INTRODUCTION
Atopic dermatitis (AD) is a common inflammatory skin condition characterized by xerosis, lichenification, and eczematous lesions with severe itch. As there is no cure for this disease, the majority of therapy used to manage AD is limited towards symptomatic control and restoration of the disrupted skin barrier. Topical corticosteroids (TCS) have been the mainstay of AD therapy for decades.1,2 Topical calcineurin inhibitors (TCI) were introduced in 2000 as an alternative to TCSs, with claims that they were equally as efficacious as TCSs but without the side effect of cutaneous atrophy commonly feared with extended TCS use.3,4 When topical treatments fail, providers often resort to systemic immunosuppressants to control inflammation, including systemic steroids, cyclosporine, methotrexate, and mycophenolate mofetil. Their use, however, is limited due to concern for their toxic side effect profiles and suboptimal risk-benefit ratios. Adjunctive therapies used in AD include antibiotics to treat bacterial super-infections and anti-histamines to disrupt the itch-scratch cycle.5,6 While these therapies are often sufficient to manage mild disease, their effect is only transient in patients with moderate or severe disease. There has been a recent surge in the number of clinical trials evaluating new treatment modalities for the management of moderate-to-severe AD.7,8 Interest is particularly strong for topical phosphodiesterase (PDE)-4 inhibitors and systemic biologic agents that target pathways central to AD pathogenesis.7,8 With the multitude of new treatments set to emerge for AD, we characterize how AD is currently being managed in order to determine how new agents may play a role in AD management in the future.We previously reported on the treatment of AD in the office-based setting using data from the National Ambulatory Medical Care Survey (NAMCS) from 1990-1997.9 Dermatologists and allergists used more complex topical corticosteroid regimens in the management of AD than did other physicians. Dermatologists also used higher-potency anti-inflammatory agents more frequently than other physicians.10 Horii et al used the same dataset to examine treatments for AD between 1997-2004 and found similar rates of TCS and TCI use for AD in the pediatric population.11 We update these results with more recent data to examine trends in AD management over time.
METHODS
Data were compiled from the United States (US) National Ambulatory Medical Care Survey (NAMCS), which is an ongoing national
