Guidelines for the Management of Atopic Dermatitis in Singapore

Abstract

Introduction: Atopic dermatitis is a common, chronic pruritic condition affecting both children and adults, which has a negative impact on the quality of life. These guidelines were developed by an expert workgroup appointed by the Dermatological Society of Singapore, to provide doctors with information to assist in the management of their patients with atopic dermatitis. The workgroup members are experienced dermatologists with interest and expertise in eczemas. Materials and Methods: Workgroup members arrived at a consensus on the topics to be included. Relevant studies from the literature were assessed for best evidence, supplemented by the collective experience of the workgroup. Results: For mild atopic dermatitis, emollients, mild potency topical steroids and topical calcineurin inhibitors are recommended. For moderate-to-severe atopic dermatitis, the use of emollients, moderate-to-potent topical steroids, topical calcineurin inhibitors, wet dressings, antimicrobials for secondary skin infection, phototherapy, and systemic therapy (e.g. prednisolone, cyclosporine, azathioprine or methotrexate) may be warranted. Patients with moderate-to-severe atopic dermatitis should be managed in conjunction with a dermatologist. Conclusion: Good outcomes can be achieved with an individualised therapeutic approach combined with adequate patient and parental education. Key words: Antimicrobials, Calcineurin inhibitors, Corticosteroids, Eczema, Moisturisers

Global Guidelines in Dermatology Mapping Project (GUIDEMAP), a systematic review of atopic dermatitis clinical practice guidelines: are they clear, unbiased, trustworthy and evidence based (CUTE)?*

“…The hand search yielded 14 additional full‐text reports. Thorough examination of eligibility resulted in 40 included CPGs on AD, published in 56 reports 12–67 . The reason for the latter is that some CPGs were published in parts as journal articles (Figure 1).…”

“…Nine CPGs came from Asia 13,36–40,46–49,59–61 ; one from Australia 14 ; 22 from Europe 29–35,41–45,51–58,62–66 ; four from North America 16–27,67 and four from South America 12,15,28,50 . Funding was not disclosed in seven CPGs 44,45,56,57,59,62,63 ; eight were funded and/or facilitated by pharmaceutical companies 12–14,17–27,40,50,67 ; 10 were not funded 15,16,30,31,33,36–39,43,64,65,66 and the remaining 15 were funded by the government, through a research grant or by the medical societies involved 28,29,32,34,35,41,42,46–49,51–55,58,60,61 . Dissemination was mostly done through medical journals (30) and 10 reports 12,28–31,34,49,51,57,63,66 were only available on the website of either a medical society or a governmental agency.…”

“…We included 40 CPGs, 12–67 of which the majority (27) were from countries with a high sociodemographic index (SDI), 14,16–27,29–36,41–48,51–55,59–61,64–67 with only two 37–40 from a country with a middle‐low SDI (both from India) and none from countries with a low SDI. Nine CPGs came from Asia 13,36–40,46–49,59–61 ; one from Australia 14 ; 22 from Europe 29–35,41–45,51–58,62–66 ; four from North America 16–27,67 and four from South America 12,15,28,50 . Funding was not disclosed in seven CPGs 44,45,56,57,59,62,63 ; eight were funded and/or facilitated by pharmaceutical companies…”

“…We included 40 CPGs, of which the majority (27) were from countries with a high sociodemographic index (SDI), 14,[16][17][18][19][20][21][22][23][24][25][26][27][29][30][31][32][33][34][35][36][41][42][43][44][45][46][47][48][51][52][53][54][55][59][60][61][64][65][66][67] with only two [37][38][39][40] from a country with a middle-low SDI (both from India) and none from countries with a low SDI. Nine CPGs came from Asia 13,[36][37][38]…”

Overcoming challenges in management of atopic dermatitis: Role of oxidative stress in the pathogenesis and treatment target of atopic dermatitis (ROAD)

“…This is a multifactorial phenomenon that prevails patients aged above two years old. [2,23,24] The new cristoborole topical cream is available in Hong Kong, the clinical benefits are yet to be proven and familiarized by clinicians together with the consideration of cost.…”