Topical Corticosteroid Use for Atopic Dermatitis in the Pediatric Emergency Department Pediatric Dermatology

TAKE-HOME MESSAGE

• In this single-institution retrospective review from 2012 to 2017, the pediatric emergency department reported 167 visits for atopic dermatitis. Topical corticosteroids (TCS) were not prescribed in 37.7% of visits while over-the-counter hydrocortisone was recommended in 27.5% of visits. Dermatology consultation was performed in 14 visits. Dermatology consultation was associated with higher rates of TCS prescription, higher class of TCS prescribed, higher rates of systemic antibiotic use, and higher recommendation rates for emollient use.

• Children who present to the emergency department for atopic dermatitis have low rates of prescription for appropriate strength TCS, and this may represent an opportunity to improve the management of this population.

–  Kelly B. Scarberry, MD

Written by

 

 

Sarah L. Chamlin MD

Pediatric emergency departments (ED) are used with increased frequency for the care of atopic dermatitis (AD). These authors report 167 ED visits for pediatric patients over a 5-year period. Most patients (70%) had Medicaid insurance and were given over-the-counter or no topical corticosteroids (TCS), 66%. Dermatology consultation resulted in significantly higher rates of TCS prescribing and a higher potency of the TCS given.

This study highlights an important knowledge gap. ED providers are less likely to provide the needed prescriptions and follow the standard of care that is greatly needed by this population. In my experience, primary and ED providers also often misjudge the quantity of medication needed or designate quantity as "one tube," translating into a pharmacy dispensing 15 grams. I applaud the authors and am personally motivated to develop an ED care pathway for our institution.

Abstract 

BACKGROUND/OBJECTIVES

To investigate the evaluation and management of atopic dermatitis (AD) in the pediatric emergency department (PED).

METHODS

This retrospective chart review was performed at the PED of a single institution and examined data from 2012 to 2017. Of 335 visits from patients 18 years and younger coded for AD, 167 visits with documented findings that supported a diagnosis of AD according to guidelines from the American Academy of Dermatology were included.

RESULTS

The mean age of presentation was 6.3 years (standard deviation [SD]: 5.9). Of 11 patients with multiple visits, the mean between-visit interval was 31 days (SD: 41). Topical corticosteroids (TCSs) were not prescribed or recommended in 63/167 visits. In an additional 46/167 visits, over-the-counter topical hydrocortisone was recommended. Of prescribed TCS, the mean TCS class was 5.5 (SD: 1.9). 61/104 recommended or prescribed TCSs were weak (Class 7), the most likely used class (P < .001). Dermatology consultation was requested in 14/167 visits and was associated with higher rates of TCS prescriptions (13/14 vs 91/153, P = .018), a higher mean class of TCS prescribed (3.1 vs 5.9, P < .001), higher prescription rates of systemic antibiotics (8/14 vs 10/153, P < .001), and higher recommendation rates for emollient usage (10/14 vs 46/153, P = .005).

CONCLUSIONS

Most patients presenting to the PED for AD were either not prescribed a TCS or were prescribed a weak TCS, often one that is over-the-counter. While there may be a variety of explanations for these findings, it is possible they reveal a practice gap regarding AD management in the PED.

Pediatric Dermatology

Topical Corticosteroid Use for Atopic Dermatitis in the Pediatric Emergency Department

Pediatr Dermatol 2021 Apr 19;[EPub Ahead of Print], JF Wang, TK Young, LE Melnick, SJ Orlow, VS Oza 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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