Atopic dermatitis in adults: An Australian management consensus.
algorithm
atopic dermatitis
recommendations
severity
treatment
Journal
The Australasian journal of dermatology
ISSN: 1440-0960
Titre abrégé: Australas J Dermatol
Pays: Australia
ID NLM: 0135232
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
13
12
2018
accepted:
27
06
2019
pubmed:
3
8
2019
medline:
15
12
2020
entrez:
3
8
2019
Statut:
ppublish
Résumé
Atopic dermatitis (AD) has significant negative impact on health-related quality of life, mood, sleep, work productivity and everyday activities. Research into the use of new drugs in the management of AD continues to develop, and international updates and recommendations have been published. However, questions remain in the Australian setting. This consensus aims to provide evidence-based insights and practical advice on the management of adult AD in Australia. A panel (five dermatologists and one clinical immunologist) met to review the literature, critically examine clinical questions of relevance to Australian healthcare practitioners and develop a series of recommendation statements. A consensus panel, comprising the initial panel plus nine additional members, used a 2-round Delphi voting process to determine a set of final guidance statements. ≥75% agreement in the range 7-9. Round 1 voting comprised 66 guidance statements. Of these, consensus was reached on 26, which were retained, and five were removed. The remainder (35) were modified and one new guidance statement was added for inclusion in round 2 voting. After round 2, consensus was reached on 35, which were retained, and one was removed (considered redundant). The 61 guidance statements upon which consensus was reached were then used to support a series of core consensus recommendations and a management flow chart. Expert consensus recommendations providing practical guidance of clinical relevance to specialists and primary care physicians in Australia have been developed. Dissemination of this guidance and evaluation of its impact on patient outcomes remain to be undertaken.
Sections du résumé
BACKGROUND/OBJECTIVES
OBJECTIVE
Atopic dermatitis (AD) has significant negative impact on health-related quality of life, mood, sleep, work productivity and everyday activities. Research into the use of new drugs in the management of AD continues to develop, and international updates and recommendations have been published. However, questions remain in the Australian setting. This consensus aims to provide evidence-based insights and practical advice on the management of adult AD in Australia.
METHODS
METHODS
A panel (five dermatologists and one clinical immunologist) met to review the literature, critically examine clinical questions of relevance to Australian healthcare practitioners and develop a series of recommendation statements. A consensus panel, comprising the initial panel plus nine additional members, used a 2-round Delphi voting process to determine a set of final guidance statements.
CONSENSUS
METHODS
≥75% agreement in the range 7-9.
RESULTS
RESULTS
Round 1 voting comprised 66 guidance statements. Of these, consensus was reached on 26, which were retained, and five were removed. The remainder (35) were modified and one new guidance statement was added for inclusion in round 2 voting. After round 2, consensus was reached on 35, which were retained, and one was removed (considered redundant). The 61 guidance statements upon which consensus was reached were then used to support a series of core consensus recommendations and a management flow chart.
CONCLUSIONS
CONCLUSIONS
Expert consensus recommendations providing practical guidance of clinical relevance to specialists and primary care physicians in Australia have been developed. Dissemination of this guidance and evaluation of its impact on patient outcomes remain to be undertaken.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
23-32Subventions
Organisme : Sanofi Genzyme Australia Pty Ltd
Informations de copyright
© 2019 The Australasian College of Dermatologists.
Références
Saeki H. Management of atopic dermatitis in Japan. J. Nippon Med. Sch. 2017; 84: 2-11.
Paller AS, Kabashima K, Bieber T. Therapeutic pipeline for atopic dermatitis: end of the drought? J. Allergy Clin. Immunol. 2017; 140: 633-43.
Boguniewicz M, Alexis AF, Beck LA et al. Expert perspectives on management of moderate-to-severe atopic dermatitis: a multidisciplinary consensus addressing current and emerging therapies. J. Allergy Clin. Immunol. Pract. 2017; 5: 1519-31.
Lynde CW, Bourcier M, Gooderham M et al. A treatment algorithm for moderate to severe atopic dermatitis in adults. J. Cutan. Med. Surg. 2018; 22: 78-83.
Simpson EL, Bruin-Weller M, Flohr C et al. When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council. J. Am. Acad. Dermatol. 2017; 77: 623-33.
Garmhausen D, Hagemann T, Bieber T et al. Characterization of different courses of atopic dermatitis in adolescent and adult patients. Allergy 2013; 68: 498-506.
Hanifin JM, Reed ML, Eczema Prevalence Impact Working Group. A population-based survey of eczema prevalence in the United States. Dermatitis 2007; 18: 82-91.
