Atopic dermatitis in China: challenge in diagnosis and treatment

Abstract

Although atopic dermatitis is a common skin disease world-wide, the prevalence vary between ethnic groups. In China, AD is not as common as in Japan. However, the prevalence increased in recent years. In 2000, the prevalence of AD in 6-20 year children and young adults were 0.69% . In 2004, the prevalence of AD was 2.78% in children of 1-7 years. In 2012, the cumulative prevalence of AD was reported to be 15.3% in children under 6 years and 10.9% in children of 6-12 years.
Clinically, atopic dermatitis is common in pediatric patients. However, it is not so common in adults. Most adult patients were diagnosed as eczema. Although Williams' criteria was recommended for the diagnosis of AD, the elevation of eosinophil and/or serum IgE level were regarded as the marker of AD by many dermatologists. If adult patients had chronic and generalized eczematous dermatitis without elevation of eosinophil and/or serum IgE level, he or she are often diagnosed as generalized eczema not atopic dermatitis. It might be a long way for Chinese dermatologists to change their idea about eczema and atopic dermatitis.
Inappropriate use of topical steroids had been a problem especially in rural area. Because of the shortage of dermatologists, patients in rural area often buy topical steroid themselves and use it until side-effects occur. Also, general practitioner often prescribe topical steroid without knowing their potency and course of treatment. The side-effects of topical steroid prescribed by dermatologists are rare.
To help Chinese dermatologists to manage AD properly and to avoid inappropriate use of topical steroids, the Chinese Society of Dermatology made a guideline for management of atopic dermatitis in 2008, which included patient education, use of topical steroids and calcineurin inhibitors, UVB treatment and systemic treatment. Topical steroids is the first line treatment. Chinese dermatologists also had a problem of facing negative opinion to steroid from patients. It might be largely due to over-concern about the side-effect that adult patients and parents of AD children are often reluctant or even refuse to use steroid. Dermatologists have to explain quite a lot before their patients agree to use topical steroids. Quite often, the patients stopped using topical steroids by themselves. So over-use and under-use of topical steroid are both problems in China.
Tacrolimus ointment and pemecrolimus cream were the second line treatment for AD. Tacrolimus ointment and pemecrolimus cream are both available in China. The only problem preventing their wide use is the price. For example, the price of tacrolimus ointment and pemecrolimus cream is 5-10 times of steroid creams. They are often prescribed for lesions on face and anogenital area.
To overcome the problems in steroid use, the Chinese Society of Dermatology launched a continuing medical education program, helping dermatologists in underdeveloped area to follow the AD guideline and to use topical steroid and calcineurin inhibitor properly. It turned out that this improved their treatments on atopic dermatitis.