Article first published online: 16 Sep 2019
Despite decades of use, the actual amounts of topical corticosteroids ( TCS ) and emollients used in moderate‐to‐severe atopic dermatitis ( AD ) under real‐world conditions are unknown. Thus, it remains unclear whether inadequate use is widespread.
To quantify the use of TCS and emollients in moderate‐to‐severe AD .
Double‐blinded drug prescribing was recorded prospectively at the point of drug dispensing within a catchment area of approximately 450 000 people over a 31‐year period in a population‐based cohort marked by failure of disease control in primary care (n = 844). For each patient, prescribing was recorded over a 12‐month period in order to minimize fluctuations.
This approach resulted in a near‐complete dataset, which was essentially free of reporting bias and recording bias. Atopic comorbidities matched expected frequencies. Median use of TCS was statistically significantly higher in juvenile patients (age < 16 years) compared with adult patients (49·2 vs. 38·1 g per month), in male vs. female patients (46·8 vs. 29·7 g per month) and in patients receiving concurrent asthma treatment (40·4 vs. 26·7 g per month). TCS use was strongly associated with antidepressant treatment. Emollient use was unexpectedly low with a median of 9·6 g per day (range 1·4–30·1). Results were replicated in an independent validation cohort.
Deficient use of emollients may be a factor contributing to AD severity. Our analysis showed that the use of TCS does not exceed current guidelines. Accurate quantification of topical treatments provides a widely accessible strategy to measure the real‐world impact of novel AD treatments.
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