Improving Atopic Dermatitis Management in Pediatric Patients Under 2 Years Old

Anna Fishbein, MD

A new investigation from Chicago incorporated insights and practices from several primary care pediatricians regarding the treatment of atopic dermatitis in pediatric patients under 2 years old.

The findings were presented at the 2021 American College of Allergy, Asthma, and Immunology (ACAAI) Scientific Meeting in New Orleans.

Investigators led by Anna Fishbein, MD, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois, noted that atopic dermatitis in pediatric patients under 2 years old had often gone untreated, and that no specific guidelines for this age group existed prior to the study.

As such, Fishbein and colleagues conducted focus groups with community-based pediatricians on how the under-treatment of atopic dermatitis could be improved, with the primary goal of informing future interventions to improve management in this age group.

The Methods

Fishbein and colleagues conducted 5 individual focus groups with primary care pediatricians throughout the study

According to investigators, the focus groups were centered around 1 question: “How can we, as researchers, help community-based pediatricians manage AD in children under 2 years old?”.

A convenience sample 5 community-based pediatric practices were invited to participate in the 40-minute audio-recorded focus groups. Of these practices, 17 primary care pediatricians had participated.

Semi-structured interview guides were proposed during the meetings to better navigate the issue of atopic dermatitis management.

Additionally, conversations regarding barriers and facilitators to treatments were approved, and pediatricians suggested solutions to address barriers to treatment.

From there, 2 investigators read the transcripts recorded from the focus group sessions and created a code list. These codes would later be applied to the transcripts using Dedoose software.

Finally, 2 research assistants independently applied the codes to the transcripts, which were then refined to achieve a Cohen’s kappa of 0.8 by both.

The Findings

After the coding of the transcripts, Fishbein and colleagues detailed 5 themes for approving atopic dermatitis management in pediatric patients under 2 years old.

Among these themes were educating caregivers on atopic dermatitis, educating providers on atopic dermatitis, creating emergency medical responder (EMR) aids for providers, improving access to specialists, and modeling existing interventions.

Some themes shared codes, such as “addressing topical corticosteroids safety”; however, a majority of the established codes were tailored to each individual theme.

Key quotes from the 5 focus groups sessions were included in the ACAAI presentation. Though unattributed to an individual pediatrician, quotes were marked with the focus group they were associated with.

Various quotes pertained to educational materials, with 1 quote from the final focus group reading “If there is a handout…that tell parents about topical steroids, their safety profile, because we do have some steroid hesitant families”, and another suggesting an informative video.

Comparisons to asthma models, as well as concerns on the fears of steroids and biologics, were addressed in a myriad of other quotes featured in the presentation.

Overall, Fishbein and colleagues felt that community-based pediatricians faced “specific and surmountable” challenges in the management of atopic dermatitis in children under 2 years.

Additionally, investigators write that the participating pediatricians were able to identify potential solutions to common challenges that included educational materials for caregivers, stepwise guidelines, and EMR aids to help with documentation and disease management.

“Further research is warranted to create and disseminate clinician-friendly atopic dermatitis management guidelines for this age group and pilot test EM aids,” the team wrote.