Management and Referral Patterns in Pediatric Atopic Dermatitis: A Survey of Pediatric Healthcare Professionals

Main Article Content

Courtney Nicole Bernett
Emma Hignett
Pearl Kwong


atopic dermatitis, pediatric


Background: The incidence of pediatric atopic dermatitis (AD) has continued to increase worldwide and pediatric healthcare providers (PHPs) are typically the initial healthcare provider tasked with management of this disease. The consequences of inadequately managed AD and misdiagnosed food allergies are devastating for patients and their families, and the financial burden associated with these scenarios can be overwhelming.

Objective: To assess the management and referral patterns of pediatric AD patients by PHPs in the Jacksonville, Florida (FL) area.

Methods: An online electronic survey was distributed to 70 PHPs using Survey Monkey©.  Data was collected over a 6-week period. The survey yielded a sample size of 28.

Results: Most participants were physicians (92.8%), with an average of 21.75 years in practice. Just over half (53%) of PHPs were aware of the American Academy of Dermatology (AAD) Guidelines of care for the management of AD. Dermatologists were the initial referral choice for AD management in 2/3, while 1/3 indicated preference for an allergist. Diet alteration was used by 14.3% as an initial AD management step and 35.7% tried elimination diets prior to referral to an allergist. Referral to specialists were low with 75% PHPs referring <25 % of their AD patients to dermatology.

Conclusion: With the number of outpatient AD visits increasing amongst PHPs, knowledge of management guidelines, in-depth understanding of appropriate use and limitations of elimination diets and food allergen testing, and referral to specialists suitable for management of this cutaneous disorder are imperative, but found to be highly variable.


1. Silverberg JI, Simpson EL. Associations of childhood eczema severity: a US population-based study. Dermatitis. 2014;25(3):107–114. doi:10.1097/DER.0000000000000034

2. Flohr C, Mann J. New insights into the epidemiology of childhood atopic dermatitis. Allergy. 2014;69(1):3–16. doi:10.1111/all.12270

3. Druker, AM, Wang AR,, Li WQ, et al. The Burden of Atopic Dermatitis: Summary of a Report for the National Eczema Association. J Invest Dermatol. 2017;137(1):26-30. doi:

4. Beattie*, P. and Lewis‐Jones, M. (2006), A comparative study of impairment of quality of life in children with skin disease and children with other chronic childhood diseases. British Journal of Dermatology, 155: 145-151. doi:10.1111/j.1365-2133.2006.07185.x

5. Singh P, Silverberg JI. Outpatient utilization patterns for atopic dermatitis in the United States [published online ahead of print, 2019 Mar 15]. J Am Acad Dermatol. 2019;S0190-9622(19)30435-9. doi:10.1016/j.jaad.2019.03.021

6. Bird JA, Crain M, Varshney P. Food allergen panel testing often results in misdiagnosis of food allergy. J Pediatr. 2015;166(1):97–100. doi:10.1016/j.jpeds.2014.07.062

7. Fleischer DM, Burks AW. Pitfalls in food allergy diagnosis: serum IgE testing. J Pediatr. 2015;166(1):8–10. doi:10.1016/j.jpeds.2014.09.057

8. Sidbury R, Tom WL, Bergman JN, et al. Guidelines of care for the management of atopic dermatitis: Section 4. Prevention of disease flares and use of adjunctive therapies and approaches. J Am Acad Dermatol. 2014;71(6):1218–1233. doi:10.1016/j.jaad.2014.08.038

9. NIAID-Sponsored Expert Panel, Boyce JA, Assa'ad A, et al. Guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Allergy Clin Immunol. 2010;126(6 Suppl):S1–S58. doi:10.1016/j.jaci.2010.10.007

10. Eichenfield LF, Ahluwalia J, Waldman A, Borok J, Udkoff J, Boguniewicz M. Current guidelines for the evaluation and management of atopic dermatitis: A comparison of the Joint Task Force Practice Parameter and American Academy of Dermatology guidelines. J Allergy Clin Immunol. 2017;139(4S):S49–S57. doi:10.1016/j.jaci.2017.01.009

11. Resnick SD, Hornung R, Konrad TR. A comparison of dermatologists and generalists. Management of childhood atopic dermatitis. Arch Dermatol. 1996;132(9):1047–1052.

12. Saavedra JM, Boguniewicz M, Chamlin S, et al. Patterns of clinical management of atopic dermatitis in infants and toddlers: a survey of three physician specialties in the United States. J Pediatr. 2013;163(6):1747–1753. doi:10.1016/j.jpeds.2013.06.073

13. Charman CR, Morris AD, Williams HC. Topical corticosteroid phobia in patients with atopic eczema. Br J Dermatol. 2000;142(5):931–936. doi:10.1046/j.1365-2133.2000.03473.x

14. Thompson MM, Tofte SJ, Simpson EL, Hanifin JM. Patterns of care and referral in children with atopic dermatitis and concern for food allergy. Dermatol Ther. 2006;19(2):91–96. doi:10.1111/j.1529-8019.2006.00062.x

15. Thompson MM, Hanifin JM. Effective therapy of childhood atopic dermatitis allays food allergy concerns. J Am Acad Dermatol. 2005;53(2 Suppl 2):S214–S219. doi:10.1016/j.jaad.2005.04.065

16. Jackson KD, Howie LD, Akinbami LJ. Trends in allergic conditions among children: United States, 1997-2011. NCHS Data Brief. 2013;(121):1–8.

17. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9–e17. doi:10.1542/peds.2011-0204

18. Sicherer SH, Wood RA; American Academy of Pediatrics Section On Allergy And Immunology. Allergy testing in childhood: using allergen-specific IgE tests. Pediatrics. 2012;129(1):193–197. doi:10.1542/peds.2011-2382

19. Tham EH, Leung DY. Mechanisms by Which Atopic Dermatitis Predisposes to Food Allergy and the Atopic March. Allergy Asthma Immunol Res. 2019;11(1):4–15. doi:10.4168/aair.2019.11.1.4

20. Strid J, Hourihane J, Kimber I, Callard R, Strobel S. Disruption of the stratum corneum allows potent epicutaneous immunization with protein antigens resulting in a dominant systemic Th2 response. Eur J Immunol. 2004;34(8):2100–2109. doi:10.1002/eji.200425196

Most read articles by the same author(s)