Kantor R, Silverberg JI. Environmental risk factors and their role in the management of atopic dermatitis. Expert Rev. Clin. Immunol. 2017; 13: 15-26.
Deckers IA, McLean S, Linssen S et al. Investigating international time trends in the incidence and prevalence of atopic eczema 1990-2010: a systematic review of epidemiological studies. PLoS ONE 2012; 7: e39803.
Hanifin J, Rajka G. Diagnostic features of atopic dermatitis. Acta. Derm. Venereol. Suppl. (Stockh) 1980; 92: 44-7.
Bieber T, D'Erme AM, Akdis CA et al. Clinical phenotypes and endophenotypes of atopic dermatitis: where are we, and where should we go? J. Allergy Clin. Immunol. 2017; 139: S58-64.
Kapur S, Watson W, Carr S. Atopic dermatitis. Ann. Allergy Asthma Immunol. 2018; 14: 52.
Hill MK, Kheirandish Pishkenari A, Braunberger TL et al. Recent trends in disease severity and quality of life instruments for patients with atopic dermatitis: a systematic review. J. Am. Acad. Dermatol. 2016; 75: 906-17.
Wei W, Anderson P, Gadkari A et al. Discordance between physician- and patient-reported disease severity in adults with atopic dermatitis: a US cross-sectional survey. Am. J. Clin. Dermatol. 2017; 18: 825-35.
Thyssen JP, Hamann CR, Linneberg A et al. Atopic dermatitis is associated with anxiety, depression, and suicidal ideation, but not with psychiatric hospitalization or suicide. Allergy 2018; 73: 214-20.
Eckert L, Gupta S, Amand C et al. Impact of atopic dermatitis on health-related quality of life and productivity in adults in the United States: an analysis using the National Health and Wellness Survey. J. Am. Acad. Dermatol. 2017; 77: 274-9.e3.
Jenner N, Campbell J, Marks R. Morbidity and cost of atopic eczema in Australia. Australas. J. Dermatol. 2004; 45: 16-22.
Simpson EL, Bieber T, Eckert L et al. Patient burden of moderate to severe atopic dermatitis (AD): insights from a phase 2b clinical trial of dupilumab in adults. J. Am. Acad. Dermatol. 2016; 74: 491-8.
Eichenfield LF, Tom WL, Berger TG et al. Guidelines of care for the management of atopic dermatitis: Section 2. Management and treatment of atopic dermatitis with topical therapies. J. Am. Acad. Dermatol. 2014; 71: 116-32.
Huang YJ, Marsland BJ, Bunyavanich S et al. The microbiome in allergic disease: current understanding and future opportunities-2017 PRACTALL document of the American Academy of Allergy, Asthma & Immunology and the European Academy of Allergy and Clinical Immunology. J. Allergy Clin. Immunol. 2017; 139: 1099-110.
Lee M, Van Bever H. The role of antiseptic agents in atopic dermatitis. Asia Pac. Allergy 2014; 4: 230-40.
Rangel SM, Paller AS. Bacterial colonization, overgrowth, and superinfection in atopic dermatitis. Clin. Dermatol. 2018; 36: 641-7.
Nankervis H, Pynn EV, Boyle RJ et al. House dust mite reduction and avoidance measures for treating eczema. Cochrane Database Syst. Rev. 2015; 1: Cd008426.
Wollenberg A, Oranje A, Deleuran M et al. ETFAD/EADV Eczema task force 2015 position paper on diagnosis and treatment of atopic dermatitis in adult and paediatric patients. J. Eur. Acad. Dermatol. Venereol. 2016; 30: 729-47.
Ortiz-Salvador JM, Perez-Ferriols A. Phototherapy in atopic dermatitis. Adv. Exp. Med. Biol. 2017; 996: 279-86.
Patrizi A, Raone B, Ravaioli GM. Safety and efficacy of phototherapy in the management of eczema. Adv. Exp. Med. Biol. 2017; 996: 319-31.
Drucker AM, Ellis A, Jabbar-Lopez Z et al. Systemic immunomodulatory treatments for atopic dermatitis: protocol for a systematic review with network meta-analysis. BMJ Open 2018; 8: e023061.
Heratizadeh A, Werfel T, Wollenberg A et al. Effects of structured patient education in adults with atopic dermatitis: multicenter randomized controlled trial. J. Allergy Clin. Immunol. 2017; 140: 845-53.e3.
Drucker AM, Eyerich K, de Bruin-Weller MS et al. Use of systemic corticosteroids for atopic dermatitis: international Eczema Council consensus statement. Br. J. Dermatol. 2017.
Gooderham M, Lynde CW, Papp K et al. Review of systemic treatment options for adult atopic dermatitis. J. Cutan. Med. Surg. 2017; 21: 31-9.