Management of Mild-to-Moderate Atopic Dermatitis With Topical Treatments by Dermatologists: A Questionnaire-Based Study

Abstract

Background

Atopic dermatitis (AD) is a chronic, immune-mediated, inflammatory skin disorder affecting a heterogeneous population. Most patients with mild-to-moderate AD are treated with topical medication.

Objectives

To gain an understanding of the management of mild-to-moderate AD with topical treatments by examining the practices of dermatologists worldwide using a questionnaire.

Methods

Participants from North America, the Middle East, Asia, South America and the United Kingdom completed an electronic questionnaire composed of 43 questions assessing their clinical practice with topical treatment for patients with mild-to-moderate AD among different age groups ( < 2, 2−12 and > 12 years) and disease severity (mild or moderate AD).

Results

Seventeen dermatologists completed the questionnaire. For patients of all ages with mild-to-moderate AD, nearly all participants indicated that topical corticosteroids (TCSs) are the first-line topical treatment for a duration of ≤ 4 weeks before reassessment. Less-potent TCSs were preferred for younger patients and for sensitive regions of the body. Time until treatment re-evaluation was guided by disease severity: the greater the disease severity, the shorter the time until re-evaluation (1 week to 4 months). In all age groups, after initial treatment, most participants would continue the regimen previously prescribed, switch to a non-TCS agent (e.g., a topical calcineurin inhibitor, crisaborole or topical JAK inhibitor), or reduce the dose. All participants would utilize TCSs with or without non-TCS agents for treating flares depending on patient age and affected region(s) of the skin. Infection, drug-related adverse effects, worsening AD, corticophobia and limited access to topical pharmacologic treatment were the main reasons for deviation from the standard regimen.

Conclusions

Management of mild-to-moderate AD in practice is influenced by several patient-specific factors, access to specialist care and therapies, safety concerns and limitations associated with treatment options.