Atopic dermatitis (AD) often requires combination treatment regimens. However, little is known about treatment combinations and polypharmacy in AD. We sought to characterize patterns of outpatient prescriptions and polypharmacy among US children and adults with AD. Data from the 1993–2015 National Ambulatory Medical Care Survey were analyzed, including 128,300 pediatric and 623,935 adult outpatient visits. Among AD visits, dermatologists prescribed more topical corticosteroids (TCSs, P = 0.01) than any other clinicians, particularly multiple TCSs (P < 0.0001), topical calcineurin inhibitors (TCI, P = 0.009), combination TCIs with TCSs (P = 0.004), and systemic immunosuppressants (P = 0.003). Prescriptions for multiple TCSs increased from ages 0 to 19 years, 20 to 39 years, and peaked at 40 to 59 years (P = 0.0002). Prescriptions for prednisone peaked at ages of 40 to 59 years (P = 0.003). A subset of AD patients was prescribed oral antibiotics (7.1%), although fewer than half had a diagnosis of bacterial infection (42.1%). The proportion of patients receiving multiple prescriptions was higher in visits to primary care practitioners versus dermatologists, those with private versus public insurance, and 50 years or older versus 20 to 49 years versus 0 to 19 years. Visits with 4 or more prescriptions by dermatologists increased between 1993–2000 (10%) and 2011–2015 (29%, P = 0.0001). In conclusion, significant treatment variation exists among specialists managing AD, with increasing polypharmacy over time.
From the Departments of *Dermatology
†Dermatology, Preventive Medicine, and Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Address reprint requests to Jonathan Silverberg, MD, PhD, MPH, 676 N St Claire St, Suite 1600, Chicago, IL 60611. E-mail: JonathanISilverberg@gmail.com.
This study was supported by the Dermatology Foundation.
The authors have no conflicts of interest to declare.
P.S. and J.S. had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
P.S. and J.S. conceived and designed the study, performed analysis and interpretation of data, drafted the manuscript, critically revised the manuscript, and performed statistical analysis. J.S. obtained funding and administrative, technical, or material support and did the study supervision.