Management of Atopic Dermatitis in Adults in Saudi Arabia: Consensus Recommendations from the Dermatological Expert Group

Abstract

Background: Atopic dermatitis (AD) is a long-term, pruritic, recurrent, systemic, inflammatory skin disorder. In the Middle East region, the burden of AD is understudied, and there is a dearth of AD guideline documents for practitioners. Methods: An expert panel meeting, encompassing 12 dermatologists from the Kingdom of Saudi Arabia (KSA), was congregated to develop evidence-and experience-based consensus recommendations for AD management, especially in adults in KSA. They completed a questionnaire with seven clinical statements, and a consensus was defined when the responses of ≥75% of participants coincided. Results: The expert recommendations were as follows: American Association of Dermatology guidelines are to be followed for defining AD; Eczema Area and Severity Index or SCORing atopic dermatitis index may be used to quantify the disease severity; Dermatology Life Quality Index may be used to determine the impact of AD on patients' quality of life; Atopic Dermatitis Control Tool may be used to assess long-term disease control in AD patients; and the European guidelines are to be followed for the management of AD. In AD patients who are inadequately controlled with topical or systemic therapies, the preferred systemic agent for use either alone or in combination with topical treatments is dupilumab, cyclosporine, methotrexate, phototherapy, or other available systemic treatments that may include mycophenolate mofetil or oral corticosteroids. Conclusion: These expert recommendations assist physicians by providing a reference framework for optimal care of adult AD patients.

Burden of Disease and Unmet Needs in the Diagnosis and Management of Atopic Dermatitis in the Arabic Population of the Middle East

“…Amongst 13-and 14-year-olds, the lifetime prevalence of AD was estimated to be 10.8% in the Eastern Mediterranean region, compared with a global prevalence of 12.8% for this age range. The ISAAC also reported the prevalence of AD in 13-to 14-year-old adolescents in Syria (3.9%), Kuwait (11.3%), and Oman (14.4%) [5,6]. In these large population studies, prevalence is reported to vary between and within countries in the Middle East [7].…”

“…Prevalence rates vary greatly within the same country depending on the study city and population. A 2008-2009 Saudi Arabian study conducted of 854 Taif citizens reported the prevalence of AD to be 45.4% [6]. In a recent study by Al-Frayh et al, the prevalence rates of AD in different Saudi Arabian cities, determined with questionnaire-based assessments, was found to be 43.5% in Hofuf, 32.6% in Riyadh, and 31.9% in Jeddah [8].…”

“…Current guidelines derived from European and North American populations may not be suitable for Arab Middle Eastern patients [2]. Biologic medications and other newer therapies referenced in existing AD guidelines may not be approved in the country of interest [6]. Therefore, it is essential to develop guidelines specifically tailored to the Arab Middle Eastern population to address these disparities.…”

Patterns of Clinical Management of Atopic Dermatitis: A Survey of Three Physician Specialties in the Middle East

“…Patients whose AD is not controlled with topical therapies may utilize phototherapy or general systemic immunomodulators, such as methotrexate, azathioprine, and cyclosporine, or biologics such as dupilumab. Dupilumab is an interleukin 4 (IL-4) receptor antagonist that is administered subcutaneously for the treatment of moderate-to-severe AD and is approved in all of the countries surveyed in this study [ 26 , 27 ]. The oral Janus kinase (JAK) inhibitors baricitinib (approved in Egypt), abrocitinib (approved in Egypt and the UAE), and upadacitinib (approved in the UAE and Saudi Arabia) can also be used for the treatment of moderate-to-severe AD [ 1 , 25 , 28 , 29 ].…”

Topical Corticosteroid Phobia Among Parents of Children with Atopic Dermatitis (Eczema)- A Cross-Sectional Study

“…7,8 Due to rapid urbanization in recent years, the prevalence of AD has significantly increased in Saudi Arabia, which has imposed a burden on children and their caregivers and the healthcare system. 9,10 Many studies showed the phobia might be increased by the information displayed on the Internet, social media, among family, friends, and even information provided by medical professionals about the long-term use of TCS. [11][12][13] TOPICOP is a tool used to measure corticosteroid phobia, which has excellent psychometric properties and should be easy to use in everyday clinical practice for clinicians and researchers.…”