Prescriptions for atopic dermatitis: oral corticosteroids remain commonplace

Abstract

Introduction: Atopic dermatitis (AD) is a common, chronic inflammatory skin disease characterized by pruritic, often lichenified, patches and plaques.

Methods: Data were obtained from the Humana database, a large claim-based database encompassing more than 20 million patients under a commercial healthcare insurance plan. Our cohort included 39,526 subjects who saw a dermatologist for a primary ICD-9 diagnosis of atopic dermatitis (691.8) between the years of 2010 and 2015. Subjects were stratified according to gender, age and race. Prescribed medication lists were obtained and sorted based on potential indication for atopic dermatitis.

Results: The most common medications prescribed for atopic dermatitis in descending order were topical corticosteroids (60.2% of patients), oral antibiotics (17.3% of patients), antifungals (6.7% of patients), antihistamines (6.4% of patients), oral corticosteroids (5.9% of patients), calcineurin inhibitors (2.3% of patients) and emollients (1.2% of patients). Males ages 20–39 and 40–59 had the highest rates of oral steroids prescribed, at 9.2% and 9.8% of patients, respectively.

Conclusions: Presumably, individuals who are prescribed multiple courses of oral corticosteroids over time have severe atopic dermatitis with recalcitrance to other options. Given the side effect profile of oral corticosteroids, steroid-sparing systemic agents may be a better long-term option in the absence of contraindications.

Keywords:

• Treatment
• eczema
• steroid sparing

Additional information

Funding

Dr. Feldman has received research, speaking and/or consulting support from a variety of companies including Galderma, GSK/Stiefel, Almirall, Leo Pharma, Baxter, Boeringer Ingelheim, Mylan, Celgene, Pfizer, Valeant, Abbvie, Cosmederm, Anacor, Astellas, Janssen, Lilly, Merck, Merz, Novartis, Qurient, National Biological Corporation, Caremark, Advance Medical, Suncare Research, Informa, UpToDate and National Psoriasis Foundation. Tiffany Alexander, Elena Maxim, Leah Cardwell and Aneesh Chawla have no conflicts to disclose.