Atopic dermatitis ‘snapshot’ raises concerns about GP use of steroids


By Michael Woodhead

17 Mar 2020

The first ‘snapshot’ of atopic dermatitis prevalence and treatment in Australian primary care has raised concerns about overuse of oral steroids.

The study based on data for 2.1 million patients in almost 500 GP practices found there was a lifetime prevalence of atopic dermatitis of 16.4% (346,000 people) and an annual incidence of around 2%.

One in five (21.4%) of cases of atopic dermatitis were classified moderate-to -severe disease and about one in seven cases 14.9%) were in young children under 10 years of age.

But the findings for treatments prescribed for atopic dermatitis raised some concerns about both overtreatment and undertreatment of the condition, according to the study investigators from NPS MedicineWise and co-author Dr Saxon Smith.

While topical corticosteroids were the most common medication (36.5% of patients), prescribed for atopic dermatitis, 15.6% of patients were prescribed systemic corticosteroids during the two year study period.

“Guidelines recommend oral corticosteroids be used for atopic dermatitis only with careful consideration. “Our finding that one in six patients with atopic dermatitis were prescribed oral corticosteroids is potentially concerning,” the authors wrote in the Australasian Journal of Dermatology.

The relatively high use of oral steroids might be due to “gaps in consumer and GP knowledge about optimising the use of topical therapies before moving to oral corticosteroids,” they suggested.

The study also showed that around 40% of patients with a lifetime diagnosis of atopic dermatitis had no record of guideline recommended prescribed medication for atopic dermatitis (topical corticosteroids, topical calcineurin inhibitors, systemic agents and antibacterial medicines).

Potent topical corticosteroids were the most common prescribed medication for atopic dermatitis (22.5%), followed by moderate (11.5%), mild (7.5%) and very potent topical steroids (0.8%).

Topical calcineurin inhibitors were prescribed for only 0.1% of patients.

The snapshot of atopic dermatitis which covered the years 2017-2018 found that current estimated prevalence of atopic dermatitis was 6.3% overall, and 13.8% in the 0-4 years age group.

AD was associated with an increased risk of insomnia (79% higher) , anxiety (44% higher) and depression (41% higher), compared with the general patient population without atopic dermatitis.

The study authors said the findings would help fill the gap in data relating to the burden of atopic dermatitis in Australia and its management in primary care.

“This information is useful for planning effective interventions to support GPs, and other primary care providers, in the optimal management of their patients with atopic dermatitis, particularly those experiencing uncontrolled atopic dermatitis and acute flares,” they concluded.

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