When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Simpson, Eric L.; Bruin‐Weller, Marjolein de; Flohr, Carsten; Ardern‐Jones, Michael R.; Barbarot, S.; Deleuran, Mette; Bieber, Thomas; Vestergaard, Christian; Brown, Sara J.; Cork, Michael J.; Drucker, Aaron M.; Eichenfield, Lawrence F.; Foelster-Holst, Regina; Guttman‐Yassky, Emma; Nosbaum, Audrey; Reynolds, Nick J.; Silverberg, Jonathan I.; Schmitt, Jochen; Seyger, M.M.B.; Spuls, Phyllis I.; Stalder, J.F.; Su, John; Takaoka, Roberto; Traidl‐Hoffmann, Claudia; Thyssen, Jacob P.; Schaft, Jorien van der; Wollenberg, Andreas; Irvine, Alan D.; Paller, Amy S.

doi:10.1016/j.jaad.2017.06.042

Cited by 197 publications

(222 citation statements)

References 67 publications

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“…Combined with psychotherapy, early medical intervention can greatly improve QoL . Aggressive treatment, including phototherapy and systemic therapy, should be considered early on for patients with significant QoL impairment …”

Section: Discussionmentioning

confidence: 99%

The impact of pediatric atopic dermatitis on families: A review

Yang

Beck

Sekhon

et al. 2018

Pediatric Dermatology

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Background Atopic dermatitis (AD) is an extremely common childhood disease, with considerable impact on the quality of life of affected children and their families. While pruritus is the hallmark symptom of this disease, AD has been well‐documented to impact patients beyond physical symptoms, resulting in behavior problems, mood disorders, and sleep disturbance. Objective This literature review outlines how atopic dermatitis impacts the quality of life of families of children affected by AD. Methods A total of 3436 articles were identified via an online search of the MEDLINE health literature database and were screened for relevance to quality of life impacts on families with children affected by AD. Results Caring for children affected by AD can be an extremely time‐consuming task that can impair personal relationships, decrease psychosocial functioning, and cause sleep loss among family members of affected patients. Additionally, AD may result in work absence or decreased work productivity for caregivers. Special diets, irritant and allergen avoidance strategies, and alternative therapies are commonly used by patients to manage their disease and require large amounts of family involvement. Conclusions Atopic dermatitis can greatly decrease quality of life of families of affected children in various domains, including sleep, finances, and relationships. Early intervention and psychotherapy may be needed in some patients to address these quality of life impairments.

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Section: Discussionmentioning

confidence: 99%

The impact of pediatric atopic dermatitis on families: A review

Yang

Beck

Sekhon

et al. 2018

Pediatric Dermatology

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“…There is now focused research interest on the interplay of the epidermis and immune system in patients with AD; multiple molecular targets are being explored with agents in development that target specific components of the immune system and inflammation‐related itch . This has prompted several international updates, and consensus ‘best practice’ recommendations have been published . The aim of this consensus is to provide evidence‐based insights and practical advice on the management of adult AD in Australia.…”

Section: Introductionmentioning

confidence: 99%

Atopic dermatitis in adults: An Australian management consensus

et al. 2019

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Background/Objectives 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 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: ≥75% agreement in the range 7–9. 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 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.

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“…In atopic dermatitis, patients’ own assessments of their quality of life often cannot be directly correlated with the physical extent of their disease, suggesting that physicians cannot accurately determine how patients feel [1]. Physician assessment of a patient’s quality of life is variable, subjective and often inaccurate.…”

Section: Introductionmentioning

confidence: 99%

Patient Reported Improvement After Patch Testing and Allergen Avoidance Counseling: A Retrospective Analysis

Steuer

Botto

2018

Dermatol Ther (Heidelb)

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IntroductionOur objectives were to assess patient-reported improvement after patch testing at the 2–3-month follow-up visit in patients referred for patch testing with relevant positive patch test reactions at the University of California, San Francisco.MethodsCross-sectional analyses of patients patch tested between 2013 and 2016 who returned for a follow-up visit approximately 2–3 months after patch testing. We examined positive patch test results considered of definite, probable or possible relevance to the patient’s eczematous eruptions. Patients reported improvement after patch testing as a percentage: 0–100%. Patients were categorized into four groups: (1) those that reported no improvement or worsened, (2) those that reported > 0% and ≤ 60% improvement, (3) those that reported > 60% but < 100% improvement and (4) those that reported 100% improvement. Secondary measures included the association of allergens, gender, age and location of the rash.ResultsThe majority (81%) of patients seen at follow-up reported improvement after patch testing. Women reported more improvement than men with statistical significance. Notably, there does not appear to be a statistically significant relationship in patient-reported improvement and age, atopy, strength of a the patient’s positive reactions, number of positive reactions and follow-up time or with potential systemic contact allergens (i.e., balsam of Peru, nickel, chrome and cobalt).ConclusionWe find the large percentage of patients that self-report global benefit from patch testing encouraging, as we believe this to be a powerful measure of disease and symptom activity, as well as quality of life. The gender differences we found contradict the previous literature.

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When does atopic dermatitis warrant systemic therapy? Recommendations from an expert panel of the International Eczema Council

Abstract: The decision to start systemic medication should include assessment of severity and quality of life while considering the individual's general health status, psychologic needs, and personal attitudes toward systemic therapies.

Cited by 197 publications

References 67 publications

The impact of pediatric atopic dermatitis on families: A review

The impact of pediatric atopic dermatitis on families: A review

Atopic dermatitis in adults: An Australian management consensus

Patient Reported Improvement After Patch Testing and Allergen Avoidance Counseling: A Retrospective Analysis

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