Atopic Dermatitis Phenotype Algorithm
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Atopic Dermatitis Phenotype Algorithm at the Center for Applied Genomics Background: Atopic Dermatitis is a chronic inflammatory skin disease that affects adults and children with worldwide prevalence rates of 1-20%. The prevalence in the United States is around 11%. The condition is characterized by intense pruritus and a course marked by exacerbations and remissions. The vast majority of cases have an onset before 5 years of age. Case inclusion criteria: -Individuals 60 days old or older with relevant ICD9 code for Atopic Dermatitis (691.8) in two or more in person visits, on separate calendar days. Plus - Individual’s medical record includes two or more prescriptions Atopic Dermatitisrelated medications (see Table 1) Or - Individuals 60 days old or older with relevant ICD9 code for Atopic Dermatitis (691.8) in three or more in person visits, on separate calendar days. Case exclusion criteria: - Individual’s medical record includes one or more of the ICD9 codes shown in Table2. Controls: - Individuals 60 days old or older - Must have two or more in person visits in the last 5 years - No diagnosis code for atopic dermatitis (691.8) - No history of relevant medications (see Table 4) - No exclusionary ICD 9 codes (see Table 3) Covariates: -Age -Gender -Ethnicity -Race -History of asthma (icd9code) -History of allergic rhinitis (icd9code) -History of allergic rhinoconjuctivitis(icd9code) -History of contact dermatitis (icd9code) -History of dermatitis due to substances taken internally (icd9code) -History of seborrheic dermatitis (icd9code) -History of psoriasis and similar disorders (icd9code) -Allergy tests -History of atopic dermatitis related medications -Age in days of all in-person visits per EMR Table 1- Medications related to Atopic Dermatitis Topical Corticosteroids Generic name Betamethasone dipropionate Clobetasol propionate Diprolene, Diprosone Temovate, Clobex, Olux-E, Olux, Cormax Halobetasol propionate Fluocinonide Flurandrenolide Diflorasone diacetate Amcinonide Halcinonide Desoximetasone Triamcinolone acetonide Ultravate Vanos, Lidex Cordran Psorcon, ApexiCon, Florone Cyclocort, Amcort Halog Topicort Kenalog, Triderm, Aristocort HP, Aristocort A Valisone, Luxiq, Beta-Val Cutivate Elocon Synalar, Capex, Derma-Smoothe/FS Westcort Cloderm Betamethasone valerate Fluticasone propionate Mometasone furoate Fluocinolone acetonide Hydrocortisone valerate Clocortolone pivalate Prednicarbate Desonide Dermatop DesOwen, Tridesilon ,Desonate , LoKara, Verdeso Locoid, Cortizone10 Pandel Aclovate Hytone , Nutracort ,Texacort , Cortaid, Synacort, Aquinil HC, Sarnol HC, Cortizone-10, Noble, Scalp relief Hydrocortisone butyrate Hydrocortisone probutate Alclometasone dipropionate Hydrocortisone Hydrocortisone acetate with pramoxine 1 percent combination Pramosone, Analpram HC, Epifoam Topical calcineurin inhibitors Generic name Tacrolimus Pimecrolimus Protopic Elidel Emollients Generic name Emollient Aquaphor, Cerave, Atopiclair… Antihistamines Generic name Hydroxyzine Diphenhydramine Clemastine Fumarate Cyproheptadine Chlorpherinamine Promethazine Cetrizine Loratadine Fexofenadine Mizolastine Desloratadine Vistaril,Atarax Benadryl,Sominex, Hydramine Tavist Periactin,Peritol Chlor-Trimeton, Phenetron, Antagonate Phenergan Zyrtec Claritin Allegra Mistamine, Mizollen Clarinex Oral Costicosteroids Generic name Hydrocortisone Prednisone Prednisolone Cortef, Hydrocortone Orasone