Translating Atopic Dermatitis Management Guidelines Into Practice for Primary Care Providers

Abstract

Atopic dermatitis affects a substantial number of children, many of whom seek initial treatment from their pediatrician or other primary care provider. Approximately two-thirds of these patients have mild disease and can be adequately managed at the primary care level. However, recent treatment guidelines are written primarily for use by specialists and lack certain elements that would make them more useful to primary care providers. This article evaluates these recent treatment guidelines in terms of evaluation criteria, treatment recommendations, usability, accessibility, and applicability to nonspecialists and integrates them with clinical evidence to present a streamlined severity-based treatment model for the management of a majority of atopic dermatitis cases. Because each patient's situation is unique, individualization of treatment plans is critical as is efficient communication and implementation of the plan with patients and caregivers. Specifically, practical suggestions for individualizing, optimizing, implementing, and communicating treatment plans such as choosing a moisturizer formulation, avoiding common triggers, educating patients/ caregivers, providing written treatment plans, and scheduling physician follow-up are provided along with a discussion of available resources for patients/caregivers and providers.

Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines

“…Although specialists in allergy and dermatology might be able to read through the extensive guidelines and supporting references, primary care clinicians, who take care of the majority of patients with mild-tomoderate AD, need streamlined guidelines that can be incorporated into their busy practices. 8…”

Evaluation of Hypothalamic-Pituitary-Adrenal Axis Suppression following Cutaneous Use of Topical Corticosteroids in Children: A Meta-Analysis

“…For this group, lower-potency TCS (classes 6–7) are generally applied once or twice daily or medium-potency TCS (classes 3–5) once or twice weekly as maintenance therapy [6]. Higher-potency TCS are reserved for the treatment of acute disease flares with pediatric guidelines limiting the use from several days to a few weeks [6, 7]. However, repeated or prolonged use of high-potency TCS is often warranted for those with severe skin disease.…”

Use of topical glucocorticoids: a population‐based cohort study

“…Whether prescriptions issued by dermatologists induced fewer adverse events and/or less glucocorticoid phobia than those issued by general practitioners or other physicians remains unknown. Nevertheless, if indeed topical glucocorticoids are prescribed much more frequently by physicians other than dermatologists, all initiatives to improve the use of these treatments in primary care, as has been done for atopic dermatitis, are welcome.…”