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

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 < 0.05), they were more likely to choose TCI for the same reason of patient steroid phobia against TCS ( < 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.