# Real-World Treatment Patterns and Determinants of Therapy in Pediatric Atopic Dermatitis: A 10-Year Experience from a Tertiary Referral Center in Thailand

## TL;DR

This study examines treatment trends for pediatric atopic dermatitis in Thailand over 10 years, finding that conventional therapies like antihistamines and corticosteroids are most common, while access to newer treatments is limited by age and insurance coverage.

## Contribution

The study provides real-world data on pediatric atopic dermatitis treatment patterns and identifies socioeconomic and insurance factors influencing access to advanced therapies.

## Key findings

- Antihistamines and moderate-potency topical corticosteroids were the most commonly prescribed treatments.
- Adolescents were less likely to receive topical non-steroidal medications than infants.
- Patients under the Civil Servant Medical Benefit Scheme had higher access to non-steroidal therapies.

## Abstract

What are the main findings?
Antihistamines and moderate-potency topical corticosteroids were the most commonly prescribed treatments for pediatric atopic dermatitis.The use of topical non-steroidal agents and biologic therapies remained limited over the 10-year study period.Adolescents were less likely to receive topical non-steroidal medications than infants.Healthcare coverage, particularly under the Civil Servant Medical Benefit Scheme, strongly influenced access to non-steroidal therapies.

Antihistamines and moderate-potency topical corticosteroids were the most commonly prescribed treatments for pediatric atopic dermatitis.

The use of topical non-steroidal agents and biologic therapies remained limited over the 10-year study period.

Adolescents were less likely to receive topical non-steroidal medications than infants.

Healthcare coverage, particularly under the Civil Servant Medical Benefit Scheme, strongly influenced access to non-steroidal therapies.

What are the implications of the main findings?
Pediatric atopic dermatitis management in Thailand remains dominated by conventional therapies.Socioeconomic and insurance-related factors contribute to unequal access to advanced treatments.Improved reimbursement policies and treatment accessibility may enhance equity in pediatric AD care.Targeted education for healthcare providers and families may support more appropriate and guideline-based treatment use.

Pediatric atopic dermatitis management in Thailand remains dominated by conventional therapies.

Socioeconomic and insurance-related factors contribute to unequal access to advanced treatments.

Improved reimbursement policies and treatment accessibility may enhance equity in pediatric AD care.

Targeted education for healthcare providers and families may support more appropriate and guideline-based treatment use.

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease in children requiring long-term management, yet real-world data on treatment patterns remain limited. Objective: To evaluate treatment trends and factors associated with topical non-steroidal medication use in pediatric AD. Methods: We retrospectively analyzed 3982 children with AD treated at a tertiary referral center in Thailand between 2015 and 2024. Demographic data, healthcare coverage, and prescribed treatments were reviewed. Multivariable logistic regression was used to identify factors associated with topical non-steroidal use. Results: The median age was 7 years, with no sex difference. The most commonly prescribed treatments were antihistamines (75.0%), topical corticosteroids (47.6%), moisturizers (43.9%), systemic immunosuppressants (15.7%), topical non-steroidal agents including topical calcineurin inhibitors, phosphodiesterase-4 inhibitors, and Janus kinase (JAK) inhibitors (12.7%), and biologics (0.1%). Moderate-potency corticosteroids predominated. Adolescents were less likely to receive topical non-steroidal agents than infants (OR 0.66, 95% CI 0.50–0.87), whereas patients under the Civil Servant Medical Benefit Scheme (CSMBS) had higher access than those under the Universal Coverage Scheme (UCS) (OR 8.40, 95% CI 5.76–12.25). Conclusions: Pediatric AD management was dominated by conventional therapies, with limited access to advanced treatments. Age and healthcare coverage strongly influenced prescribing patterns, highlighting the need for more equitable access.