Management of Pediatric Atopic Dermatitis by Primary Care Providers: A Systematic Review

BACKGROUND: Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines. OBJECTIVE:To review existing literature examining manage-ment components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs. DATA SOURCES: PubMed/Medline and Embase. STUDY ELIGIBILITY CRITERIA: English-language articles dated 2015 to 2020 reporting outcomes addressing management of pediatric AD by PCPs. STUDY APPRAISAL AND SYNTHESIS METHODS: Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author. RESULTS: Twenty articles were included. Surveys and national database analyses were the most common methodolo-gies (n = 7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed nonsedating antihistamines, and avoided TCIs. PCPs commonly recom-mended emollients, although this was not universal. Data char-acterizing nonmedication management were limited. LIMITATIONS: Most studies did not examine individual patient encounters, but rather relied on providers reporting their gen-eral behaviors. Provider behavior may vary based on country of practice. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Knowl-edge and management gaps exist among PCPs in treating pedi-atric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing nonmedication management, highlighting the need for future research in this area.

Automated summary

This review examines the management of pediatric atopic dermatitis by primary care providers, revealing common practices such as prescribing low-potency corticosteroids, overprescribing nonsedating antihistamines, and avoiding calcineurin inhibitors. PCPs typically recommend emollients, but there is limited data on nonmedication management.