Delta-Cortef, Prelone, Orapred, Pediapred, Medrol Decadron, Dexpak Aristocort Methylprednisolone Dexamethasone Triamcinolone Phototherapy Generic name UVA, UVAB,BB-UVB,nb-UVB,PUVA Other Generic name Cyclosporine (CyA) Interferon gamma Doxepin (Topical) Azathioprine Methotrexate Mycophenolate mofetil Restasis, Neoral, Sandimmune, Gengraf Actimmune Zonalon, Prudoxin, Xepin Imuran, Azasan Trexall Cellcept Table 2- Case exclusion criteria ICD9 133.0 279.12 287.0 757.1 758.x Scabies Wiskott-Aldrich Syndrome Allergic Purpura Ichtyosis congenita Chromosomal anomalies Table 3- Control exclusion criteria ICD9 690.x 692.x 693.x Erythematosquamous dermatosis Contact dermatitis and other eczema Dermatitis due to substances taken internally 694.x 695.x 696.x 697.x 698.x 691.0 133.0 279.x 260-269 172.x 173.x Bullous dermatoses Erythematous conditions Psoriasis and similar disorders Lichen Pruritus and related conditions Diaper or Napkin rash Scabies Disorders involving the immune mechanism Nutritional deficiencies Malignant melanoma of skin Other and unspecified malignant neoplasm of skin Carcinoma in situ of skin Allergic purpura Functional disorders of polymorphonuclear neutrophils Asthma Other chronic allergic rhinoconjunctivitis Allergic rhinitis Impetigo Urticaria Rash and other nonspecific skin eruption Unspecified adverse effect of drug medicinal and biological substance not elsewhere classified Allergy,unspecified Ichtyosis congenita Chromosomal anomalies Personal Hx of dieases of skin and subcutaneous tissue Personal Hx of allergy to medicinal agents Personal Hx of allergy, other than to medicinal agents Personal Hx of malignant melanoma of skin Personal Hx of malignant neoplasm of skin 232.x 287.0 288.1 493.x 372.14 477.x 684 708.x 782.1 995.2x 995.3 757.1 758.x V13.3 V14.x V15.0x V10.82 V10.83 Table 4- Medications for control exclusion Topical Corticosteroids Generic name Betamethasone dipropionate Clobetasol propionate Diprolene, Diprosone Temovate, Clobex, Olux-E, Olux, Cormax Halobetasol propionate Fluocinonide Flurandrenolide Ultravate Vanos, Lidex Cordran Diflorasone diacetate Amcinonide Halcinonide Desoximetasone Triamcinolone acetonide Psorcon, ApexiCon, Florone Cyclocort, Amcort Halog Topicort Kenalog, Triderm, Aristocort HP, Aristocort A Valisone, Luxiq, Beta-Val Cutivate Elocon Synalar, Capex, Derma-Smoothe/FS Westcort Cloderm Betamethasone valerate Fluticasone propionate Mometasone furoate Fluocinolone acetonide Hydrocortisone valerate Clocortolone pivalate Prednicarbate Desonide Dermatop DesOwen, Tridesilon ,Desonate , LoKara, Verdeso Locoid, Cortizone10 Pandel Aclovate Hytone , Nutracort ,Texacort , Cortaid, Synacort, Aquinil HC, Sarnol HC, Cortizone-10, Noble, Scalp relief Hydrocortisone butyrate Hydrocortisone probutate Alclometasone dipropionate Hydrocortisone Hydrocortisone acetate with pramoxine 1 percent combination Pramosone, Analpram HC, Epifoam Topical calcineurin inhibitors Generic name Tacrolimus Pimecrolimus Protopic Elidel Emollients Generic name Emollient Aquaphor, Cerave, Atopiclair… Oral Costicosteroids Generic name Hydrocortisone Prednisone Prednisolone Methylprednisolone Dexamethasone Triamcinolone Cortef, Hydrocortone Orasone Delta-Cortef, Prelone, Orapred, Pediapred, Medrol Decadron, Dexpak Aristocort Phototherapy Generic name UVA, UVAB,BB-UVB,nb-UVB,PUVA Other Generic name Cyclosporine (CyA) Interferon gamma Doxepin (Topical) Azathioprine Methotrexate Mycophenolate mofetil Restasis, Neoral, Sandimmune, Gengraf Actimmune Zonalon, Prudoxin, Xepin Imuran, Azasan Trexall Cellcept
