Dermatologists' Perceptions and Factors Influencing the Selection of Topical Anti-Inflammatory Agents for Atopic Dermatitis in China: A Cross-Sectional Survey Study.

Abstract

Objective: Topical corticosteroids (TCS), topical calcineurin inhibitors (TCI), and phosphodiesterase 4 (PDE-4) inhibitors are three common topical anti-inflammatory agents for treating atopic dermatitis (AD). The purpose of our study was to understand Chinese dermatologists' perceptions and the factors influencing their choices of the three agents.

Methods: An online questionnaire survey was conducted between 25 July 2022 and 25 August 2022 among Chinese dermatologists. The survey with six multiple-choice questions focused on what were their most commonly prescribed agents for treating AD, and what factors influenced their choices of the three agents. The results were assessed by chi-square test and logistic regression analysis.

Results: A total of 1, 156 valid questionnaire replies were received. For treating AD, 79.84% of Chinese dermatologists chose TCS, 81.40% chose TCI, and 18.25% chose PDE-4 inhibitors. When TCS was not chosen, the three principal reasons included local adverse effects (85.56%), suspicious infection on lesioned area (71.54%), and patient steroid phobia (61.59%). Coincidentally, when the TCI and PDE-4 inhibitors were chosen, the main reason was patient steroid phobia (76.21% and 74.74% respectively) against TCS. When PDE-4 inhibitors were not chosen, the major reasons were their intolerable adverse effects (80.36%) and their slower onset and weak efficacy (57.61%). Logistic regression analysis revealed that more senior dermatologists were less likely to choose TCS for the reason of local adverse effects and patient steroid phobia (each P < 0.05), they were more likely to choose TCI for the same reason of patient steroid phobia against TCS (P < 0.05).

Conclusion: Local adverse effects and patient steroid phobia were the reasons that limited Chinese dermatologists from choosing TCS for treating AD. Instead, more of them choose to use TCI. PDE-4 inhibitors were sometimes considered as an alternative to TCS or TCI, but its local adverse effects and limited efficacy affected the choice of this agent.