Initial management of infantile atopic dermatitis in primary care settings and predictors of topical steroid potency escalation

Summary: Abstract Body: Atopic dermatitis (AD) affects an estimated 15-20% of children worldwide, with most treatment occurring in a primary care setting. Studies from other inflammatory diseases such as psoriasis and rheumatoid arthritis reveal the type and timing of therapy initiation may impact long-term outcomes. Initial management of new onset infantile AD has not been well-characterized. The objective of this study was to describe first-line treatment for AD and investigate changes in topical therapy potency. A retrospective cohort was performed utilizing electronic medical record data from 3053 patients (ages 0-2 years) with a diagnosis of AD and one follow-up visit. The cohort had a mean age of 0.6 years, was majority male (54.4%), with an overall representative distribution of race for the area. Of the 3053 patients, 1015 had at least one additional atopic comorbidity listed in their chart with the most common being asthma, allergy, allergic rhinitis, conjunctivitis, and bacterial infection (28.8%, 33.4%, 34.7%, 41.8%, 6.7% respectively). There were 3043 total individual medications at V1, with the most common being topical corticosteroid (TCS), topical antifungal, oral antihistamine, topical antibiotic, analgesics/antipyretic, and oral antibiotics (48.4%, 4.4%, 4.0%, 2.9%, 2.2%, 2.0% respectively). In the TCS class the potencies at V1 were mostly commonly low (71.5%), medium (27.3%), and high (1.3%). 5.2% (72/1500) of children changed potency of TCS between V1 and V2 showing 5.2% escalating and 1.0% deescalating therapy, while the rest maintained their potency. Multivariate logistic regression identified those who escalated TCS therapy, were significantly more likely to have concomitant atopic comorbidity (OR 3.15, P < 0.001) These data suggest children with atopic multi-morbidity may require more aggressive initial therapy and support future studies of early intervention approaches in AD. Moira Shea¹, Carter Haag¹, Emile Latour^{1, 2}, Eric Simpson¹ 1. Dermatology, Oregon Health & Science University, Portland, OR, United States. 2. Oregon Health & Science University Knight Cancer Institute, Portland, OR, United States. Clinical Research: Epidemiology and Observational Research