Horii Kimberly A, Simon Stephen D, Liu Deede Y, Sharma Vidya
Section of Dermatology, Children's Mercy Hospitals and Clinics, 2401 Gillham Rd, Kansas City, MO 64108, USA.
Pediatrics. 2007 Sep;120(3):e527-34. doi: 10.1542/peds.2007-0289.
Atopic dermatitis is the most common chronic inflammatory skin disease of childhood and is increasing in prevalence throughout the world. Morbidity and resource use for atopic dermatitis are comparable to other chronic diseases. Topical corticosteroids are first-line therapeutic agents for atopic dermatitis; topical calcineurin inhibitors are considered second-line agents for patients who are older than 2 years. The aims of this study were to examine trends in visits for atopic dermatitis in children in the United States between 1997 and 2004, identify factors that were associated with a pediatric visit for atopic dermatitis, and assess changes in the treatment of atopic dermatitis over time.
Visits for atopic dermatitis by children (0-18 years) to office-based physicians and hospital outpatient departments using 1997-2004 National Ambulatory Medical Care Survey and National Hospital Ambulatory Care Survey databases were analyzed. Medication prescribing rates during 2 time periods (1997-2000 and 2001-2004) were also analyzed.
There were an estimated 7.4 million visits for atopic dermatitis. Statistically significant differences in patients with atopic dermatitis included age 2 to 5 years, black race, Asian race, and specialist or hospital outpatient clinic evaluation. The increase in atopic dermatitis visits per year was statistically significant. No statistical differences in prescribing rates were identified between the 2 time periods. Between 1997 and 2000, topical corticosteroids were prescribed in 34% of visits, decreasing to 25% between 2001 and 2004. Between 2001 and 2004, topical calcineurin inhibitors were prescribed in 23% of visits. In the same period, topical corticosteroids were prescribed in 24% of visits by children who were younger than 2 years; topical calcineurin inhibitors were prescribed in 22% of visits.
Visits for atopic dermatitis in children are increasing. A recommended first-line treatment was prescribed in a minority of the visits.
特应性皮炎是儿童最常见的慢性炎症性皮肤病，且在全球范围内患病率不断上升。特应性皮炎的发病率和资源利用情况与其他慢性疾病相当。外用糖皮质激素是特应性皮炎的一线治疗药物；外用钙调神经磷酸酶抑制剂被认为是2岁以上患者的二线药物。本研究的目的是调查1997年至2004年美国儿童特应性皮炎就诊趋势，确定与儿童特应性皮炎就诊相关的因素，并评估特应性皮炎治疗随时间的变化。
利用1997 - 2004年国家门诊医疗护理调查和国家医院门诊护理调查数据库，分析了0至18岁儿童到门诊医生和医院门诊部就诊特应性皮炎的情况。还分析了两个时间段（1997 - 2000年和2001 - 2004年）的药物处方率。
估计有740万次特应性皮炎就诊。特应性皮炎患者在年龄2至5岁、黑人种族、亚洲种族以及专科医生或医院门诊评估方面存在统计学显著差异。每年特应性皮炎就诊次数的增加具有统计学显著性。两个时间段之间在处方率方面未发现统计学差异。1997年至2000年期间，34%的就诊开具了外用糖皮质激素，2001年至2004年降至25%。2001年至2004年期间，23%的就诊开具了外用钙调神经磷酸酶抑制剂。同期，2岁以下儿童就诊中有24%开具了外用糖皮质激素；22%的就诊开具了外用钙调神经磷酸酶抑制剂。
儿童特应性皮炎就诊次数在增加。少数就诊中开具了推荐的一线治疗药物。
