Retrospective markers of paediatric atopic dermatitis persistence after hospital diagnosis: A nationwide cohort study

Abstract

Background Atopic dermatitis (AD) normally onsets in childhood and mostly resolves before adolescences. Disease persistence is known to be difficult to study properly, and current predictors are insufficient to identify more than a small fraction of patients at risk. Objective To study personal AD medicine history as a retrospective marker of persistent AD. Methods The study population included all Danish first hospital contacts with a diagnosis of AD (ICD‐10, L20) between 1995 and 2012. National register data following the diagnosis were used to define persistent AD activity until 2017 according to personal AD medicine history before diagnosis. Activity was defined as filled prescriptions for topical corticosteroids (TCS) or calcineurin inhibitors (TCI), dermatologist contacts or hospital re‐contacts for AD. Risk ratios (RR) for persistent activity (defined as activity >4 of the most recent 5 years) were estimated according to AD medicine history (prescriptions filled prior to diagnosis) adjusted for age at onset, parental AD and basic covariates. Results A total of 13 628 patients were diagnosed at ages 0‐16 years and had up to 21 years of follow‐up. 10 years after diagnosis, 67% showed activity (9.5% persistent). Among prior TCS users (69%), the RR10y of persistent activity increased 1‐ to 6‐fold with increasing strength of strongest TCS/TCI ever, and with number of TCS courses. Prior use of antibiotics (RR10y 1.32, 95% CI 1.09‐1.59) and antihistamines (RR10y 1.65, 95% CI 1.42‐1.91) increased the RR10y in a dose‐dependent manner. In >90% of patients, prior medication use occurred <4 years before diagnosis. Conclusions and clinical relevance The strength and type of AD medication used in the previous 4 years may predict 10‐year persistence of AD. Since children may be misjudged as having milder disease when seen between flares of skin lesions, this information may improve physicians' ability to determine the correct prognosis independently of current AD severity.

Trends in Pediatric Primary Care Visits During the Coronavirus Disease of 2019 Pandemic

“…24, 25 We identified visits based on the primary International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code on the visit (listed in Appendix Table 1). [26][27][28][29][30][31][32][33] Consistent with prior work, the ARTI condition group is composed of both bacterial and viral diagnoses including sinusitis, acute otitis media, streptococcal pharyngitis, viral upper respiratory infection, bronchiolitis, and others. 26 Gastroenteritis also included both viral and bacterial etiologies.…”

Healthcare utilization in Danish children with atopic dermatitis and parental topical corticosteroid phobia

“…3 We recently showed that medication use could predict AD persistence in children. 4 It may therefore be speculated that early identification of children with increased risk of severe and persistent disease course could improve disease management and reduce the burden of AD.…”

Clinical and Economic Burden of Pediatric Mild-to-Moderate Atopic Dermatitis: A Population-Based Nested Case–Control Study in Sweden

“…A decline in secondary healthcare resource use following index date was observed in the present study and may indicate that patients' symptoms improved over time, potentially through successful treatment regimens or spontaneous resolution of the disease in some patients. However, a recent study [34] shows that disease persistence is high and that the decline in healthcare resource use may be a consequence of patients being returned to primary care for continuous management (and thus are not captured in the present study). The evolution of costs over time suggests that healthcare resource use is the most intense in the short term after onset of the disease or at relapse of symptoms.…”