Allergy Asthma Immunol Res.  2018 May;10(3):253-259. 10.4168/aair.2018.10.3.253.

Current Management of Moderate-to-Severe Atopic Dermatitis: A Survey of Allergists, Pediatric Allergists and Dermatologists in Korea

• Yum HY
• Kim HH
• Kim HJ
• Kim WK
• Lee SY
• Li K
• Lee DH
• The KAAACI Work Group on Severe/Recalcitrant Atopic Dermatitis

• KMID: 2409060
• DOI: http://doi.org/10.4168/aair.2018.10.3.253

Abstract

PURPOSE
There is an unmet need for the treatment of moderate-to-severe atopic dermatitis (AD), leading to variation in management strategies. To investigate distinct features and treatment modalities according to physicians' specialties, we collected data on the current treatment approach to moderate-to-severe AD among allergists, pediatric allergists and dermatologists in Korea.
METHODS
This questionnaire-based study was administered to physicians from the Korean Academy of Asthma, Allergy and Clinical Immunology (KAAACI), Korean Academy of Pediatric Allergy and Respiratory Disease (KAPARD), and Korean Atopic Dermatitis Association (KADA).
RESULTS
A total of 93 physicians participated in the study; 64.5% were pediatric allergists and 31.2% were dermatologists. The major patient age groups were "less than 5 years" for 100% of pediatric allergists and "6-12 years old" for 38% of dermatologists. The proportion of patients with moderate-to-severe AD was higher for dermatologists and allergists compared to pediatric allergists. Physicians agreed on the necessity of education including demonstration of basic skin care and application of topical therapies (88.2%), nutritional consultation (83.9%) and psychological counseling (75.3%). However, less than half were able to educate and counsel their patients in real practice. There were noticeable differences in first-line treatment among physician groups. For pediatric allergists, the order of preferred systemic treatment was wet wrap therapy, systemic corticosteroids and oral cyclosporin. Dermatologists ranked cyclosporin, phototherapy, and systemic corticosteroids as first-line treatment regimens. Major reported barriers to proper management were steroid phobia, unproven complementary and alternative medicine, lack of education, and the unreasonable insurance system.
CONCLUSIONS
Our findings suggest there are distinct differences in moderate-to-severe AD treatment according to physicians' specialties. Medical policy changes along with governmental supports are required in order to implement the ideal approach in real practice. For moderate-to-severe AD, a consensus on the approach to optimal management should be reached for the best outcomes, based on further randomized controlled trials.

Keyword

Atopic dermatitis; management; questionnaire

MeSH Terms

Adrenal Cortex Hormones
Allergy and Immunology
Asthma
Complementary Therapies
Consensus
Counseling
Cyclosporine
Dermatitis, Atopic*
Education
Humans
Hypersensitivity
Insurance
Korea*
Phobic Disorders
Phototherapy
Skin Care
Adrenal Cortex Hormones
Cyclosporine

Figure

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  Fig. 1 Distribution of patient age.

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  Fig. 2 Proportion of moderate-to-severe atopic dermatitis patients grouped by the physician's specialty.

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  Fig. 3 Necessary and actually employed treatment modalities.

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  Fig. 4 Preferred systemic treatment of severe atopic dermatitis in real practice.

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  Fig. 5 Preferred systemic treatment of moderate-to-severe AD according to the physician's specialty.

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  Fig. 6 Preferred guidelines for treatment of AD according to the physician's specialty. EADV, European Academy of Dermatology and Venereology; EAACI, European Academy of Allergy and Clinical Immunology; AAD, American Academy of Dermatology; AAAAI, American Academy of Allergy, Asthma and Immunology; KADA, Korean Atopic Dermatitis Association; KAPARD, Korean Academy of Pediatric Allergy and Respiratory Disease.

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  Fig. 7 Barriers to comprehensive treatment in patients with atopic dermatitis.

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