Prescription Patterns of Topical Medications in Patients with Atopic Dermatitis: An Investigative Review Using Big Data from the National Health Insurance Corporation

Abstract

Background: Topical medications play a crucial role in the treatment of atopic dermatitis (AD). Topical corticosteroids (TCSs) remain the main treatment of choice and topical antibiotics have also been used. However, with the new topical calcineurin inhibitors (TCIs), the prescription patterns of topical agents have changed over time.

Objective: To characterize the prescription patterns of topical medications in Korean patients with AD.

Methods: We investigated topical medications prescribed to Korean patients with AD using the National Health Insurance Sharing System (NHISS) database over a 14-year period (2002~2015). Additionally, the potency of prescribed TCSs was compared with AD and psoriasis patients.

Results: The annual prescription of TCSs showed a slightly decreasing trend without significant change. In particular, in terms of steroid class, prescription of moderate-to-low potency TCSs were increased and the use of high potency TCSs were decreased. TCSs were the most commonly prescribed topical medications for AD. Tertiary hospitals had a higher prescription rate for TCIs than secondary or primary hospitals (16.2%, 3.1%, and 1.9%, respectively). Additionally, dermatologists prescribed TCIs more frequently than pediatricians and internists (4.3%, 1.2%, and 0.6%, respectively). Among TCSs, Class 5 was prescribed the most (40.6%) followed by Class 7, 6, 4, 3, 1, and 2. When we compared the potency of TCSs prescribed for AD with psoriasis patients, moderate-to-low-potency TCSs were more commonly prescribed in AD.

Conclusion: Prescription patterns of topical medications had changed from 2002 to 2015 and differed according to the type of institution and specialty of the physician.

Keywords: Antibiotics; Atopic dermatitis; Calcineurin inhibitors; Corticosteroids; Topical agents.

Fig. 1. Alteration of annual topical medication prescription pattern from 2002 to 2015. Although prescription pattern of topical corticosteroids tended to mildly decrease, it remained as the mainstay of topical therapy in atopic dermatitis. No significant increase of topical calcineurin inhibitors or topical antibiotics prescriptions was observed over time.

Fig. 2. Prescription patterns of topical medication by medical institutions and prescribers’ specialty in 2015. (A) Compared to other institutions, tertiary institutions prescribed topical calcineurin inhibitors (TCIs) and topical antibiotics the most, followed by secondary and primary institutions. (B) Compared to other specialists, TCIs were prescribed the most by dermatologists, whereas topical antibiotics were prescribed the most by pediatricians.

Fig. 3. Annual topical corticosteroids (TCSs) prescription patterns according to potency of TCSs. Moderate-to-low-potency TCSs (Classes 5 and 7) were mainly prescribed.

Fig. 4. Topical corticosteroids (TCSs) prescription pattern by medical institutions and prescribers’ specialty in 2015. (A) Primary institutions prescribed moderate-potency TCSs (Class 5) the most, while tertiary institutions prescribed TCSs with more diverse potencies. (B) Dermatologists tend to prescribe more diverse potency TCSs than pediatricians and internists.