference for the use of new emollients, pediatricians (57%) were less likely to report use than dermatologists (75.9%) and allergists (71.4%; P <.001 in addition the prevalence of wet wrap treatment was lower among dermatologists than allergists>P
When reviewing the recommendations, proactive treatment with topical corticosteroids was more frequently reported by allergists (65.3%) than pediatricians (43.3%) and dermatologists (40.8%; P
The use of oral antihistamines to control pruritus was also noted as being primarily considered by pediatricians (69.2%) and dermatologists (59.2%), and less frequently prescribed by allergists (34.7% ; P <.001>
Further results indicated that clinical experience with systemic immunomodulatory agents was higher among allergists (77.5%) and dermatologists (60.8%) than among pediatricians (16.7%; P
Environmental control of aeroallergens was recommended first by allergists (100%), followed by pediatricians (89.8%) and dermatologists (86.9%; P = .01).
“Such differences may be related to the fact that the management of AD must be individualized, tailored for its clinical variability, and delivered with the primary aim of providing patients with adequate disease control,” the researchers concluded.
by Bortoli SPZ, Neto HJC, Filho NAR. Different approaches to atopic dermatitis by allergists, dermatologists and pediatricians. Dermatol Res Pract. Published online December 3, 2021. doi: 10.1155 / 2021/6050091