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    17 views4 pages

    Poa00047 PDF

    Uploaded by

    Ari Kurniawan

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    © All Rights Reserved
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    rt Characterization of Diaper Dermatitis in the United States Daniel B. Ward, BS; Alan B. Fleischer, Jr, MD; Steven R Feldman, MD, PhD; Daniel P. Krowehuk, MD Background: Diaper dermatitis is the most common dermatologic disorder of infancy. This study evaluates the frequency of outpatient visits resulting in this diag- nosis, specialties of physicians providing services, demographics of patients, and leading agents used in Design: Records of 272841 encounters from the Na- tional Ambulatory Medical Care Survey (1990-1907) were ‘examined for visits in which diaper dermatitis was diag- nosed in children. The likelihood of diagnosis in the gen- cral pediatric population was calculated and the leading treatment agents were ranked. Results: There were approximately 8.2 million vists in which diaper dermatitis was diagnosed. For the pediat- ric population in the at-risk age range, there was a 1 in 4 Likelihood of being diagnosed with the skin disorder. Pe- diatricians provided 75% of services for the treatment of diaper dermatitis; the demographics of patients were sini- lar to those of comparably aged individuals in the gen- eral population, Nystatin was the leading treatment agent prescribed (27% of visits), followed by clotrimazole (16%), & combination product of nystatin and triameinolone (16%), hydrocortisone (8%), and a combination prod- uct of clotrimazole and betamethasone dipropionate (6%). Conelustons: Visits for diaper dermatitis are frequent, and pediatricians are the physicians most often called on to provide treatment. No portion of the pediatric popu- lation is disproportionately diagnosed. The frequent use of potent corticosteroids contained in combination agents {sa potential arget for improving the management of dia- per dermatitis Arch Pediatr Adolesc Med. 2000;154:943-946 TAPER DERMATITIS is a broad term used to de- senibe an acute inflamma: toses of various causes, fs thought tobe a reaction to iritants in the diaper environment, such as friction, oc- From the Departments of Dermatology (Drs Fleischer, Feldman, and Krowchul and ‘Mr Ward), Pathology (Dr Feldman, and Pediaties (Dr Krowehul), Wake Forest University School of Medicine, Winston-Salem, NC (aepnuyret) ARGH PEDIATR ABOU MENVOU St Se tory skin reaction in the diaper area, Itis the most common dermatologic disorder of in- fancy." resulting in alarge number of vi lus to physicians each year. The preva- lence in infants has been estimated to be 17% to 35%, with a peak in incidence be- tween ages © and 12 months.* Recently however, a large-scale study in Great Bri ain demonstrated an incidence of 25% in the first 4 weeks of life alone." This skin disorder is certainly not limited to in- fants and can occur in persons of any age who wear diapers.’ In fact, although the imeidence of diaper dermatitis in adults is unknown, itis likely quite high, given that 13 million American adults sulfer from uri- nary incontinence, and adult diaper sales exceeded $1.5 billion in 1996." Diaper dermatitis is @ geographic di- agnosis, encompassing a range of derma- (©2000 American Med clusion, dampness, maceration, urine, f ces, oF chemicals." There has also been an association with bottle-feeding, matu- rity ofthe infant, and intestinal carriage of Candida albicans. Treatment usually in- volves inereasing the frequency of diaper changes, using superabsorbent disposable diapers, and applying topical agents such as corticosteroids and barrier ointments or creams." When secondary C albicans Infection is present, a topical antifungal agent is beneficial.” The purpose of this study is to char- acterize diaper dermatitis in US children ith respect to frequency of oice visits, spe- cialties of physicians providing treatment, demographics of patients, and therapy prescribed. We specifically attempt to evalt- ate the appropriateness of treatment and the potency of topical corticosteroids when these medications are prescribed, Association, All rights reserved. MATERIALS AND METHODS Each year, the National Ambulatory Medical Care Survey (NAMCS ts conducted bythe National Cente for Health Slates, Exensive dais are collected in an ongoing effort icccharsctrize outpatient physician services inthe United