Prescribing practices for systemic agents in the treatment of severe pediatric atopic dermatitis in the US and Canada: The PeDRA TREAT survey

J Am Acad Dermatol. 2017 Feb;76(2):281-285. doi: 10.1016/j.jaad.2016.09.021. Epub 2016 Nov 14.


Background: There is a paucity of literature to direct physicians in the prescribing of immunomodulators for patients with severe atopic dermatitis (AD).

Objective: To survey systemic agent prescribing practices for severe childhood AD among clinicians in the United States and Canada.

Methods: The TREatment of severe Atopic dermatitis in children Taskforce (TREAT), US&CANADA, a project of the Pediatric Dermatology Research Alliance (PeDRA), developed an online multiple-response survey to assess clinical practice, gather demographic information and details of systemic agent selection, and identify barriers to their use in patients with recalcitrant pediatric AD.

Results: In total, 133 of 290 members (45.9%) of the Society for Pediatric Dermatology completed the survey, and 115 of 133 (86.5%) used systemic treatment for severe pediatric AD. First-line drugs of choice were cyclosporine (45.2%), methotrexate (29.6%), and mycophenolate mofetil (13.0%). The most commonly used second-line agents were methotrexate (31.3%) and mycophenolate mofetil (30.4%); azathioprine was the most commonly cited third-line agent. The main factors that discouraged use of systemic agents were side-effect profiles (82.6%) and perceived risks of long-term toxicity (81.7%).

Limitations: Investigation of the sequence of systemic medications or combination systemic therapy was limited. Recall bias may have affected the results.

Conclusion: Great variation exists in prescribing practices among American and Canadian physicians using systemic agents for treatment of pediatric AD.

Keywords: atopic dermatitis; azathioprine; cyclosporine; methotrexate; mycophenolate mofetil; oral antimicrobials; oral steroids.

MeSH terms

  • Adult
  • Azathioprine / therapeutic use*
  • Canada
  • Child
  • Cyclosporine / therapeutic use*
  • Dermatitis, Atopic / drug therapy*
  • Dermatology*
  • Drug Prescriptions / standards*
  • Female
  • Health Care Surveys
  • Humans
  • Male
  • Methotrexate / therapeutic use*
  • Middle Aged
  • Mycophenolic Acid / therapeutic use*
  • Pediatrics*
  • Practice Patterns, Physicians'*
  • Severity of Illness Index
  • United States


  • Cyclosporine
  • Mycophenolic Acid
  • Azathioprine
  • Methotrexate