Background

Primary care providers (PCPs), including pediatricians and general practitioners, are often the first to see children with eczema/atopic dermatitis (AD). Little is known about management of pediatric AD by PCPs and adherence to national guidelines.

Objective

To review existing literature examining management components of pediatric AD (topical corticosteroids [TCS], topical calcineurin inhibitors [TCIs], antihistamines, bathing, emollients, and diet) by PCPs.

Data Sources

PubMed/Medline and Embase.

Study Eligibility Criteria

English-language articles dated 2015 to 2020 reporting outcomes addressing management of pediatric AD by PCPs.

Study Appraisal and Synthesis Methods

Two authors independently screened titles/abstracts, reviewed full-text articles, extracted relevant data, and evaluated study quality. Disagreements were resolved by a third author.

Results

Twenty articles were included. Surveys and national database analyses were the most common methodologies (n = 7 each). PCPs commonly prescribed TCS but had a preference for low-potency agents, overprescribed nonsedating antihistamines, and avoided TCIs. PCPs commonly recommended emollients, although this was not universal. Data characterizing nonmedication management were limited.

Limitations

Most studies did not examine individual patient encounters, but rather relied on providers reporting their general behaviors. Provider behavior may vary based on country of practice.

Conclusions and Implications of Key Findings

Knowledge and management gaps exist among PCPs in treating pediatric AD in key areas including knowledge of TCS safety profiles and prescribing of TCIs. The current literature is largely limited to small studies that evaluate prescribing behaviors with limited data characterizing nonmedication management, highlighting the need for future research in this area.

中文翻译：

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初级保健提供者对小儿特应性皮炎的管理：系统评价

背景

初级保健提供者 (PCP)，包括儿科医生和全科医生，通常是第一个看到患有湿疹/特应性皮炎 (AD) 儿童的人。关于 PCP 对儿科 AD 的管理以及对国家指南的遵守情况知之甚少。

客观的

回顾现有文献，检查 PCP 对儿科 AD 的管理成分（外用皮质类固醇 [TCS]、外用钙调神经磷酸酶抑制剂 [TCIs]、抗组胺药、沐浴、润肤剂和饮食）。

数据源

PubMed/Medline 和 Embase。

研究资格标准

2015 年至 2020 年的英文文章报告了 PCP 对儿科 AD 管理的结果。

研究评价与综合方法

两位作者独立筛选标题/摘要、审阅全文文章、提取相关数据并评估研究质量。分歧由第三位作者解决。

结果

收录了二十篇文章。调查和国家数据库分析是最常用的方法（每种方法 n = 7）。PCP 通常开出 TCS，但偏爱低效药物，过度开具非镇静性抗组胺药，并避免使用 TCI。PCP 通常推荐使用润肤剂，尽管这并不普遍。表征非药物管理的数据有限。

限制

大多数研究没有检查个别患者的遭遇，而是依赖于提供者报告他们的一般行为。提供者的行为可能因实践国家/地区而异。

主要发现的结论和意义

PCP 在治疗儿科 AD 的关键领域存在知识和管理差距，包括 TCS 安全性知识和 TCI 处方。目前的文献主要限于使用有限数据来评估处方行为的小型研究，这些数据表征非药物管理，突出了该领域未来研究的必要性。