Ste The sampling indo no daly employed Physicians principally engaged in owpatien care activ ths The multistage probably insampling design sia fied by primary sampling unit (county, contiguous coun- ties, or standard metropolitan statistical ares) then by Phyaican practices within the sampling unt, and finally by patient visits within the 52 weekly tandomized pert cole Wiihin smal practices, a 100% sample of weeks vist twas possible. For very large practices, 20% of paint vi {ts were randomly sampled. The resulting national ext tnates describe the use of ambulatory care services inthe United states” The study interval of 1900 to 1997 was chosen be- case these were the most recent data avalable. A total of 372041 records collected from 1990 to 1997 ae represen- iatve ofthe more than 5.68 billion outpatient pkysiclan ‘sts the United States during this period. Fo each visit Eampled, a I-page patient log was completed that in- Glued demographic dats, reason for visits physicians ‘gnoses, services provided, and eeral practices. For nor talzation with national estimates, each individual record twas assigned an inflation factor called the paient vist ‘eight, which was then used to predict the toa number oie vst made inthe United Sates ll estimates from the NAMCS are ested to the numberof patient visits and se subject o sampling variably. The relative SE ts used to messure the sampling variably. Representative rel tive SEs forthe 1990 NAMCS ae as follows: forest tnates of TO million vist, 224% for estimates of 1 milion ists, 31.5% for estimates of 300000 visits, and 69.7% for Cstlmates of 100000 vist” Relative SE rates from other years ate similar to these and can be obtained fom Na- onal Center for Health Statistics published information When considering the reliability of estimates, the Na- ‘onal Cente for Health tas considers anestimate to be reable fi has arelative SE of 30% or les of he es in this study, the NAMCS data were reviewed fr all wists in which the Intemational Cassiftcaion of Diseases, Ninth Revision, Clinical Modification (TCD-9-CM)" code or diaper dermatitis (691.0) was designated as the primary, secondary, or trary diagnosts. To cape oer diaper dermatitis visits that were not diagnosed with ICD-9-€M cove 691.0, we aso examined vss for diagnoses includ ing balanitis (1121), vulvovaginitis (112-2), inerrigo (iz) and candidiasis ofan unspecified sit (112.9) An ag limit of les than or equal to yars was sed to elm fate vst rom older patients in which these diagnoses ‘would not be related te diaper dermatitis The numberof births fron 1090 to 1997 was ob- tained," and this population was designated as the popu lation at sk for daper dermatitis durin the period when the NAMCS data were gathered. The toll numberof ou patient office visite in which diaper dermatitis was dag Fosed was divided by the numberof children inthe at Fisk population to obtain the isk thata child nthe United Slates would be dlagnosed with ape dermatitis an out Pa The frequency of mentions of primary, secondary, and tertiary drug foreach diagnosis was determined. Trade~ tame drugs were converted to ther generic equivalent, and drugs with different ate names but the samme generic equivalent were grouped int generic group, all daa man fgement and analysis was performed with tastical Analy He System software, version 6.12 (GAS ntti, Cary, NO) —_ i dy Using the most restrictive classification of diaper derma- Uitis (691.0), there were an estimated 4.8 million outpa- tient visits from 1990 to 1997 (approximately 600000 per year). When we incorporated the additional ICD- 9.CM codes for balanitis (112.1), vulvovaginitis (112.2), intertrigo (112.3), and candidiasis of an unspecified site (212.9), there were an estimated total of 82 million out- patient visits approximately 1.0 million per year). Chil- dren born during these years had a risk of 1 in 4 (25%) of being diagnosed with diaper dermatitis. Of the visits, 75% were to pediatricians, whereas 20%, 2.4%, 1.6%, and 1.4% were to family physicians, internists, dermatolo- ists, and other specialists, respectively. Patients were 51% male and 49% female. The racial distribution was as fol- lows: 82.0% white, 12% black, 4.7% Asian/Pacific Is- lander, and 0.8% American Indian/Eskimo/Aleut, The el nicity distribution was 70% non-Hispanic and 16.4% Hispanic. In 91.5% of the visits, patients were younger than 2 yeats (60.3% were aged

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