Initial Management of Infantile Atopic Dermatitis in Primary Care Settings and Predictors of Topical Steroid Potency Escalation.

BACKGROUND/

OBJECTIVES

Atopic dermatitis (AD) affects 15%-20% of children worldwide, with most treatment in primary care. Initial management of new-onset infantile AD remains poorly characterized.

METHODS

This retrospective cohort study included 3053 patients aged 0-2 years diagnosed with AD at pediatric and family medicine clinics at a single institution. Demographic, comorbidities, and treatment information were collected.

RESULTS

The mean age was 0.6 years at initial diagnosis; 54.4% were male. Of 3053 patients, 1015 (33.2%) had ≥ 1 additional atopic comorbidity or complication, most commonly asthma (28.8%), allergy (33.4%), allergic rhinitis (34.7%), conjunctivitis (41.8%), and bacterial infection (6.7%). At diagnosis, 66.8% (2038/3053) received prescription therapy, mostly topical (57.3%, 1743/3043 initial prescriptions). Common treatments at visit 1 (V1) included topical corticosteroid (TCS, 48.4%, 1472/3043 prescriptions), topical antifungal (4.4%, 134/3043), oral antihistamine (4.0%, 121/3043), while only 0.2% (7/3043) received topical calcineurin inhibitors. TCS potency was predominantly low (71.5%, 1053/1472), with medium (27.3%, 402/1472) and high (1.2%, 17/1472) less frequent. 78/1261 children (6.2%) changed potency of TCS between V1 and visit 2 (V2), with 5.2% escalating and 1.0% de-escalating therapy. Escalation was significantly associated with existing atopic comorbidities/complications (OR 3.15, p < 0.001).

CONCLUSIONS

Fewer than half of children received anti-inflammatory prescriptions at their initial AD visit. More research is needed to investigate whether this finding represents mild cases or undertreatment. Children with allergic comorbidities were more likely to require escalation to stronger TCS, warranting future exploration of the relationship between initial therapies and disease severity or comorbidity development.