Atopic dermatitis in adults: An Australian management consensus

Abstract

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.

The cost of dupilumab treatment for severe atopic dermatitis is largely offset by broader health‐care savings and improvement in quality of life

“…In the year following commencement of dupilumab treatment, these patients reported that 'everything has improved', describe themselves as being 'a totally different person' and that it 'feels like a new life now'. These results accord with a core outcome focus in the recommendations of the latest Australian atopic dermatitis management consensus 9 and outcome measure recommendations of a recent review of systemic therapies for atopic dermatitis in the Australian and New Zealand context. 10 In the patients analysed, dupilumab resulted in significantly reduced outpatient costs, hospital stays, complications and laboratory monitoring.…”

Prevalence, incidence and management of atopic dermatitis in Australian general practice using routinely collected data from MedicineInsight

“…Data, such as objective signs and subjective symptoms on which validated measures such as the SCORing Atopic Dermatitis index are based, are not available in MedicineInsight, and this presents challenges in classifying patients according to severity. For this analysis, patients were classified into two categories – ‘mild’ or ‘moderate‐to‐severe' – in accordance with the Australian consensus recommendations for management of atopic dermatitis . A record of systemic therapies for atopic dermatitis or a referral to a specialist were used as indicators of disease severity in this study.…”

“…Mild atopic dermatitis is typically managed in primary care by avoiding irritants and disease triggers and by using emollients (moisturisers) and standard topical anti‐inflammatory therapies such as corticosteroids, calcineurin inhibitors and phosphodiesterase type 4 inhibitors . Other therapies used to manage atopic dermatitis include systemic agents such as corticosteroids, biologics and other immunosuppressants; phototherapy; and other agents (such as antihistamines and antibacterial medicines).…”

“…Other therapies used to manage atopic dermatitis include systemic agents such as corticosteroids, biologics and other immunosuppressants; phototherapy; and other agents (such as antihistamines and antibacterial medicines). The Australian management consensus recommends referral to a dermatologist or immunologist if atopic dermatitis is not responsive to standard treatment, causes significant distress and interferes with sleep, school or work, an allergy is suspected, or there are recurrent infections …”

Burden and socioeconomics of asthma, allergic rhinitis, atopic dermatitis and food allergy

“…The siloed etiology, epidemiology, and management of asthma [19,20], allergic rhinitis [21,22], atopic dermatitis [12,[23][24][25], and food allergy have been extensively described in earlier reviews. Fewer studies have been performed describing the totality of the burden of these Th2-related diseases [26][27][28][29][30][31].…”